Surgeons operating

RCSI trains non-doctors to provide safe surgery in Malawi

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Seventeen district non-physician clinicians have been trained in general surgery in Malawi as part of the RCSI-led COST-Africa (Clinical Officer Surgical Training in Africa) project.

Approximately 84% of the 18 million population in Malawi live in rural locations with little or no access to surgical care. Accredited by the University of Malawi, the trainees have been awarded a BSc in General Surgery and are now able to help provide improved access to surgical care for the population of Malawi.

Access to surgical care is a significant challenge in Malawi with each of the country’s 42 surgeons working in the main city hospitals, leaving patients in rural areas with access to a network of 24 under-staffed and under-resourced district hospitals. Surgery in such facilities is provided mainly by non-physician clinicians.

Poor access contributes to the fact that almost 30% of the population in Malawi lives with a surgically treatable condition, while delays in surgery for treatable common conditions such as hernias and hydroceles often result in increased morbidity, disability and even fatalities. In addition, those forced to travel for more complex surgical cases undergo financial struggle.

The course blends central training at the College of Medicine at the University of Malawi and two years of in-service training in district hospitals with fortnightly visits from surgeons.

A report published in the British Journal of Surgery shows that the number of general surgery procedures almost doubled in the hospitals that took part in the project, which was carried out between 2011 and 2016. Outcomes of surgery were also comparable with outcomes of similar surgeries conducted by medical doctors who practiced in the intervention facilities and with surgical specialists from central hospitals. No surgical deaths were recorded in the duration of the project.

With a new cohort of graduates coming through the programme each year since it began, the COST-Africa initiative demonstrates that surgery for rural populations can be delivered by non-specialised providers cost-effectively and safely and bring important health benefits to patients attending district hospitals in rural sub-Saharan Africa.

The COST-Africa project was spearheaded by a team of health systems research experts from RCSI led by Professor Ruairi Brugha and Dr Jakub Gajewski.

Earlier this year, RCSI launched a new Institute of Global Surgery, led by Professor Mark Shrime. Building on the impact of the COST-Africa initiative and others, the IGS collaborates with partners in Africa to improve access to surgery by building local capacity in a sustainable way.


RCSI is committed to achieving a better and more sustainable future through the UN Sustainable Development Goals.