Scaling up Safe Surgery for District and Rural Populations in Africa (SURG-Africa) was a five-year implementation research project to improve access to safe and quality-assured surgical care for district and rural populations in Africa. Comprising three African and three European institutions, the project, led by RCSI’s Professor Ruairi Brugha has been awarded €6 million in research funding by the European Commission’s Horizon 2020 Programme. 

SURG-Africa has worked in Malawi, Zambia and Tanzania, under the guidance of the ministries of health (MoH) and in close consultation with key local stakeholders, such as professional associations and other groups supporting delivery of surgical services.

The SURG-Africa project was a supervision model based on the findings from an earlier study – COST-Africa – in Zambia and Malawi.


The objective was to build the capacity of district hospitals surgical teams through in-service training and mentoring delivered during periodic visits to surgically active hospitals and remote support of district staff according to their needs.

Based on the baseline study findings, the project has adapted the original model to the needs of each country with the aim to deliver country-specific models of effective and affordable district level supervision to inform country-wide scale-up. 

In-service training comprises the necessary skills and attitudes to deliver safe surgery, appropriate to the district level of care, including:

  • Clinical decision-making
  • Safe anaesthesia, peri and post-operative monitoring of surgical patients
  • Safe surgery for MoH-approved elective and common emergency conditions
  • Surgical team leadership and management skills

Evaluation methods include: 

  • Experimental studies to test innovative approaches for quality assuring services and referral systems
  • Quality of life outcome studies, comparing district and referral hospital outcomes for common elective surgical procedures
  • Cost-effectiveness analyses, again comparing district and referral hospital surgery 

The fully evaluated and costed models tested during the project have been presented to the MoH, in view to roll out an agreed surgical supervision/mentoring model country-wide. 

The RCSI team

The team is currently focused on analysing the project data and writing research outputs.