Capacity In sub-Saharan Africa Research Articles

The price of mistrust: the impact of a medical ethics scandal on scientific capacity in Sub-Saharan Africa

The price of mistrust: the impact of a medical ethics scandal on scientific capacity in Sub-Saharan Africa

PDOC-02 SUB-SAHARAN AFRICAN EXPERIENCE OF NEUROSURGICAL-ONCOLOGIC CARE: CHALLENGES AND BARRIERS ENCOUNTERED AT 7 CANCER TREATMENT CENTERS

Abstract BACKGROUND Wide disparities in neurosurgical-oncologic care and treatment outcomes exists globally despite recent improvements in diagnostics and cancer therapy. To better understand the challenges to neurosurgical-oncologic care in low resource settings, we collected data on national neurosurgery capacity and hospital diagnostic and treatment capacity across 7 national referral hospitals in 7 countries Sub-Saharan Africa (SSA). METHODS A 42-item self-administered questionnaire was distributed to partner neurosurgeons at the 7 sites via REDCap in April 2023 to provide country and hospital level capacity data on neurosurgical-oncologic care. RESULTS Neurosurgical and neurosurgical-oncologic care was reported to be available in a limited number of provinces/states/regions in 6 out of the 7 countries. The neurosurgery and pediatric neurosurgery workforce density across the 7 countries ranged between 0.03 – 0.67 per 100,000 and 0 – 0.05 per 100,000 respectively. Three hospitals had no pediatric ICU with the remaining four having between 2-8 bed-capacity pediatric ICU. One hospital did not have both CT and MRI scanner available and relied solely on private diagnostic facilities for neuroimaging. Histopathology services were largely limited to basic hematoxylin and eosin (H&E) and/or advanced histopathology staining. Molecular subtyping was available at only one hospital. None of the 7 hospitals had neurocritical care expertise, neuroradiologist, or neuropathologist. Four hospitals had a pediatric anesthesiologist. Only one hospital had a neuro-oncologist, but none had a pediatric neuro-oncologist. Both adjuvant chemotherapy and radiotherapy was unavailable at 3 hospitals. Rehabilitation was largely limited to basic physical and occupational therapy at all 7 hospitals. Although all 7 countries had a multiple health payer system, the payment structure differed across the 7 hospitals for different neurosurgical-oncologic services with patients making out-of-pocket payments for all services in some cases. Financial constraint was reported as a major barrier to care. CONCLUSION System-level interventions are needed to strengthen neurosurgical-oncologic care capacity in SSA.

Sub-Saharan African experience of neurosurgical oncology care: challenges and barriers encountered at 7 cancer treatment centers

OBJECTIVE Wide disparities in neurosurgical oncology care and treatment outcomes exist globally despite recent improvements in diagnostics and cancer therapy. To better understand the challenges to neurosurgical oncology care in low-resource settings, the authors collected data on national neurosurgical capacity and hospital diagnostic and treatment capacity across 7 national referral hospitals in 7 countries in sub-Saharan Africa (SSA). METHODS In April 2023, a 42-item self-administered questionnaire was distributed to partner neurosurgeons at the 7 centers via REDCap to provide country- and hospital-level capacity data on neurosurgical oncology care. RESULTS Neurosurgical and neurosurgical oncology care were reported to be available in a limited number of provinces, states, regions, and counties in 6 of the 7 countries. The general neurosurgical workforce density across the 7 countries ranged from 0.03 to 0.67 per 100,000 persons, and that of the pediatric neurosurgical workforce ranged from 0 to 0.05 per 100,000 persons. Two centers had no pediatric ICUs, and the remaining 5 centers had pediatric ICUs with bed capacities between 1 and 8. One hospital had neither a CT nor an MRI scanner available and relied solely on private diagnostic facilities for neuroimaging. Histopathology services were largely limited to basic histopathology staining only; molecular subtyping was available at a single center. Three hospitals offered pediatric anesthesia expertise. None of the hospitals offered subspecialty neuro-oncology care or had a pediatric neuro-oncologist. None of the 7 hospitals had formal neurocritical care, neuroradiology, or neuropathology expertise. Neither adjuvant chemotherapy nor radiotherapy was available at 3 centers. Rehabilitation was largely limited to basic physical and occupational therapy at all 7 centers. Although all 7 countries had a multiple health payer system, the payment structure differed across the 7 hospitals for different neurosurgical oncology services, with patients making out-of-pocket payments for all services in some cases. CONCLUSIONS There are significant challenges to timely and quality neurosurgical oncology care in SSA especially for children. System-level interventions are needed to strengthen neurosurgical oncology care capacity in SSA.

Building consensus on priority areas for Sub-Saharan Africa's ageing population research: An e-Delphi study protocol.

Improvement in medico-social services has increased life expectancy and population ageing in Sub-Saharan Africa (SSA). It was estimated that about 163 million people aged 65 and older will be resident in SSA by 2050. There is inadequate ageing research capacity in SSA which necessitates this study to (a) identify a decade-long ageing research opportunities, challenges, and solutions, and (b) prioritize critical ageing research areas and methodologies relevant to the SSA. We designed an e-Delphi protocol following the Reporting Guideline for Priority Setting of Health Research with Stakeholder. The stakeholders will be researchers, practitioners, older adults, and caregivers purposively selected through snowballing quota sampling to complete three rounds of e-Delphi surveys. Round 1 will involve open-ended questions derived from the study objectives. Responses from round 1 will be prepared as a checklist for stakeholders to rate during rounds 2 & 3, using a 9-point scale: low priority (1-3), moderate priority (4-6), and high priority (7-9). The criterion for reaching a consensus will be ≥ 70% of stakeholders rating an item "high priority" and ≤ 15% as "low priority." Quantitative data will be analysed using descriptive statistics, Wilcoxon matched-pairs signed-rank test will be used to assess the stability of stakeholders' responses, and qualitative comments will be analysed using content analysis. Setting aging research/practice priorities will help maximize the benefits of research investment and provide valuable direction for allocating public and private research funds to areas of strategic importance.

Increasing pediatric radiation oncology capacity in sub-saharan Africa using technology: a pilot of a pediatric radiation oncology virtual training course

BackgroundThe shortage of skilled healthcare professionals in pediatric oncology and the limited access to training programs remain significant challenges in Nigeria and sub-Saharan Africa. The the Pediatric Radiation Oncology (Virtual) Course, ‘PedROC’ project aims to contribute to improving pediatric cancer outcomes in Nigeria by increasing the capacity of radiation oncology professionals. To address the gap in access to pediatric radiation oncology professional development, the PedROC project was created, harnessing technology to improve radiation oncology training via a curriculum delivered through web-conferencing. This study aimed to evaluate the effectiveness of the PedROC pilot in enhancing the capacity, confidence, and skill of radiation oncologists in decision-making, prescribing, and treatment planning of radiotherapy for children diagnosed with cancer.MethodsA multidisciplinary faculty of specialists in radiation oncology, pediatric oncology, oncology nursing, radiation therapy technology, and medical physics collaborated to identify the key learning needs in pediatric radiation oncology in the country. The team collaborated to develop a comprehensive curriculum covering the most common pediatric cancers in sub-Saharan Africa for the training program. The training course was conducted over two days, delivering twenty-four half-hour sessions for a total of 12 h, from July 31 to August 01, 2021.ResultsAnalysis of pre and post - training surveys showed a significant increase in self-reported confidence measures across all domains among radiation oncologists. The program successfully improved participants’ knowledge and confidence levels in managing common pediatric cancers using radiotherapy, particularly addressing radiotherapy-specific issues such as appropriate dose, target volume delineation, treatment planning, dose constraints, and plan evaluation.ConclusionThe PedROC pilot showed the efficacy of this model in enhancing the capacity and confidence of radiation oncology professionals involved in the treatment of pediatric cancer. The findings indicate that technology holds significant potential to increase pediatric radiation oncology capacity in Africa, ensuring improved access to proper treatment and ultimately improving pediatric cancer outcomes.

Building pathology capacity in sub-Saharan Africa to improve breast cancer diagnosis and treatment: training laboratory technicians in high-quality manual immunohistochemistry

BackgroundTo address the need for a skilled workforce in breast cancer (BC) pathology in sub-Saharan Africa (SSA), we implemented an education program to train laboratory technicians in manual immunohistochemistry (IHC).MethodsA quality improvement education project was developed. Interactive webinars were held every six months with didactics and presentations from African experts with experience in IHC. We conducted knowledge assessments and surveys on current practice, equipment, and human resources. A digital mentorship platform (DMP) was created for discussions, sharing SOPs, and networking. For one year (2022–2023), we followed developments in pathology capacity, practice changes, and educational needs. A paired t-test was used to calculate the significance of changes in knowledge immediately after the webinar and comfort level with topics 35 days after the webinar.ResultsTwo hundred and sixty six participants from 10 SSA countries attended the first webinar, a series of six lectures on IHC theory, methods, and practice. Ninety-five participants from nine SSA countries provided a baseline assessment of pathology capacity and feedback. Mean knowledge increased by 17.4% immediately after the webinar (from 41.8% pre-webinar to 59.2% post, p = < 0.0001). Self-reported comfort level in topics 35 days after the webinar increased by 11.3%, but this was not statistically significant (mean 3.36 pre- to 3.74 post, p = 0.1). Over six months, recordings were accessed 412 times. After six months, the second webinar had 93 participants from eight SSA countries. Membership in the DMP increased from 64 to 172; recordings were viewed 412 times in six months; and 113 participants from nine SSA countries completed surveys. Among 74 respondents who perform IHC, 43.5% reported moderate or significant positive practice changes such as improved antigen retrieval techniques and optimization of preanalytical variables. Over half (52.7%, n = 39) reported the quality of slides had moderately or significantly improved. After one year, a third webinar had 98 participants from eight SSA countries. Thirty-eight completed surveys, DMP membership increased to 199, and 1 reported launching IHC in a lab in Nigeria.ConclusionsOur program 1) reached hundreds of participants and provided a baseline assessment of pathology capacity across nine SSA countries; 2) created a novel mechanism to build pathology capacity and assess progress with this cohort; and 3) improved practices and the preparation of slides for over half performing manual IHC. After one year, interest was sustained. Tracking impact on diagnosis and treatment of BC in the region is needed long-term.

Strengthening surgical healthcare research capacity in sub-Saharan Africa: impact of a research training programme in Nigeria.

Limited research capacity has contributed to the lack of high-quality research from low-and middle-income countries. This is compounded by limited research training opportunities. Research capacity scale-up training was deployed as part of the implementation of the National Surgical, Obstetrics, Anaesthesia, and Nursing Plan for Nigeria. We report the impact of this locally contextualized efforts to scale up research capacity in sub-Saharan Africa. This is an evaluation of the training of 65 participants in research, grant writing and manuscript writing and publication. Pre- and post-training surveys using a 5-point Likert scale and open-ended questions were administered to evaluate the impact of the programme. There were 39 (60%) males and 26 (40%) females aged 26-62 years (median 42 years). Thirty-nine (60%) participants had previous training in research, but only 12 (18.5%) had previously received grant writing training, and 17 (26.2%) had previously received manuscript writing and publishing training. Following training, 45 (70.3%) participants agreed that the training was relevant. The research, grant writing and manuscript writing, and publication components of the training were rated high by the participants (45-59, 70.3-92.2%). However, 41.2% felt that there was not enough time, and 32.4% felt that the training was too comprehensive. Nearly all the participants agreed that the training had improved their skills in research, grant writing and manuscript writing and publication, and more than two-thirds subsequently engaged in informal mentoring of others. Overall, participants achieved success in designing their own research projects and publishing manuscripts and grants. Three (4.6%) of the participants had gone on to become faculty for the research training programme. The three top barriers encountered following training were time constraints (67.3%), lack of funding (36.5%) and not being able to find research collaborators (25%). Outcome of this training programme is encouraging and highlights the feasibility and potential impact of deploying such programmes in low and middle income countries (LMICs). Despite the positive outcomes, barriers including time constraints, funding limitations, and difficulties in finding research collaborators remain to be addressed. Such training programmes need to be supported to strengthen the research capacity in this and similar settings.

Realities and challenges of head and neck free flap reconstruction in sub-Saharan Africa.

With an increased need to decentralize and train more head and neck ablative and reconstructive surgeons in sub-Saharan Africa, we assess the realities and challenges of free flap reconstruction in sub-Saharan Africa to provide context of its use as a reconstructive option. Head and neck free flap reconstruction has been performed by local teams as well as visiting teams in Sub Saharan Africa with good results. Free flap success rates are similar to high income regions at 89% vs. 85-100%. However, flap salvage rates are significantly lower (45% compared to 64.1% reported in high income regions). This has been attributed to resource constraints. With increasing efforts to increase free flap reconstructive capacity in sub-Saharan Africa, these efforts need to be in the context of available healthcare resources including infrastructure and workforce outside of the surgical team. As training of head and neck ablative and reconstructive surgeons is expanded, reconstructive training needs take the healthcare resource availability into account.

Failure to receive prescribed imaging is associated with increased early mortality after injury in Cameroon.

Despite having the highest rates of injury-related mortality in the world, trauma system capacity in sub-Saharan Africa remains underdeveloped. One barrier to prompt diagnosis of injury is limited access to diagnostic imaging. As part of a larger quality improvement initiative and to assist priority setting for policy makers, we evaluated trauma outcomes among patients who did and did not receive indicated imaging in the Emergency Department (ED). We hypothesize that receiving imaging is associated with increased early injury survival. We evaluated patterns of imaging performance in a prospective multi-site trauma registry cohort in Cameroon. All trauma patients enrolled in the Cameroon Trauma Registry (CTR) between 2017 and 2019 were included, regardless of injury severity. Patients prescribed diagnostic imaging were grouped into cohorts who did and did not receive their prescribed study. Patient demographics, clinical course, and outcomes were compared using chi-squared and Kruskal-Wallis tests. Multivariate logistic regression was used to explore associations between radiologic testing and survival after injury. Of 9,635 injured patients, 47.5% (4,574) were prescribed at least one imaging study. Of these, 77.8% (3,556) completed the study (COMPLETED) and 22.2% (1,018) did not receive the prescribed study (NC). Compared to COMPLETED patients, NC patients were younger (p = 0.02), male (p<0.01), and had markers of lower socioeconomic status (SES) (p<0.01). Multivariate regression adjusted for age, sex, SES, and injury severity demonstrated that receiving a prescribed study was strongly associated with ED survival (OR 5.00, 95% CI 3.32-7.55). Completing prescribed imaging was associated with increased early survival in injured Cameroonian patients. In a resource-limited setting, subsidizing access to diagnostic imaging may be a feasible target for improving trauma outcomes.

Institutions and tax capacity in sub-Saharan Africa

AbstractThis paper contributes to research on the institutional determinants of tax capacity using annual data from 39 sub-Saharan African countries from 1985 to 2018 to construct a measure of tax capacity for each country based on the trend component of the ratio of actual to potential tax revenue. Potential revenue is estimated by a parsimonious tax performance specification, including only variables found to be robust determinants of the tax/GDP ratio. The results show that, on average, tax capacity is high (given potential) and has improved over time (especially for low-income countries). The final stage of analysis selects, from a wide variety of economic and institutional variables, the most important determinants of cross-country variation in tax capacity. Equal distribution of resources is the most important institutional factor associated with greater capacity, consistent with perceptions of equity supporting the fiscal bargain; corruption is associated with lower capacity, consistent with undermining trust in government. Private consumption and resource rents are associated with greater capacity. Other institutional factors are indirectly associated with greater capacity, such as accountability and elements of democracy associated with equity in the allocation and use of public resources.

Letter: Evaluating Brain Tumor Surgical Management Capacity in Sub-Saharan Africa.

Letter: Evaluating Brain Tumor Surgical Management Capacity in Sub-Saharan Africa.

Strengthening local capacity for abortion-related research in contexts with highly restrictive abortion laws: The case of STARS in Mali.

Strong local abortion research capacity is missing in many African countries. We report on the Strengthening Abortion Research Capacity in sub-Saharan Africa (STARS) program, an ongoing initiative to strengthen local capacity for abortion research in Mali, West Africa. We highlight the background, context, and methodology of the initiative as well as its achievements, challenges, and emerging lessons. Within a short time, STARS has initiated some key studies on abortion in Mali and created a much-needed platform for nurturing the country's next generation of abortion researchers, institutionalizing abortion research, increasing the quantity and quality of locally generated evidence on abortion, and facilitating evidence-informed abortion policy and programmatic action. The program's learning-by-doing approach has boosted the skills of individual researchers while also enhancing institution-based abortion and sexual and reproductive health and rights (SRHR) research expertise in Mali. Although STARS' capacity to deliver its mandate over time is evident, ultimate results will depend on the sustained commitment of funders to the program in the full realization that capacity building requires long-term investment and support for it to fully bear fruits.

A framework for advancing sustainable magnetic resonance imaging access in Africa.

Magnetic resonance imaging (MRI) technology has profoundly transformed current healthcare systems globally, owing to advances in hardware and software research innovations. Despite these advances, MRI remains largely inaccessible to clinicians, patients, and researchers in low-resource areas, such as Africa. The rapidly growing burden of noncommunicable diseases in Africa underscores the importance of improving access to MRI equipment as well as training and research opportunities on the continent. The Consortium for Advancement of MRI Education and Research in Africa (CAMERA) is a network of African biomedical imaging experts and global partners, implementing novel strategies to advance MRI access and research in Africa. Upon its inception in 2019, CAMERA sets out to identify challenges to MRI usage and provide a framework for addressing MRI needs in the region. To this end, CAMERA conducted a needs assessment survey (NAS) and a series of symposia at international MRI society meetings over a 2-year period. The 68-question NAS was distributed to MRI users in Africa and was completed by 157 clinicians and scientists from across Sub-Saharan Africa (SSA). On average, the number of MRI scanners per million people remained at less than one, of which 39% were obsolete low-field systems but still in use to meet daily clinical needs. The feasibility of coupling stable energy supplies from various sources has contributed to the growing number of higher-field (1.5 T) MRI scanners in the region. However, these systems are underutilized, with only 8% of facilities reporting clinical scans of 15 or more patients per day, per scanner. The most frequently reported MRI scans were neurological and musculoskeletal. The CAMERA NAS combined with the World Health Organization and International Atomic Energy Agency data provides the most up-to-date data on MRI density in Africa and offers a unique insight into Africa's MRI needs. Reported gaps in training, maintenance, and research capacity indicate ongoing challenges in providing sustainable high-value MRI access in SSA. Findings from the NAS and focused discussions at international MRI society meetings provided the basis for the framework presented here for advancing MRI capacity in SSA. While these findings pertain to SSA, the framework provides a model for advancing imaging needs in other low-resource settings.

The role of telepathology in improving cancer diagnostic and research capacity in sub-Saharan Africa.

Non-communicable disease (NCD), including cancer, disproportionately affect Low- and Middle-Income Countries (LMICs). This inequity is in part due to limitations of pathology services, both human and infrastructural. While significant improvements have been made to address these gaps, creative approaches that are mindful of regional priorities, cultural differences, and unique local challenges are needed. In this perspective, we will describe the implementation of telepathology services in sub-Saharan Africa (SSA) that serve as cornerstones for direct patient care, multi-disciplinary care coordination, research programs, and building human capacity through training. Models and challenges of system implementation, sustainability, and pathologist engagement will be discussed. Using disease and site-specific examples, we will suggest metrics for quality control and improvement initiatives that are critical for providing high-quality cancer registry data and necessary for future implementation of therapeutic and interventional clinical trials.

Addressing the Lassa Fever Epidemic in West Africa: A Mathematical Modelling Approach

Lassa fever is a viral haemorraghic fever, accounting for about 5,000-10,000 deaths annually. The disease is endemic in West-Africa with seasonal epidemics. We proposed that with the use of mathematical modelling studies, we can predict accurately when the outbreak will likely occur by computing the infectivity rate, weather patterns and population of rodents. With this, adequate preventive measures and public health control interventions can be put in place to prevent the outbreak. This necessitates the need for more policy-relevant mathematical modelling studies on Lassa Fever, starting with building capacity in sub-Saharan Africa, where the disease is prevalent.

Building Perinatal Pathology Research Capacity in Sub-Saharan Africa.

IntroductionOver two million stillbirths and neonatal deaths occur in sub-Saharan Africa (sSA) annually. Despite multilateral efforts, reducing perinatal mortality has been slow. Although targeted pathologic investigation can often determine the cause of perinatal death, in resource-limited settings, stillbirths, early neonatal deaths, and placentas are rarely examined pathologically. However, the placenta is a key source of diagnostic information and is the main determinant of fetal growth and development in utero, influencing child health outcomes.MethodsIn 2016, our collaborative intercontinental group began investigating infectious perinatal death and adverse child health outcomes in Uganda. We developed and initiated a 4-day combined didactic/practical curriculum to train health workers in placental collection, gross placental examination, and tissue sampling for histology. We also trained a local technician to perform immunohistochemistry staining.ResultsOverall, we trained 12 health workers who performed gross placental assessment for > 1,000 placentas, obtaining > 5,000 formalin-fixed tissue samples for research diagnostic use. Median placental weights ranged from 425 to 456 g, and 33.3% of placentas were < 10th percentile in weight, corrected for gestational age. Acute chorioamnionitis (32.3%) and maternal vascular malperfusion (25.4%) were common diagnoses.DiscussionThrough a targeted training program, we built capacity at a university-affiliated hospital in sSA to independently perform placental collection, gross pathologic examination, and placental tissue processing for histology and special stains. Our training model can be applied to other collaborative research endeavors in diverse resource-limited settings to improve research and clinical capacity and competency for diagnostics and management of stillbirth, neonatal death, and child health outcomes.

A framework for assessing freshwater vulnerability along China's Belt and Road Initiative: An exposure, sensitivity and adaptive capacity approach

In the Belt and Road Initiative (BRI) countries, freshwater systems are sensitive and prone to natural variability, human interventions and climate change. Yet, freshwater vulnerability has not been quantified at the BRI scale. The primary goal of this study was to identify and quantify the most vulnerable BRI regions and explain reasons for identified vulnerability. The assessment was based on the conceptual framework recommended by the Intergovernmental Panel on Climate Change (IPCC), which considers three components of vulnerability including exposure, sensitivity and adaptive capacity. Twenty-four key indicators were selected and the TOPSIS-entropy-weight algorithm was used to calculate weights and ranks of each component that were then used to rank 123 BRI countries based on their closeness coefficient. The results indicate that 69% of them were categorized as having medium to highest freshwater vulnerability. Of these, countries in developing regions, particularly those in Sub-Saharan Africa and in the stretch from South Asia to the Mediterranean, were among the highest vulnerable. The analysis revealed that root causes for the highest vulnerability differ among regions. In Sub-Saharan Africa, low adaptive capacity was the primary reason for this, while high sensitivity was the predominant cause in the most vulnerable stretch of Asia. These findings highlight the importance of developing context-specific policies to improve adaption capacity in Sub-Saharan Africa and to decrease sensitivity in vulnerable parts of Asia. Therefore, to address hazards associated with the highest level of vulnerability, BRI investments should combine adequate water-efficient physical infrastructures with fostering economic performance and institutional capacities.

The role of telepathology in improving cancer diagnostic and research capacity in sub-Saharan Africa

The role of telepathology in improving cancer diagnostic and research capacity in sub-Saharan Africa

Understanding the landscape of electrophysiology services for children in sub-Saharan Africa.

Incidence of epilepsy is greatest in infancy and childhood; this is especially evident in sub-Saharan Africa (SSA). The aim of this study was to understand access to electrophysiology services in SSA including which health practitioner performs and interprets paediatric electroencephalogram (EEG) studies as well as their training in paediatric EEG. A web-based survey was sent to a cohort of health care practitioners who manage children with epilepsy in SSA. The questions addressed whether EEG was available to these health care practitioners, how the practitioners accessed EEG and who assisted interpretation of the study results. The survey was circulated (June-December 2019) to 305 participants from 32 African countries. A total of 73 (16 partial and 57 complete) surveys were returned from 18 countries. The respondents fell into two main categories: those with access to an EEG machine (44/73; 60%) and those without access to an EEG machine (29/73; 40%). For 32% (23/73), there was no dedicated technician and for 34% (25/73) no neurologist. Access to a neurologist resulted in the highest proportion of EEGs performed per annum. Of the respondents, 77% (56/73) agreed that there was a need for a paediatric apprenticeship in EEG skills. Qualitative data to justify need for paediatric EEG training was grouped into three themes: (1) "professional development"; (2) "better care"; and (3) "help paediatric patients and neurologists". There is a lack of paediatric EEG training amongst doctors and technicians working with epilepsy in SSA. Expanding training beyond current capacity in SSA, for technicians and practitioners involved in EEG, is necessary.

Gastrointestinal endoscopy capacity in Eastern Africa.

Background and study aims Limited evidence suggests that endoscopy capacity in sub-Saharan Africa is insufficient to meet the levels of gastrointestinal disease. We aimed to quantify the human and material resources for endoscopy services in eastern African countries, and to identify barriers to expanding endoscopy capacity. Patients and methods In partnership with national professional societies, digestive healthcare professionals in participating countries were invited to complete an online survey between August 2018 and August 2020. Results Of 344 digestive healthcare professionals in Ethiopia, Kenya, Malawi, and Zambia, 87 (25.3 %) completed the survey, reporting data for 91 healthcare facilities and identifying 20 additional facilities. Most respondents (73.6 %) perform endoscopy and 59.8 % perform at least one therapeutic modality. Facilities have a median of two functioning gastroscopes and one functioning colonoscope each. Overall endoscopy capacity, adjusted for non-response and additional facilities, includes 0.12 endoscopists, 0.12 gastroscopes, and 0.09 colonoscopes per 100,000 population in the participating countries. Adjusted maximum upper gastrointestinal and lower gastrointestinal endoscopic capacity were 106 and 45 procedures per 100,000 persons per year, respectively. These values are 1 % to 10 % of those reported from resource-rich countries. Most respondents identified a lack of endoscopic equipment, lack of trained endoscopists and costs as barriers to provision of endoscopy services. Conclusions Endoscopy capacity is severely limited in eastern sub-Saharan Africa, despite a high burden of gastrointestinal disease. Expanding capacity requires investment in additional human and material resources, and technological innovations that improve the cost and sustainability of endoscopic services.