COST - AFRICA

Clinical Officer Surgical Training in Africa

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 Obiettivo del progetto (Objective)

'Obstetrical and abdominal emergencies, and trauma, much of it affecting children, represent a major and neglected part of Africa’s burden of disease. Countries cannot train and retain sufficient specialist surgeons (doctors) to address these priorities. We propose a surgical training intervention targeted at Clinical officers (COs), who are trained non-physician clinicians that form the backbone of Africa’s district hospital services. Lacking medical degrees, COs have fewer opportunities for emigration. Surgical training of non-clinician physicians has been tried and reportedly worked well in African countries. It has never been rigorously evaluated, nor been subject to economic and population impact assessments. Two different 2 year training models are proposed: district hospital in-service training in Malawi and centralised training in Zambia. Before-and-after and randomized controlled trial evaluations are planned. The latter is the strongest study design for evaluating an intervention. Outcomes will include direct health benefits to patients, including morbidity and mortality averted; improved provider knowledge, skills and performance; direct (surgical) and indirect (management and other services) improvements in district hospital performance. Cost-effectiveness analyses and population impact assessments will be conducted. Clinical Officer training has for long been a feasible and acceptable model to African national policy makers; and COST-Africa has already elicited high level expressions of support. There will be an ongoing interaction with national stakeholders in both countries to ensure attractive career paths, salaries and retention strategies are in place for the graduates. A proven model for training and retaining a new cadre of non-physician surgical officers has the potential to provide a standard of life-saving surgical care often denied to African populations; tackle major rural:urban inequities; and transform district hospital care. Without such a resource, Africa has no hope of reaching MDG 5 on maternal mortality; and reduced hope for MDG 4 on childhood mortality.'

Introduzione (Teaser)

Researchers are developing a model to provide surgical training to non-physician clinicians who can be retained in rural areas where they are most needed.

Descrizione progetto (Article)

People in rural sub-Saharan African regions often don't have access to hospitals and staff to perform basic emergency and elective surgical procedures. This leads to needless deaths and on-going morbidity related to pregnancy, accidents and a variety of conditions that can be surgically managed at the district hospital level.

To remedy this situation, the EU-funded 'Clinical officer surgical training in Africa' (http://www.costafrica.eu/ (COST - AFRICA)) project aims to establish training programmes for non-physician clinical officers (COs) in Malawi and Zambia.

The training programmes cover surgical training for common conditions, management and research. Furthermore, researchers have designed and are using data collection tools to measure surgical outputs, cost effectiveness and impacts of the programme.

Due to this project and at the request of host country ministries, Bachelor of Science degree programmes in surgery have been accredited at the Universities of Malawi and Zambia, thereby creating more attractive career paths for retaining clinical officers in these countries.

COST - AFRICA will provide a tested model for African countries for using trained and supervised surgically competent COs to serve the needs of rural populations, working in the district hospitals where they are most needed.