Availability and gaps in operating theatre structural resources for fracture fixation in Tanzania: a national cross-sectional analysis

Objectives To evaluate the availability of operating theatre structural resources for fracture fixation, identify key resource gaps and assess variation across facility tiers in hospitals delivering orthopaedic and trauma services in Tanzania. Design National cross-sectional survey. Setting Hospitals providing orthopaedic and trauma services across all levels of care and ownership types in Tanzania. Participants Licensed orthopaedic and trauma surgeons in Tanzania (n=171) reported on 92 unique hospitals nationwide. Primary outcome measures Operating theatre structural resources for fracture fixation across three domains: theatre infrastructure, core orthopaedic equipment and operative support resources. A composite score summarised overall structural resource availability. Results Basic operating theatre infrastructure and utilities were widely reported; however, specialised infrastructure components and orthopaedic-specific resources were inconsistently available. Access to traction tables (23.9%), limb positioning systems (27.2%) and disposable sterile drapes and gowns (14.1%) was limited. Adequate orthopaedic instruments were reported in 45.7% of hospitals, while fluoroscopy and digital imaging systems were reported to be available in 47.8% and 29.3%, respectively. Implant supply and equipment maintenance systems were inconsistently reported. Overall, only 17.4% of hospitals reported high structural resource availability, while 55.4% were moderate and 27.2% low. Marked disparities were observed across facility tiers, with 55.0% of zonal and national hospitals reporting high resource availability compared with 8.2% of regional and 4.3% of district hospitals. Higher tier hospitals demonstrated significantly greater availability of orthopaedic equipment, imaging and operative support resources (p<0.05). In multivariable analysis, facility tier and adequacy of orthopaedic instruments were independently associated with higher structural resource availability. Conclusions Operating theatre structural resources for fracture fixation are variably available across hospitals in Tanzania, with key deficiencies in orthopaedic-specific equipment, intraoperative imaging, instrument adequacy and operative support systems, including implant supply and equipment maintenance. These gaps are most pronounced at lower tier facilities, highlighting substantial disparities in resource distribution. Strengthening orthopaedic equipment, improving imaging access and reinforcing support systems, particularly at lower level hospitals, is essential to support more equitable delivery of fracture fixation services.