90 per cent to injuries occur in low- and middle income countries

Project title: Capacity Building in Postgraduate Surgical Training and Research in Malawi.

This NORHED-project wants to change that. The project aims to strengthen the capacity of College of Medicine (COM) at the University of Malawi in collaboration with Kamuzu Central Hospital (KCH) and Queen Elisabeth Central Hospital (QECH) to train a critical mass of Malawian surgeons to sustain training programmes, clinical service delivery and research in surgery in Malawi.

Background

An estimated 5, 8 million people die of injuries each year, 32 per cent more than the fatalities that result from malaria, tuberculosis and HIV/AIDS combined. Over 90 per cent of deaths due to injuries occur in low- and middle income countries (LMICs). For every patients that dies as a result of injuries, many more survive with permanent disability. In young people between the ages of 10 and 24 years, 97 per cent of all deaths occur in LMICs. Injuries accounting for more than 40 % deaths and road traffic accidents are the most frequent cause.

There is a huge need for human resources in the health sector in Malawi. It is estimated that there is only 1 surgeon per million people in Africa South of Sahara region. In Malawi there is only 1 Malawian surgeon per 1, 75 million people, and only 1 female surgeon in the entire Malawi. 92 per cent of the established positions for Malawian surgeons are vacant, despite very modest number of positions.

There is a low number of surgical trainees in Malawi. There is a lack of trainers and mentors in-country to correct this. In addition, there is a underfunding of public health system and the training environment is not adequate. Hence, there is a huge unmet need for surgeons in Sub Saharan Africa, including Malawi.

Currently no surgical trainers in Malawi have higher academic degrees (PhD). Furthermore, there is a sever lack of research on the need for and results of surgery in low-income countries (LICs), resulting in surgery being almost totally neglected in global health priorities. Surgeons in LICs need to be encouraged and mentored to do this important research to advise future health priorities in LICs.

Malawi is seriously affected by “brain drain” in the health sector. A recent resercah publication has showed that the most important factor stemming from the brain drain is the establishment of an in-country medical specialist training programme.

Strengthening capacity at College of Medicine and Central Hospitals in Malawi to ensure sustainable educational specialist programmes in surgery will improve surgical services to the population of Malawi

The project will build capacity for surgical training and research in Malawi through support to an on-going training programme, established through Norwegian government support in 2008. This will include education of surgical specialists through a 5 year training program with College of Surgeons of East, Central and Southern Africa (COSECSA) as well as expansion of COM Master medical surgical program, which will focus on introduction to resercah early in the careers. At the end of the NORHED project period it is expected that 30 surgical specialists have graduated and will be involved in the training of new trainees.

Small scale infrastructure and equipment for conducive teaching environment will be included. To improve the environment for research and postgraduate training at the two main training sites for surgery in Malawi and to create incentives for keeping the very few mentors already available in public service, the project will provide PhD Fellowships at University of Bergen (UiB) for some surgical consultants at KCH and QECH. They will be conducting their work and research in Malawi, but will attend PhD courses and mentorship at UiB. The candidates will teach and supervise the trainees in surgical specialization. Upon completing their degree they will bring additional academic capacity to CoM, which will be valuable if CoM succeed in establishing their own PhD in surgery, which is an aim during the NORHED project. 

The project will stimulate to research in the field of surgery in Malawi and will include a survey on surgical needs and availability in Malawi, surgical results and safety, and surgery and HIV.

Surgery is a male dominated profession, also in Malawi. A gender action plan for the postgraduate surgical training programme has been developed to ensure equal opportunities for male and female doctors to participate in the training programme. The action plan tries to find suitable ways of influencing young female doctors to choose a career in surgery, and a long list of strategies are presented including female mentors for female trainees as role models and creation of a network of female surgeons and trainees dealing with gender-specific issues. The plan has a deliberate goal of at least 50 % recruitment of females into the training programmes and states that gender mainstreaming shall be integrated into all aspects of research studies.

Key goals and achievements

Overall goal

Malawi has a sustainable number of surgical specialists to treat the national burden of surgical disease.

The objectives of the project are

1. Increased surgical capacity at national level
2. Strengthen and increase national and regional postgraduate surgical training capacity through locally relevant Masters, PhDs and COSECSA Fellowship training programmes to meet national and regional needs
3. Strengthen the quality of postgraduate education and research capacity in surgery
4. Increase and strengthen academic staff at COM
5. Regional/International collaboration in education and research strengthened
6. Appropriate infrastructure & equipment to ensure sustainable capacity to educate and research