Methods

Project Design - Training and Evaluation 

Two different training models are currently being evaluated:

1. In Zambia, The Chainama College of Health Sciences (CCHS) and the Surgical Society of Zambia (SSZ) have jointly overseen an enhanced surgical training programme building on the existing Medical Licentiate programme delivered to the 2009, 2010 and 2011 ML cohorts. This additional training took place over a 3 month period either before Medical Licentiates/Clinical Officers were allocated to their internship hospital for 12 months or while they were practicing their internships. COST-Africa is committed to supporting the delivery of a BSc training programme in surgery to Medical Licentiates/Clinical Officers in Zambia, that has been already approved by the Health Professions Council and other national stakeholders. 
2. In Malawi, surgeons at The College of Medicine has overseen a programme of blended training for Clinical Officers, combining short periods of training at central hospitals with district hospital in-service training. COST-Africa is committed to supporting the delivery of a BSc training programme in surgery to Clinical Officers in Malawi.
   

 
A cluster randomized controlled trial is being used to evaluate the health impact (ie. increased numbers of major surgical cases such as hernia repairs) as a result of the surgical intervention, with district hospitals in both countries randomly allocated to intervention and control arms. This is being led by the team form the Royal College of Surgeons in Ireland (Coordinator). An economic evaluation is currently being conducted by the Radboud University Nijmegen to measure the cost per DALY averted.