RCSI/COSECSA Collaboration Programme
The RCSI works in partnership with regional and Irish professional bodies to strengthen surgical training and advance safe surgical care across East, Central and Southern Africa.
By supporting locally led education systems and multidisciplinary collaboration, the programme aims to enhance quality standards and build sustainable capacity across the surgical pathway. Emphasis is placed on rural and decentralised training, enabling partners to expand access to safe surgery and anaesthesia for underserved populations.
Across Sub-Saharan Africa, an estimated 93% of people still lack timely access to safe, essential surgical care, driven in large part by a severe shortage of trained surgical providers. Addressing this gap requires sustained, locally led training systems that grow and retain the specialist workforce.
Since 2007, RCSI – supported by Irish Aid – has partnered with the College of Surgeons of East, Central and Southern Africa (COSECSA) to build long-term capacity in surgical education, training and examinations. The programme supports COSECSA to expand and sustain the training of competent surgeons. expand accredited training sites and enhance standards of care regionally.
The impact is substantial and measurable. With RCSI’s support, COSECSA has become the largest single contributor to the surgical workforce in East, Central and Southern Africa, with 1,350 trainees currently enrolled across 15 member countries (and accredited training sites in additional African countries). As of December 2025, 1,183 surgeons have graduated, strengthening surgical services and improving access to lifesaving and disability-preventing care for millions of people.
The long-term partnership between RCSI and COSECSA and its impact on surgical training in the region has recently been described in the World Journal of Surgery, highlighting both the challenges and solutions involved in sustaining impactful global health collaboration.
Since 2021, the Collaboration Programme has broadened its scope to support the wider multidisciplinary surgical workforce. This evolution reflects a systems-based approach to advancing safe surgery and anaesthesia.
Alongside its long-standing partnership with COSECSA, RCSI collaborates with:
- College of Anaesthesiologists of East, Central and Southern Africa (CANECSA)
- East, Central and Southern African College of Obstetrics and Gynaecology (ECSACOG)
- East, Central and Southern African College of Nursing and Midwifery (ECSACONM)
These regional partnerships are delivered in cooperation with Irish professional bodies, including the College of Anaesthesiologists of Ireland, the Royal College of Physicians of Ireland (RCPI) and the Faculty of Nursing and Midwifery at RCSI University of Medicine and Health Sciences.
Together, partners co-develop initiatives that align training across disciplines and strengthen the full surgical pathway.
The RCSI/COSECSA Collaboration Programme advances surgical systems through four interconnected pillars, developed jointly with regional colleges to ensure relevance, sustainability and local ownership.
Strengthening training quality and standard
Partners work together on curriculum development, examinations, accreditation and faculty development to maintain consistent standards across member countries. This includes examiner training, quality assurance mechanisms and expansion of accredited training sites.
Building digital systems for accountability and growth
Digital tools are co-designed to support training oversight and workforce planning. This includes the continued enhancement of the COSECSA eLogbook, the development of an offline mobile logbook for low-connectivity settings, and the creation of a dedicated digital logbook with CANECSA to strengthen anaesthesia training oversight.
Expanding multidisciplinary surgical education
The programme supports coordinated development across the surgical pathway. This includes strengthening anaesthesia training systems with CANECSA, collaborative specialist development with ECSACOG, and nursing workforce development through the Perioperative Nursing E-Learning Foundational Programme (PeN) with ECSACONM.
Ensuring long-term institutional sustainability
Regional colleges are supported to strengthen governance, financial sustainability, research capacity and strategic planning, ensuring that workforce growth is matched by institutional resilience and leadership.
The COSECSA eLogbook provides real-time insight into surgical training activity across member countries. It supports quality assurance, competency monitoring and workforce planning, ensuring that trainees meet required procedural thresholds while generating valuable regional data.
In 2025, 801 COSECSA trainees logged a total of 115,188 surgical procedures in the logbook. The predominant patient age groups were 19-39 and 40-64 years.
The majority of procedures were elective rather than emergency in nature. General surgery accounted for the largest proportion of logged cases, followed by orthopaedic surgery and plastic surgery.
| Specialty | % of total | Top three operations per specialty |
| General Surgery | 35% |
– Exploratory laparotomy |
| Orthopaedic Surgery | 21% | – Diaphyseal femur fracture intramedullary nailing – Diaphyseal tibial fracture intramedullary nailing – Ankle fracture/dislocation ORIF |
| Plastic Surgery | 11% | – Skin graft – Primary repair unilateral cleft lip – Wound-debridement/haematoma/delayed closure |
| Neurosurgery | 10% | – Burr hole or craniectomy for subdural collection – Insertion of ventriculoperitoneal shunt – Craniotomy for extradural haematoma |
| Urology | 10% | – Transurethral prostatectomy – Urethroplasty – Open prostatectomy |
| Paediatric Surgery | 9% | – Inguinal hernia repair – Umbilical hernia repair – Formation of colostomy/ileostomy |
| Otorhinolaryngology | 2% | – Adenotonsillectomy – Tonsillectomy – Open tracheostomy |
| Cardiothoracic Surgery | 1% | – Oesophageal reconstruction incl. interposition – Decortication for empyema – Feeding jejunostomy or gastrostomy |
Considerable geographic variation was observed in procedure volume. Kenya and Uganda collectively accounted for approximately 50% of all logged operations, while Namibia, Botswana, the Democratic Republic of Congo, Burundi, and Ethiopia together represented fewer than 10% of the total caseload.
There is a widespread perception that low and middle-income countries lose their most skilled health professionals through 'brain drain'. Evidence from the region tells a different story. Research shows that 93% of surgeons trained in East, Central and Southern Africa remain working within the region, demonstrating the strength of locally led specialist training models.
COSECSA-trained surgeons perform an average of 300 to 400 major operations annually. With approximately 140 new graduates each year, this equates to an estimated additional 50,000 major surgical procedures added to regional capacity annually.
Cumulatively, workforce growth has generated sufficient specialist capacity to support approximately 400,000 operations per year, representing a transformative and lasting contribution to surgical services.
Many graduates go on to serve as trainers, examiners and mentors, further strengthening national training systems and ensuring continued sustainable expansion.
Retention within the region was further confirmed in 2024 in a peer-reviewed study published in the World Journal of Surgery. The study provides independent evidence of high regional retention and reinforces the value of investment in regional specialist training.
The Government of Ireland has provided sustained support to the RCSI/COSECSA Collaboration Programme since 2008, enabling long-term investment in specialist surgical training across African countries.
Learn more about Irish Aid here.
Publications
The team
The RCSI/COSECSA Collaboration Programme works through a large and diverse team of collaborators from RCSI and other institutions. Key Irish institutional partners are the College of Anaesthesiologists of Ireland and Institute of Obstetricians and Gynaecologists in the Royal College of Physicians of Ireland.
The important contributions of the RCSI Department of Surgical Affairs and Faculty of Nursing and Midwifery must be acknowledged.
RCSI/COSECSA Collaboration Programme management and leadership includes:
- James Geraghty (RCSI Co-Chair of the Steering Committee)
- Lucia Brocato (Programme Manager)
- Lawa Shaban (Research Assistant)