What is already known?
An estimated 5 billion people do not have access to basic, safe surgical care.
The proportion of the population that can access, within 2 hours, a health facility with capacity to perform caesarean delivery, laparotomy and treatment of open fracture (the bellwether procedures) is unknown in sub-Saharan Africa.
What are the new findings?
The majority of the population in sub-Saharan Africa resided in areas within 2 hours of a major hospital that could theoretically carry out the bellwether procedures.
The estimated need for surgery in sub-Saharan Africa lies between 257.8 million and 294.7 million people.
The estimated burden in children under 15 years was 115.3 million to 131.8 million and had similar spatial distribution to the all-age pattern.
What do the new findings imply?
Sub-Saharan countries need to overcome barriers of access to safe surgery to reduce negative outcomes such as deaths.