Using participatory action research to empower district hospital staff to deliver quality-assured essential surgery to rural populations in Malawi, Zambia, and Tanzania

Abstract

BackgroundIn 2017 the SURG-Africa project set out to institute a surgical, obstetric, trauma and anesthesia (SOTA) care capacity-building intervention focused on non-specialist providers at district hospitals in Zambia, Malawi and Tanzania. The aim was to scale up quality-assured SOTA care for rural populations. This paper reports the process of developing the intervention and our experience of initial implementation, using a participatory approach.MethodsParticipatory Action Research workshops were held in the 3 countries in July–October 2017 and in October 2018–July 2019, involving representatives of key local stakeholder groups: district hospital (DH) surgical teams and administrators, referral hospital SOTA specialists, professional associations and local authorities. Through semi-structured discussions, qualitative data were collected on participants’ perceptions and experiences of barriers to the provision of SOTA care at district level, and on the training and supervision needs of district surgical teams. Data were compared for themes across countries and across surgical team cadres.ResultsAll groups reported a lack of in-service training to develop essential skills to manage common SOTA cases; use and care of equipment; essential anesthesia care including resuscitation skills; and infection prevention and control. Very few district surgical teams had access to supervision. SOTA providers at DHs reported a demand for more feedback on referrals. Participants prioritized training needs that could be addressed through regular in-service training and supervision visits from referral hospital specialists to DHs. These data were used by participants in an action-planning cycle to develop site-specific training plans for each research site.ConclusionThe inclusive, participatory approach to stakeholder involvement in SOTA system strengthening employed by this study supported the design of a locally relevant and contextualized intervention. This study provides lessons on how to rebalance power dynamics in Global Surgery, through giving a voice to district surgical teams.

Action Research in Agricultural Development Projects: Case Study of a Dairy Project in Ethiopia

“…The perception of the participants that BRIDGE action research activities provide a good platform for learning, bridges disciplinary gaps and puts a focus on the practical issues affecting the participants is consistent with reported findings from applying an action research approach to development projects in sub-Saharan Africa (Wood and Govender 2013;Niyobuhungiro and Schenck 2022;Pittalis et al 2023). Wood and Govender (2013) observed that there is learning through the action research process, as already discussed above.…”

“…Wood and Govender (2013) observed that there is learning through the action research process, as already discussed above. According to Pittalis et al (2023), feedback from the action research participants based on their perception could provide support for the design of a locally relevant and contextualized intervention. In addition, this can contribute to co-development of knowledge, which requires collaboration of different groups of stakeholders, and this gives voice to the concerned communities on issues that affect them.…”

Evidence-Informed Surgical Systems Strengthening with Meaningful Stakeholder Involvement in Low-Resource Settings: A Response to Recent Commentaries

“…13 We also published a paper demonstrating the successful participatory research model for collaboration in three African countries between a wide range of incountry stakeholders, local ministries of health and other regulatory bodies, as part of the international SURG-Africa research consortium. 14…”