Access to surgical care in Africa: the contribution of non-physician clinicians in surgical care in rural Malawi and Zambia.

Conditions amenable to surgery account for an estimated 11-15% of the global disease burden, with 1.4 million preventable deaths occurring annually. Yet, access to surgical care around the world continues to be inequitable, particularly in Sub-Saharan African (SSA) countries where the performance of health systems is undermined by chronic resource scarcity and severe surgical workforce shortages. It is estimated that up to 95% of the population in SSA has limited access to safe, affordable surgical and anaesthetic care because general surgical services are concentrated around urban centres. If comprehensive universal health coverage is to be achieved, the surgical needs of rural dwellers need to be met.

A key challenge, however, is the shortage of qualified staff – surgical clinicians, anaesthetists and nurses – aggravated by labour migration, with as few as one surgeon per 2.5 million people in some SSA rural settings. This human resource gap is often filled by health professionals with non-specialist training such as medical officers, non-physician clinicians and general nurses.

This presentation will highlight effective surgical workforce training and health systems strengthening interventions implemented in sub-Saharan Africa.

Dr Jakub Gajewski is the Director of Research at RCSI Institute of Global Surgery. He is a health sociologist with nearly twenty years of research, teaching and project management experience in global health. He has been involved in several population-based studies, including studies of young people’s well-being, diabetes and epilepsy conducted in over 50 countries worldwide. He was the lead researcher on the COST-Africa project 2011-2016, which implemented on the-job-training of non-physician clinicians in Malawi and tested the supervision model for this cadre in Zambia. He was the international coordinator and the lead researcher for the Horizon 2020-funded SURG-Africa project which successfully developed and delivered a capacity-building intervention targeting non-specialist surgical providers at district hospitals in Malawi, Zambia and Tanzania. Currently, he is the PI on the kidSURG project, scaling up the non-specialist training model tested in SURG-Africa to address the needs of surgical paediatric patients in rural Malawi. He is also co-PI in the MeLD-Track project in Zambia, documenting the contribution of non-specialist surgical providers in rural hospitals.