Association of surgery and economic development in low- and middle-income countries

Evidence from a dynamic panel data analysis

Bibliographic Data

ID22431220
AuthorsMartilord Ifeanyichi (0000-0003-0611-6795, University of Nigeria), Johnson Ezema Nchege (0000-0002-4375-0683, University of Nigeria), Ebikabowei Biedomo Aduku (University of Nigeria), Meskerem Aleka Kebede (0009-0007-7427-0897, London School of Economics and Political Science), Maeve Bognini (London School of Economics and Political Science), Rachel Hargest (0000-0001-9830-3832, University Hospital of Wales), Rocco Friebel (0000-0003-1256-9096, London School of Economics and Political Science)
Year2026
Volume11
IssueSuppl 2
Pagese021115
Publication date2026-04-01
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2025-021115
PMID42448423
OpenAlexW7168286870
LanguageEN
References cited36

INTRODUCTION: While health improvements drive economic growth, the specific macroeconomic impact of surgery remains unknown. Previous studies have quantified economic losses from unmet need but have not established whether surgery generates economic returns. This study investigates the association between surgical activity and economic growth across low- and middle-income countries (LMICs). METHODS: We analysed panel data from 95 LMICs (2000-2022) using System Generalised Method of Moments (GMM) estimation. Surgical volume was proxied by per capita suture consumption in kilograms (kg) measured by per capita suture imports (in kg), with gross domestic product (GDP) per capita adjusted for purchasing power parity as the outcome variable. We controlled for education, labour force, infrastructure, quality of governance, health expenditure, and credit availability while addressing endogeneity through internal instrumentation. RESULTS: Each 1% increase in per capita suture consumed corresponded to a 0.0083% increase in per capita GDP (p 0.05) or below the 75th percentile surgical activity settings (0.0049%; p>0.05). In a secondary (non-log-transformed) model, a 1-kg increase in per capita sutures consumption corresponded to an increase of 89 international dollars in per capita GDP (p<0.05). CONCLUSION: Surgical activity is positively associated with economic growth in LMICs, particularly in higher capacity settings. This provides novel empirical evidence suggesting that surgical investments may yield macroeconomic returns, supporting integration of surgical system strengthening into economic development strategies. Low-income countries may require coordinated investments to build capacity to levels where economic benefits become visible.

Endogeneity · Fixed effects model · Gross domestic product · Panel data · Per capita · Per capita income · Percentile

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Open DOIOpen Access