The American Pediatric Surgical Association (APSA) Manpower taskforce recommends that the number of qualified pediatric surgeons in a population should be at least 2 per million (or 1 per 100,000 patients between 0 and 15 years of age). [
13] Even though only a handful of countries (e.g. the US, Finland, Canada, Australia and Switzerland) meet the above-mentioned standards, the growth rate of pediatric surgical graduates’ numbers in the western world in recent years is higher than that previously forecasted, which provides some reassurance. [
13,
14] However, data from developing countries are less encouraging. For instance, the reported numbers of pediatric surgeons (per hundred thousand population) in Asian countries (e.g. Bangladesh, 0·30; India, 0·28; Pakistan, 0·26; Indonesia, 0·03; and Malaysia, 0·22) is suboptimal. [
14] This shortage of pediatric surgeons, in conjunction with other hurdles to quality healthcare in resource-limited settings, has dire consequences for population health. For example, according to an estimate in 2015, Nepal has more than 700,000 children with unmet needs for surgical care. [
15] Butler et al., while focusing on four low- and middle-income countries (LMICs) (Rwanda, Sierra Leone, Nepal and Uganda) found that 62% of children (3.4 million children) in need of surgical intervention had not received the required care. [
16] This highlights the need to bridge gaps in provision of specialized pediatric surgical care in LMICs. In view of the growing global pediatric population and the mounting needs for surgical care that this entails, the current sub-optimally planned approach to pediatric surgery will inevitably lead to crises in health service delivery mechanisms, particularly in LMICs.
In Pakistan, reasons for the mismatch between the number of graduating pediatric surgeons and the growing population needs are manifold. [
17] Pediatric surgery training involves post-graduate fellowships at major institutions under the aegis of College of Physicians and Surgeons, Pakistan (CPSP). [
17] Variations in training programs offered by different institutions, despite the presence of a CPSP standardized curriculum, need to be addressed. Furthermore, we propose that greater exposure to pediatric surgery in formative medical training may result in greater motivation to pursue a career in pediatric surgery among young surgical/medical graduates. [
17,
18] To tackle these issues, a multi-pronged strategy is required. Incorporation of some pediatric surgical care training into general surgical training programs will not only instill the required skills and confidence in general surgeons to handle pediatric patients, especially in rural areas without access to pediatric surgery specialists, but may also spawn their interest in this field as a potential fellowship option. Reforms to simplify the lengthy CPSP accreditation process could also pave the way for setting up of new fellowship programs.