Training the surgeons of the African future
Accessible, affordable healthcare shouldn't just be the domain of city dwellers. The team behind an EU-funded project is training non-physician clinicians in Malawi and Zambia to bring essential surgeries to rural communities in Africa.
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Access to essential healthcare in rural Africa is at a premium. Those living in rural communities often have to travel long distances to the nearest big city to get to a central hospital that can perform vital surgery, and that comes at a financial and medical cost. Though a system of district hospitals exists to cater for those in the provinces, each is limited in the range of operations it can perform, leaving many in medical limbo. But an EU-funded project is seeking to improve the health prospects of millions of underserved rural dwellers across Africa.
COST-Africa – Clinical Officer Surgical Training, Africa – seeks to give those living in rural communities in Malawi and Zambia the opportunity to receive safe, accessible and cost-effective surgery by training Clinical Officers (COs) in surgical skills. COs are common across sub-Saharan Africa, where they’re qualified to provide specialised and general medical services that in other countries would be the preserve of physicians.
By training COs to deliver various elective surgeries, such as hernia repairs and tubal ligations, the team behind the project hopes to not only provide access to surgery at the point of need, but to improve the retention rate of medical professionals in rural communities. “The project is addressing a critical shortage of doctors,” says Ruairi Brugha of the Royal College of Surgeons in Ireland, COST-Africa Coordinator. “Because of this shortage, it’s impossible in practise to train doctors as specialist surgeons and then keep them working and living down at the district hospital level.”
“Gold standard research”
The team trained 17 COs in Malawi and deployed them to eight district hospitals. This group is in the final six months of a three-year BSc degree programme that COST-Africa supported the national institutions to accredit. In Zambia, 35 clinical officers, known as medical licenciates, were given additional training in surgical skills.
“We have demonstrated using gold standard research methods that it’s feasible to deliver this surgery safely. These clinical officers get supervised regularly by specialist surgeons and, as a result, we have shown a significant increase in the number of these indexed cases undertaken by the COs.”
The COST-Africa model is showing economic as well as health benefits. “It's already becoming evident that delivering surgery at the district hospital is cost effective. It may well turn out to be as or even more cost effective than doing the same cases at the central hospital. We've undertaken a study of the costs to patients of seeking surgery at the district hospitals, and we're comparing those costs with those incurred if they went to the central specialist hospital.”
The COST-Africa team is in the process of evaluating a scalable district CO surgical training programme. The team has received a six-month no-cost extension to work with national ministries of health in Malawi and Zambia to cost and define the model. They have also submitted a Horizon 2020 proposal to implement the project on a much larger scale.
“The aim is to work within regions and provinces, rolling out a core model across all surgically-active government and faith-based district hospitals,” Brugha says. “We also plan to transfer the model to a third country, Tanzania. That would mean reaching a population of 75 million, in all.”
By partnering with the College of Surgeons of East, Central and Southern Africa, the project team plans to test similar models in pilot sites in another five countries in the region. “The ultimate goal is to make safe, affordable surgical care accessible to millions of people, wherever they live.
“Tackling the determinants and the effects of poverty are fundamental to the Sustainable Development Goals which Europe is committed to. Looking at the world now and the nature of migration, there’s a realisation that we really need to make essential health services available to all, so as to make these countries more sustainable. How many of us would tolerate living in a setting where it was not possible get a simple life saving operation?” asks Brugha.