COSECSA collaborates to address surgical shortages in sub-Saharan Africa

The College of Surgeons of East, Central and Southern Africa (COSECSA) was founded in 1999. COSECSA is a not-for-profit organization that operates in 12 countries in sub-Saharan Africa and is an independent body that fosters postgraduate education in surgery and provides surgical training throughout sub-Saharan Africa (see Figure 1). COSECSA’s primary objectives are to advance education, training, standards, research, and practice in surgical care in this region. More specifically, COSECSA shapes and leads the training of surgeons in East, Central, and Southern (ECSA) Africa. The College offers a surgical training program with a standardized examination that is internationally recognized. To date, 214 specialist surgeons have graduated from COSECSA-affiliated programs. Admission to the College is open to all registered health care practitioners who comply with the professional requirements for admission.1

Figure 1. COSECSA member countries with Sudan and Namibia as new additions

Figure 1

Source: College of Surgeons of East, Central and Southern Africa. What is COSECSA? Available at: www.cosecsa.org/about/what-cosecsa. Accessed March 9, 2018.

Surgical workforce in the ECSA region

Access to surgical care remains one of the most significant and underreported issues in the region. A situational analysis of the COSECSA region workforce was recently conducted. The study results indicate that the region has only 1,690 surgeons serving a population of more than 320 million. Of these surgeons, 53 percent are general surgeons, whereas the others have additional subspecialty training. The surgeon-to-population ratio is 0.53 per 100,000 population.2

In addition to the workforce shortage, the region has a significant misdistribution issue. The data indicate that 71 percent of surgeons practice in urban areas with populations greater than 500,000. Women are underrepresented, comprising only 7 percent of the surgical workforce.2

In partnership with the Royal College of Surgeons in Ireland (RCSI) and other members of the International Collaborators for Essential Surgery network of surgeons and public health specialists, an interactive map showing the location of all surgeons throughout the ECSA region has been created. The interactive map shows the number of surgeons per 100,000 individuals in any given COSECSA region.3

Strategic plan and implementation of WHA Resolution 68.15

A five-year strategic plan for implementing the World Health Assembly (WHA) Resolution 68.15 in 2016−2020 has been developed and is under way. The COSECSA strategic plan is a dynamic blueprint for the growth of COSECSA as an organization and is based on four key goals. These strategic goals are as follows.

Graduate 500 surgeons by 2020

COSECSA training sites have been increasing steadily. A recent count shows 99 accredited sites. The enrollment of surgical trainees continues to increase, with 127 enrollees in 2017 and 135 in 2018. Because of the innovative approach to hospital-based training in the COSECSA region, the attrition of graduates has been minimal. A study on the retention rate of surgical graduates (COSECSA and 24 master of medicine institutions) from 1974 to 2013 across eight COSECSA countries was completed in October 2017. The data showed that 85.1 percent of graduates were retained in their home country, 88.3 percent in the COSECSA region, and 93.4 percent of graduates remained within Africa.

Achieve excellence in training and research

Together with international partners, COSECSA is building the research infrastructure. Data collection through a resident logbook has been centralized, and the electronic logbook contains records of more than 100,000 cases. In 2016, four COSECSA trainees (Philip Blasto, MD, from Kenya; Gift Mulima, MD, from Malawi; Vanda Amado, MD, from Mozambique; and Ryuba Nyamsogoro, MD, from Tanzania) received research grants of $3,500 (U.S.) each to undertake independent research projects in the ECSA region. A COSECSA country representative supervises each grant, and the research findings are due to be published soon.

COSECSA has a comprehensive e-learning platform known as School for Surgeons (SFS), which contains mandatory learning materials for trainees in the following programs: Fellowship of the College of Surgeons (also known as FCS) and Membership of the College of Surgeons (also known as MCS).4 The SFS was fully redeveloped in 2016 to match the new COSECSA branding and make it more user-friendly and accessible. The new features of the SFS included mobile optimization of the platform. This platform is viewed as a more effective and efficient way of delivering mobile-optimized learning for trainees.

Increasing knowledge and competence in surgery through skills courses is one of the strategies the College has been developing. In 2016, more than 40 courses were conducted for different surgical specialties in the COSECSA member countries. The number of courses conducted increased to 45 in 2017.

Essential surgical training (EST) aims to ensure that standardized, cost-efficient, and high-quality essential surgical services are accessible to the rural population in the district’s hospitals in Zimbabwe (ZEST) and Rwanda (REST). A total of 102 nonsurgeons participated in ZEST courses, and 87 nonsurgeons participated in REST courses.

In addition to these basic courses, four additional basic surgical skills courses took place in conjunction with the RCSI COSECSA Mobile Surgical Skills Unit in 2016.

Maintain best practice in examinations and assessment

The COSECSA Council has recently passed a resolution to inaugurate the college’s own court of examiners from among its senior fellows. The main responsibility of the examiners will be to participate in a training workshop prior to the examinations and to administer the clinical examinations. We anticipate that the establishment of the court will improve the postgraduate surgical examining process and the standardization of the exam.

Build to organizational excellence, financial sustainability, and partnerships

Within the COSECSA, Women in Surgery Africa (WISA) was founded in December 2015, with the aim of increasing the number of women surgeons in the region by supporting women physicians who train in surgery. The college will ensure these physicians are mentored while they complete the training program and beyond. This initiative will increase the number of women surgeons, which comprise just 9 percent of the total number of surgeons in the region.

COSECSA’s standing and recognition in the region is growing, as evidenced by the fact that more countries in Africa have joined our organization. We continue to build international partnerships based on mutual benefits. Over the last few years, COSECSA has partnered with the American College of Surgeons to support the increase of women in surgery efforts, sharing educational resources, and supporting leadership training when there is greatest need. COSECSA’s relationships with the Royal Colleges of Surgeons in the U.K. and Ireland have been very productive. COSESCA and the RCSI just celebrated 10 years of collaboration—a partnership that has been the most productive for our college.

Conclusion

The COSECSA region is facing one of the greatest surgical workforce shortage crises in the world. It is of paramount importance that the organization’s partnerships focus on workforce development. COSECSA is looking forward to improving the quality of our trainees, as well as scaling up the overall number of trainees. We welcome support and collaborative partnerships with surgical organizations from high-income countries and nongovernmental organizations dedicated to improving the care of the surgical patient to help us achieve our goal of graduating 500 surgeons by 2020.


References

  1. College of Surgeons of East, Central and Southern Africa. Candidate registration. Available at: www.cosecsa.org/registration-information. Accessed March 9, 2018.
  2. O’Flynn E, Andrew J, Hutch A, et al. The specialist surgeon workforce in East, Central and Southern Africa: A situation analysis. World J Surg. 2016;40(11):2620-2627.
  3. College of Surgeons of East, Central and Southern Africa. Global surgery map. Available at: www.cosecsa.org/global-surgery-map. Accessed March 9, 2018.
  4. College of Surgeons of East, Central and Southern Africa. School for Surgeons. Available at: www.cosecsa.org/school-surgeons-portal. Accessed March 9, 2018.

 

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