Evaluation of a surgical training programme for clinical officers in Malawi

Abstract

Background Shortages of specialist surgeons in African countries mean that the needs of rural populations go unmet. Task‐shifting from surgical specialists to other cadres of clinicians occurs in some countries, but without widespread acceptance. Clinical Officer Surgical Training in Africa (COST‐Africa) developed and implemented BSc surgical training for clinical officers in Malawi. Methods Trainees participated in the COST‐Africa BSc training programme between 2013 and 2016. This prospective study done in 16 hospitals compared crude numbers of selected numbers of major surgical procedures between intervention and control sites before and after the intervention. Volume and outcomes of surgery were compared within intervention hospitals between the COST‐Africa trainees and other surgically active cadres. Results Seventeen trainees participated in the COST‐Africa BSc training. The volume of surgical procedures undertaken at intervention hospitals almost doubled between 2013 and 2015 (+74 per cent), and there was a slight reduction in the number of procedures done in the control hospitals (–4 per cent) (P = 0·059). In the intervention hospitals, general surgery procedures were more often undertaken by COST‐Africa trainees (61·2 per cent) than other clinical officers (31·3 per cent) and medical doctors (7·4 per cent). There was no significant difference in postoperative wound infection rates for hernia procedures at intervention hospitals between trainees and medical doctors (P = 0·065). Conclusion The COST‐Africa study demonstrated that in‐service training of practising clinical officers can improve the surgical productivity of district‐level hospitals.

Impact of Medical Doctors Global Health and Tropical Medicine on decision-making in caesarean section: a pre- and post-implementation study in a rural hospital in Malawi

“…It is therefore also challenging to predict the sustainability of the observed effect. Supervision and training may have long-term effects, especially with the enrolment of surgical and obstetric training for associate clinicians [ 22 , 23 , 26 ]. Effectivity of task-sharing with associate clinicians has been studied previously, but not on the matter of indications and caesarean section rate [ 22 , 27 ].…”

Barriers to surgery performed by non-physician clinicians in sub-Saharan Africa—a scoping review

“…There are major shortages worldwide in surgical workforce [2,6], especially in sub-Saharan Africa (SSA) which has only 3% of the global health workforce [7] while facing the highest rate of surgical disability-adjusted life years (DALYs) lost, at 38 per 1000 population [3,4]. Surgical care in SSA is mainly concentrated in urban referral hospitals [1,5,7], which have better surgical expertise and infrastructure than rural hospitals [1,7].…”

Why Do They Leave? Challenges to Retention of Surgical Clinical Officers in District Hospitals in Malawi

“…6 Given the chronic shortage of surgeons in SSA, nonphysician clinicians (NPCs) are trained to perform essential surgical tasks. 7 NPCs are health-workers who have not been trained to the level of a medical doctor but take on some of their diagnostic and clinical functions. 8 They are hailed as an alternative due to low training costs, reduced training duration and better retention rates in rural placements compared to medical doctors.…”