Prof. Abebe Bekele

Background: Increasing surgical specialist workforce density in sub‐ Saharan Africa is essential for improving access to surgical care. However, out‐migration creates a significant challenge to attaining provider targets. We aimed to determine the rates and trends of retention of surgeons in the College of Surgeons of East Central and Southern Africa (COSECSA) regions. Methodology: An online, web‐based survey was distributed to COSECSA surgeons who graduated from 2004 to 2020. Current practice and migration patterns were visualized using descriptive analyses and logistic regression models. Results: Response rate was 48% (270/557). Most respondents trained as general surgeons and practiced in Ethiopia, Kenya, Zimbabwe, and Zambia. Majority practiced in public hospitals (74%), and were active in research (81%), teaching (84%) and leadership (55%). Overall country (85%), regional (92%) and Africa retention rates (99%) were high with 100% country retention in Rwanda, Botswana, Lesotho, and Namibia. Tanzania had the lowest retention (61%). Highest inter‐regional migration occurred from East to Southern Africa (26%), and continental out‐migration occurred from Zambia, Zimbabwe, and Kenya. On bivariate analysis, out‐migration from training country and region was associated working with a non‐ governmental organization (p = 0.002 and 0.0003) or a specialized hospital (p = 0.046 and 0.011). A multiple regression model with type of institution and leadership was a poor fit (McFadden R2 = 0.055; p = 0.082). Conclusion: Retention rates of surgeons trained by COSECSA in the region remain remarkably high. This can be taken as an indicator of success of the training model to increase surgical workforce density, however, contributory factors need to be qualitatively explored.

AbstractBackgroundIncreasing surgical specialist workforce density in sub‐Saharan Africa is essential for improving access to surgical care. However, out‐migration creates a significant challenge to attaining provider targets. We aimed to determine the rates and trends of retention of surgeons in the College of Surgeons of East Central and Southern Africa (COSECSA) regions.MethodologyAn online, web‐based survey was distributed to COSECSA surgeons who graduated from 2004 to 2020. Current practice and migration patterns were visualized using descriptive analyses and logistic regression models.ResultsResponse rate was 48% (270/557). Most respondents trained as general surgeons and practiced in Ethiopia, Kenya, Zimbabwe, and Zambia. Majority practiced in public hospitals (74%), and were active in research (81%), teaching (84%) and leadership (55%). Overall country (85%), regional (92%) and Africa retention rates (99%) were high with 100% country retention in Rwanda, Botswana, Lesotho, and Namibia. Tanzania had the lowest retention (61%). Highest inter‐regional migration occurred from East to Southern Africa (26%), and continental out‐migration occurred from Zambia, Zimbabwe, and Kenya. On bivariate analysis, out‐migration from training country and region was associated working with a non‐governmental organization (p = 0.002 and 0.0003) or a specialized hospital (p = 0.046 and 0.011). A multiple regression model with type of institution and leadership was a poor fit (McFadden R2 = 0.055; p = 0.082).ConclusionRetention rates of surgeons trained by COSECSA in the region remain remarkably high. This can be taken as an indicator of success of the training model to increase surgical workforce density, however, contributory factors need to be qualitatively explored.

AbstractBackgroundThe College of Surgeons of East, Central, and Southern Africa (COSECSA) comprises 14 countries, many of which currently grapple with an increasing burden of cardiothoracic surgical (CTS) diseases. Health and economic implications of unaddressed CTS conditions are profound and require a robust regional response. This study aimed to define the status of CTS specialist training in the region (including the density of specialists, facilities, and active training posts), examine implications, and proffer recommendations.MethodsA desk review of COSECSA secretariat documents and program accreditation records triangulated with information from surgical societies was performed in May 2022 and September 2023 as part of education quality improvement. A modified nominal group process involving contextual experts was used to develop a relevant action framework.ResultsOnly 6 of 14 (43%) of COSECSA countries offered active training programs with annual intake of only 18 trainees. Significant training gaps existed in Burundi, Botswana, Malawi, Rwanda, South Sudan, Zambia, and Zimbabwe. Country specialist density ranged from 1 per 400,000 (Namibia) to 1 per 8,000,000 (Ethiopia). Overall, the region had 0.2 CTS specialists per million population as compared with 7.15 surgeons per million in High‐Income Countries. Surgical education experts proposed an action framework to address the training crisis including increasing investments in CTS education, establishing regional centers of excellence, retention incentives and opportunities for women, and leveraging international partnerships.ConclusionProactive investments in infrastructure, human resources, training, and collaborative efforts by national governments, regional intergovernmental organizations, and international partners are critical to expanding regional CTS training.

Introduction The College of Surgeons of East, Central, and Southern Africa (COSECSA) training program requires completion of a mandatory rotation in vascular and cardiothoracic surgery. However, few accredited training sites offer such services regularly, hence exposure of trainees to these disciplines is limited. This study evaluates the demand, feasibility, and acceptance of an open-access, synchronous virtual surgical education series to bridge gaps in training. Methods The Center for Equity in Global Surgery at the University of Global Health Equity partnered with COSECSA to develop and deliver interactive sessions on common cardiothoracic, vascular, and transplant surgical topics facilitated by faculty from the COSECSA region and global partner institutions. All sessions were delivered via a cloud-based video conferencing service and recorded for retrospective viewing. At the end of the lecture series, trainees participated in a post-course evaluation survey. Results In total, 2,015 participants from 48 countries attended the lecture series with 977 participants in 2022 and 1,038 in 2023. In 2023, most participants were from Ethiopia (10.9%), Kenya (23.6%), and Uganda (15.4%). Two hundred and fifty-two participants contributed to the post-course evaluation survey, of which only 23% were female and 48% were general surgery trainees. Mean satisfaction with the lecture series on a 5-point Likert scale was 4.5. Participants reported an average satisfaction level of 4.4 for logistics of the series (registration process, ease of connectivity, and time management), 4.5 for content, 4.4 for in-class interactions, 4.4 for use of case-based images, and 4.2 for post-session availability of lecture material. Almost all suggested additional lectures in thoracic infection, vascular trauma, and plastic surgery to be included in subsequent lecture series. Conclusion The study has shown that such an online, synchronous, virtual teaching series is in high demand, feasible, and crucial for closing knowledge gaps in didactic cardiothoracic, vascular, and transplant surgery within the COSECSA region. These sessions are well received by COSECSA trainees and are accessible, highlighting a clear demonstrable need. It is recommended that such efforts be sustained and expanded, with additional competency areas to broaden the impact.

Background: The Association of Surgeons of East Africa (ASEA) was formed in 1952. In 1996 a Steering Committee was formed to transform ASEA into a surgical college. The College of Surgeons of East Central and Southern Africa was officially launched in December 1999 in Nairobi, Kenya. Today the College consists of 14 constituent member countries but trains in 20 countries in Sub-Saharan Africa. Programmes: COSECSA runs a 5 year training programme in all the surgical specialties. In the first 2 years trainees do the Membership (MCS) programme. This is followed by 3 years of the Fellowship (FCS) programme. More recently the College has started a 2 year subspecialty Fellowship in paediatric orthopaedics. Graduates: The main aim of the College was to expand and improve surgical training in the COSECSA region. This goal was partially realised in December 2020 when the total number of surgeons produced by the College from inception reached 557. Retention: Another key success story of COSECSA is that the majority of graduates have remained in the region leading to a high retention rate of 88.3%. Women In Surgery Africa (WISA): Since the formation of WISA in 2015 the College has witnessed an increase in the number of female trainees. Currently only 9% of surgeons in the region are women. Conclusion: In its current Strategic Plan (2021e2025) COSECSA aims not only to increase the surgical workforce in the region but also to modernise its training programmes and strengthen its governance structures.