The RCSI/COSECSA
Collaboration
Programme
Mr Eric O’Flynn
The Problem
Surgeons per 100,000 Population
40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
The Problem
• 11% of the global burden of disease, as measured in DALYs, is
conservatively estimated to be amenable to surgery. his is
increasing.
• Already in Sub-Saharan Africa injury is the main cause of death
and disability for children aged 5 and over.
• Per DALY averted surgery is cheaper than antiretroviral therapy.
• 1,390 qualified surgeons for 65 million people; a ratio of one for
190,000 people.
•
Most surgeons are based in the major urban areas.
College of Surgeons of
East, Central and Southern
Africa (COSECSA)
COSECSA is working to train surgeons to meet this need.
COSECSA develops common regional surgical training programmes
undertaken in designated training institutions with a common
examination and the award of surgical qualification that meets
international standards and is regionally recognised.
It is a “College Without Walls” which uses all healthcare resources
for training; including regional and district hospitals.
COSECSA
There are 9 Member Countries: Ethiopia, Kenya, Malawi, Mozambique,
Rwanda, Tanzania, Uganda, Zambia, Zimbabwe.
Offers Membership and Fellowship programmes. Fellowship are offered
in 7 specialities: General Surgery, Orthopaedics, Paediatrics, Urology,
Neurosurgery, Plastic Surgery and ENT.
61 specialist surgeons have been trained
since 2004. Trainee numbers are
increasing; COSECSA now has 126 trainees
in 28 training locations.
COSECSA also teaches surgical skills to
medical doctors and non physician
clinicians.
5
The Collaboration
Programme
The collaboration originated from the initiative of Prof Gerry
O’Sullivan, former president of RCSI and Prof Krikor Erzingatsian,
Former president and current CEO of COSECSA.
In 2007 RCSI, COSECSA and Irish Aid signed an MOU.
It’s now a cross – college collaboration involving RCSI departments
as diverse as Surgery, Exams, Anatomy, Pathology, Physiology,
IT, Communications, Media Services and the Leadership Institute.
The programme is overseen by a steering committee made up of
Irish-based and African-based committee members.
Collaboration:
Training
• Training the Trainer courses for all COSECSA trainers
• Basic Science Faculty development
• Fellowship level seminars in Orthopaedic Surgery and General
Surgery and membership level basic science trainings
• Training surgery to doctors : “Zimbabwe Essential Surgical
Training (ZEST)”
Collaboration:
E-Learning
• Joint development and administration of an Africa-centric
surgical E-learning platform – www.schoolforsurgeons.net
• We have equipped18 ICT labs in 7 countries, and will equip 9
more during 2012.
• In 2011 completion of a number of online case studies was
made mandatory for one tranche of trainees. Over the course of
the year, 31 out of the32 trainees completed the mandatory
work showing that e-learning is very possible even in the most
remote locations.
Collaboration:
E-Learning
Collaboration:
Exams
• Provision of External Examiners
• Benchmarking of COSECSA exams against RCSI exams
• Collaboration on delivery of pre-exam examiners seminar
Collaboration:
Organisational
Development
• Development of performance evaluation tools
• Administrative collaboration and training
• Assistance in promotion of COSECSA to the global surgery
community and to the medical community and general public
in the COSECSA region.
• Provision of a professional volunteer in COSECSA
Secretariat in Tanzania
• Mapping and facilitation of cooperation with other
international surgical training groups.
• Budgetary support
Lessons Learned:
Working Within
Existing Structures
Working within existing local structures is the most effective way to
improve and expand surgical training in developing counties. Local
medical and surgical qualifications form part of the solution to the
brain drain of doctors and surgeons from less developed countries.
The Paris Declaration on Aid Effectiveness core principals state:
Developing countries set their own strategies for poverty reduction,
improve their institutions and tackle corruption.
Donor countries align behind these objectives and use local
systems.
Lessons Learned:
E-Learning
E-learning is a scalable and cost effective way of delivering
standardised training across a wide geographic distance.
• MCS 2011 proof of concept
• Geographical difficulties
• Feel part of something greater
Lessons Learned:
Institutional
Relationships
A programme which began through a personal relationship has
evolved into something greater
Institutional relationships are more durable than those between
individuals and provide infrastructure to ensure voluntary efforts are
effectively utilised.
Challenges: Finance
Ensuring that such structures are financially self sustaining is a
major challenge.
• Surgical training worldwide is expensive and not generally
profitable.
• Surgery has not been a donor priority.
Challenges: Evaluation
It’s difficult to measure impact, especially qualitative impact.
If the numbers of surgical trainees increases, to what can we
attribute that? How much is due to the intervention and how much
to other factors?
Thanks!