West African College of Surgeons and its role in global surgery

The West African College of Surgeons (WACS) started as an association in 1960, with a membership of 25 surgeons.* According to Ajayi and co-authors in Knife in Hand: History of the West African College of Surgeons, the end of World War II resulted in a wave of disentanglement from colonial vestiges in Africa, Asia, and around the world. This decolonization resulted in a need to focus on the surgical needs of these newly independent countries. It was in this environment that Victor Anomah Ngu, MD, FWACS, a 33-year-old Cameroon-born, English-trained surgeon, met an Irish surgeon, Charles Bowesman, MD, on a ship heading to Nigeria from the U.K. Both men identified the need for a forum of practicing surgeons in West Africa to exchange ideas and share experiences. Letters of invitation were sent to known individuals and Ministries of Health of all West African countries, describing the formation of the Association of Surgeons of West Africa (ASWA) and announcing the inaugural meeting on December 3, 1960, in Ibadan, Nigeria. This organization eventually transformed into a College in 1973 to address the growing demand for surgical specialists in the region, as it had become obvious that the cost of overseas training was unsustainable.

The WACS membership now consists of more than 6,000 Fellows in seven surgical specialities, from 18 countries in West Africa (see map below for a visual representation of the West Africa sub-region). The mission of the WACS is to promote postgraduate professional surgical education, disseminating surgical knowledge and technical skills toward the attainment of the highest possible standards, with the overall goal of protecting the health of the peoples of West Africa, through cooperation among member countries.

Figure 1. West Africa sub-region

Figure 1

The WACS now has more than 220 accredited surgical training programs in 120 institutions, and between 4,000 and 5,000 trainees sit for examinations annually. In 2017, the WACS examined the first post-fellows in trauma care within the faculty of surgery.

The WACS mission

The main objectives of the WACS include the following:

  • The promotion, organization, and conduct of postgraduate education, training, and certification in surgery, related disciplines, and specialties in West Africa
  • Cooperation with appropriate national and international bodies worldwide with aims and objectives likely to promote, assist, develop, and advance the interests of the WACS

Although the mission of the WACS is broad, the core has always been training skilled surgical specialists to provide surgical services to the population of member countries. In its 57 years of existence, the WACS has made significant strides in achieving its objectives, including middle-level workforce training, endowment funding, and professional development.

Middle-level workforce training

In response to the immense need for surgical services, the WACS in the late 1980s introduced diplomate programs in anesthesia, ophthalmology, and otorhinolaryngology. Approximately 1,000 physicians have been trained so far under this model.

Today, the WACS has introduced the membership program as an exit platform to serve workforce needs of the sub-region and fast-track capacity building. There is a mandatory supervised rural surgery posting for membership level trainees, intended to scale up rural surgical services and improve trainee retention in the rural district and rural hospitals that serve the bulk of the population in West Africa.

Endowment funds

Introduced in 1990, the endowment fund program was designed to help meet the needs of local surgical training programs for the enhancement of surgical practice for community health care facilities (district and general hospitals) in member countries. All member countries have such funds, which are used under the direction of a board of trustees to fund locally identified relevant surgical training or programs. The endowment fund in each constituent country is re-launched each time the WACS Scientific and Annual Conference is held in that country.

Professional development programs

As part of its mission to update surgical knowledge and skills, the WACS organizes regional courses and workshops during the year using local, regional, and international faculty. These workshops are well-attended and some are mandatory for trainee eligibility to sit for examinations. These courses include the following:

  • Manuscript writing workshop
  • Health management and ethics course
  • Research methodology course
  • Basic surgical skills courses
  • Basic laparoscopic and endoscopic skills training
  • Advanced Trauma Operative Management course
  • Disaster management course

The WACS role in implementing WHA resolutions

Most of the functions of the WACS are already in tandem with the resolutions of the World Health Organization’s World Health Assembly (WHA). Examples of WACS programs that directly address the WHA resolutions include the following:

  • The development of a sub-regional surgical, obstetric, anesthesia, and nursing plan, which aims to update information about the capacity of member countries and use data to appropriately determine need and distribution of surgical care.
  • Surgical outreach programs, which are regularly conducted in various countries, are truly a collaborative effort involving international teams of surgeons, anesthetists, and nurses. Participants in these programs address complex surgical cases and ensure proper follow-up by handing over patients to the local surgeons who are always part of the team. The most recent outreach program took place in February in Gambia.
  • Provision of various surgical specialists on a short- to mid-term basis to member countries that are particularly disadvantaged due to natural or man-made disasters.

Challenges, goals, and opportunities for collaboration

Despite significant strides, much more work is necessary to achieve the goals of the organization. Surgical workforce density is extremely low, and with a population of 300–350 million in the sub-region, West Africa is far below the minimum of 20 specialist surgeons, anesthesiologists, and obstetricians per 100,000 recommended by The Lancet Commission on Global Surgery.

In addition to these workforce shortages, rapid population expansion and frequent disease outbreaks in the sub-region increase the burden for existing health care providers and highlight the need for a larger, more robust surgical workforce. The following areas are ripe for collaboration with our international partners:

  • Improve the quality of skills training by supporting more basic skills programs within existing training institutions and expanding the number of institutions with basic skills training programs
  • Establish a small number of regional advanced skills acquisition centers with simulation
  • Improve the efficiency of fellowship examinations using new technology and modernized testing methods
  • Enhance research capacity building and attract funding for regional multi-institutional research projects
  • Streamline data collection of basic surgical health indices from member countries through the West African surgical obstetrics and anaesthesia planning committee of the WACS

It is our hope that our sister colleges in North America and Europe will find value in working with the WACS to accomplish these goals.

*West African College of Surgeons. Available at: www.wacscoac.org/. Accessed March 9, 2018.

Ajayi OO, Quartey JKM, Adebonojo SA, editors. Knife in Hand: History of the West African College of the Surgeons (1960–2010). Ibadan, Nigeria: BookBuilders. Editions Africa; 2010.


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