1. The RCSI/COSECSA Collaboration Programme
Mr Eric O’Flynn

2. The Problem
Surgeons per 100,000 Population

3. 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.

4. 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.

5. 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 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.

6. 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.

7. 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)”

8. Collaboration: E-Learning
Joint development and administration of an Africa-centric surgical E-learning platform –
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.

9. Collaboration: E-Learning

10. Collaboration: Exams Provision of External Examiners
Benchmarking of COSECSA exams against RCSI exams
Collaboration on delivery of pre-exam examiners seminar

11. 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

12. 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.

13. 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

14. 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.

15. 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.

16. 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?

17. Thanks!