Prehabilitation in resource-limited settings: a narrative review of feasibility and barriers in surgical practice in Sub-Saharan Africa

Abstract

Prehabilitation is a proactive, multimodal approach aimed at optimizing patients’ physical, nutritional, psychological, and medical status before surgery. While evidence from high-income countries demonstrates improved postoperative outcomes, its implementation and impact in Sub-Saharan Africa (SSA) remain poorly explored. This review evaluates the concept, feasibility, barriers, and potential strategies for implementing prehabilitation in SSA to improve surgical outcomes in resource-limited settings. A narrative synthesis of global and regional evidence was conducted, focusing on the four pillars of prehabilitation: exercise training, nutritional optimization, psychological support, and medical optimization. Barriers specific to SSA, including resource constraints, short preoperative windows, socioeconomic and cultural factors, and healthcare system limitations, were identified. Strategies for overcoming these barriers, including community-based delivery, mobile health interventions, culturally tailored programs, integration with Enhanced Recovery After Surgery (ERAS) protocols, and policy support, were explored. Prehabilitation has demonstrated significant benefits in improving functional capacity, reducing postoperative complications, shortening hospital stays, and enhancing quality of life. In SSA, key challenges include limited infrastructure, workforce shortages, malnutrition, late presentation, and socioeconomic constraints. Evidence suggests that simplified, culturally appropriate, and community-driven interventions can mitigate these challenges and enhance the feasibility of prehabilitation programs. Prehabilitation is a promising, cost-effective, patient-centered strategy to improve surgical outcomes in SSA. Context-specific implementation models, rigorous evaluation, and policy support are essential to enable sustainable adoption and integration into perioperative care.