Scaling up Safe Surgery for District and Rural Populations in Africa (SURG-Africa) was a 4-year implementation research project to scale up safe accessible surgery for district and rural populations in Tanzania, Malawi and Zambia. There is a huge need to improve surgical services in rural Africa, where an estimated 95% of the population has no access to common general and life-saving emergency surgery.
SURG-Africa was testing a supervision model based on findings from an earlier EU FP7 funded study in Zambia and Malawi – COST-Africa 2011-16 (www.costafrica.eu). The model consists of in-service training and support to district hospital surgical teams through (a) periodic visits by surgical specialists to surgically active district hospitals; together with (b) mobile phone and online needs-based support of district surgical clinicians.
The overall aim of SURG-Africa was: to implement surgical systems, that deliver safe, affordable and sustainable essential surgical services to rural populations in LMICs. The specific objectives were:
1. Strengthen national surgical systems to scale to the national level, deliver – and monitor through a national surgical information system – emergency and common elective surgery in district hospitals in Tanzania, Malawi, Zambia.
2. Train surgeon specialists to supervise, mentor and provide surgical systems in-service training – comprising clinical, management and systems skills – to district hospital staff.
3. Design and implement research studies, including observational, intervention and community studies, costing studies and economic analyses, to compare processes, outcomes, patient experiences, costs, and cost-effectiveness of surgery between district and referral hospitals.
4. Design and implement participatory implementation research studies to identify and explore enablers and obstacles – at all levels, from community to national level – to accessing and delivering essential safe surgery at district hospitals.
5. Disseminate findings to national decision-makers and support them in making policy decisions, including assessing budget impacts and appraising options for making safe surgery accessible.
6. Disseminate findings to seven countries in East, Central and Southern Africa and support them in designing country-specific interventions for making safe surgery accessible.
In the participating countries, SURG-Africa worked under the guidance of the Ministries of Health in consultation with key local stakeholders such as professional associations and other groups supporting the delivery of surgical services. A high level of support and engagement by national ministries of health has been achieved in the first 18 months of the study.
