The RCSI/COSECSA Collaboration Programme Mr Eric O’Flynn

The Problem Surgeons per 100,000 Population

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.

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!