Urgent investment in human resources for surgical and anaesthesia care is needed

According to a new Commission published in The Lancet today, five billion people worldwide do not have access to safe and affordable surgery and anaesthesia when they need it. 

© John McLaughlin. Surgical trainees on a COSECSA spine surgery course in Kenya in April 2014.Trainees were from Ethiopia, Kenya, Tanzania, Zimbabwe, Zambia, Malawi, Uganda and Rwanda, and it was the first such regional course to take place.

As many as nine out of ten people care in low-income and lower-middle income countries cannot access basic surgical care. As a result, millions of people are dying from common, easily treatable conditions like appendicitis, fractures, or obstructed labour. 

Today’s surgical workforce needs to double in 15 years in order to turn this situation around.

2.2 million more surgeons, anaesthetists and obstetricians are needed to reach the Commission’s target of 80% coverage with timely access to essential services by 2030.

THET supports a diverse range of programmes and projects in low- and middle-income countries designed to deliver quality training, to build institutional capacity and to facilitate the sharing of expertise internationally in the critical area of surgery and anaesthesia care. Download Overview

Strengthening Anaesthesia Service Delivery in Zambia: : Since 2010, THET has been working with the Ministry of Health, Ministry of Community Development/Mother and Child Health and the University of Zambia to scale up training of anaesthesia service providers. The first intake of Masters of Medicine (MMed) students started in June 2011, with support from DFID. The programme currently has 23 MMed Trainees, with the first 6 to graduate in 2015. The programme has;

  • More than doubled the number of specialists physicians in Zambia
  • Improved systems and governance
  • Developed protocols and guidelines
  • Delivered SAFE Anaesthesia and Lifebox courses to health care workers around Zambia
  • Produced peer-reviewed publications.

Building on this work, THET is currently developing an innovative 5-year project to improve access to emergency obstetric and paediatric anaesthesia services in Zambia. THET’s programme will increase the number and quality of anaesthesia providers in all 10 provinces through pre-services and in-service training delivered through a mix of didactic, practical and simulation teaching methods. The project aims to train 640 anaesthesia service providers over 5 years.

Surgical projects recently funded under the Health Partnership Scheme and the Strengthening Surgical Capacity (SSC) grants scheme

  • Addenbrooke’s Abroad, Cambridge University Hospitals NHS Foundation Trust working with Yangon General Hospital, Myanmar to increase the effectiveness of trauma management through training 250 hospital staff, including paramedics, surgeons, doctors, physiotherapists and nurses, in up-to-date trauma-injury care skills and techniques. Laboratory staff will also be trained, and patient pathways introduced.
  • Association of Surgeons of Great Britain and Ireland (ASGBI) working with the College of Surgeons of East, Central and Southern Africa to increase the number of surgeons competent to undertake Anastomotic Surgery in the East Central and Southern African Region.
  • University of Oxford working with the College of Surgeons of East, Central and Southern Africa (COSECSA) and the Association of Surgeons of East Africa (ASEA) to strengthen the orthopaedic surgical capacity through the delivery of paediatric orthopaedic surgery and hip and knee surgery courses to 90 trainees in Kenya, Zambia, Ethiopia and Malawi. Many of these trainees will also undertake fellowships at CURE hospitals across the region.
  • The Royal College of Surgeons of Edinburgh working with the University of Medicine, Myanmar to support the development of technical and non-technical surgical skills for urologists across Myanmar.
  • King’s College Hospital, London working with Shifa Hospital, Gaza to provide support for the development of trauma care services in Gaza, with a particular focus on the newly established limb reconstruction service. At least 80 health workers will receive training in total.
  • NDORMS, University of Oxford working with CURE Ethiopia Children’s Hospital (CECH) to strengthen the training and delivery capacity for clubfoot treatment in sub-Saharan Africa by 2017 through the provision of Training the Trainers (TTT) as well as Provider courses. The Provider course will be delivered to 80 new health care workers in Ethiopia, and the TTT will be delivered to 60 trainers from Ethiopia and other sub-Saharan African countries.
  • A start- up grant for Queen Elizabeth Hospital, University Hospitals Birmingham working with University Teaching Hospital, Zambia to support planning towards the first kidney transplants at the hospital. The team will meet with surgical, medical, nursing, intensive care, anaesthetic and operating theatre professionals, as well as with patients with kidney failure and hospital management.
  • Cardiff University working with the University of Namibia to support anaesthesia training and development in Namibia. This project will be the first of its kind to be implemented in Namibia. With strong support from the Namibian Ministry of Health, the partners will conduct three 10-day anaesthesia courses in 2015, prior to the launch of the country’s first MMed in Anaesthesia in 2016.
  • Wirral University Teaching Hospital working with Queen Elizabeth Central Hospital, Malawi, teaching clinical staff safer methods of second stage caesarean section, as well as training in the use of the WHO checklist (the latter will also be delivered to theatre nurses, obstetricians and anaesthetic officers).