A EU-Africa partnership to co-design a training intervention to scale-up access to surgery in Africa

BACKGROUND: The EU Global Health Strategy recognises that a skilled workforce is critical to advance universal health coverage. In response, our consortium brought together researchers, academics and clinicians from Ireland, the UK, the Netherlands, Malawi, Zambia and Tanzania to co-design a surgical workforce training and supervision intervention for district hospital teams aimed at scaling-up access to essential surgery in rural East Africa. Participatory action research (PAR) informed intervention design, incorporating the needs of frontline surgical providers and tailoring the training to meet identified gaps. This is the first study of this type in global surgery. METHODS: PAR workshops were held in Malawi, Zambia and Tanzania in 2017-2019 with key stakeholder groups: local authorities, professional associations, hospital managers and multi-disciplinary representatives of surgical teams from 67 district and referral hospitals. Through semi-structured discussions, qualitative data were collected on participants’ perceptions and experiences of barriers to safe and timely surgical and anaesthesia care, challenges in referral systems, and district surgical teams’ training and supervision needs. Data were compared for themes across sites and cadres. RESULTS: District surgical providers reported: a lack of in-service training, lack of access to mentoring and a demand for feedback on referrals. Participants prioritised training needs that could be addressed through regular in-service training and supervision visits from referrals to district hospitals to be delivered over the intervention period. Participants used findings in an action-planning cycle to develop country- and site-specific training plans for each research site. CONCLUSIONS: Our approach to surgical capacity building, utilising both European and African expertise, has resulted in a demand-driven in-service training and supervision programme, now included in the participating countries’ national health strategies. KEY MESSAGES: • The inclusive, participatory approach to surgical system strengthening employed by our study enabled the co-design of a locally relevant, contextualised intervention. • Our study generated lessons on how to rebalance power dynamics in European-African health partnerships.