College of Anaesthesiologists of East, Central and Southern Africa (CANECSA)

Five billion people lack access to safe, timely, affordable surgical care[1]. This causes immense suffering, with conditions requiring surgical care causing 17 million - or one in three - deaths per year worldwide. Through World Health Assembly Resolution 68.15 the world has defined access to surgical care as an “indivisible, indispensable part of health care.”[2] To achieve the goal of surgical care for all, investments in infrastructure, systems and materials will be required, along with a substantial expansion of the surgical care workforce.

In the East, Central and Southern African region surgical training has scaled rapidly since the turn of the century, under the stewardship of the College of Surgeons of East Central and Southern Africa (COSECSA), led by strong local leadership and supported by long-term international partnerships, in particular the Royal College of Surgeons in Ireland. It is reasonable to say that anaesthesia training in East, Central and Southern Africa has lagged behind surgical training. The shortage of safe anaesthesia providers is arguably now a greater barrier to the provision of safe surgery in East, Central and Southern Africa than is the critical shortage of surgeons.

It is in this context that the College (along with other partners including the College of Surgeons of Ireland, Association of Anaesthetists and World Federation of Societies of Anaesthesiologists) were approached and requested to provide assistance with the development of the College of Anaesthesiologists of East, Central and Southern Africa (CANECSA).  The CANECSA constituent countries Kenyan, Malawi, Mozambique, Rwanda, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe.  It is estimated that the population of these countries is approximately 231 million and the number of physician anaesthesiologists servicing this population is estimated at 567[3]

The Lancet Commission Global Surgery 2030 recommended that the surgical workforce (including anaesthesiologists, surgeons and obstetricians) should meet a target of 20 specialist physicians per 100,000 population.  For the entire CANECSA region, there are only 0.25 physician anaesthesiologists per 100,000 which means that there will need to be a significant change in order to meet this target.  Whilst most of the constituent countries do have existing training programmes, the existing number of trainees will do little to address this significant workforce issue. 

Addressing this workforce defect is clearly a long-term project and we are committed to work in partnership with CANECSA and other organisations in the long term.  In order to plan and prioritise work areas, a delegation from the UK and Ireland attended a meeting in Arusha, Tanzania with representatives from all constituent countries.  The meeting was very engaging and productive and we left with a plan of action.

The College is contributing to the development of a CANECSA curriculum, which will be adopted for use within each constituent country.  We need to be mindful to ensure that competencies stipulated are deliverable in each country, where health systems differ significantly.  Alongside this, we are contributing towards the CANECSA Examinations and Credentials Committee who are currently developing syllabus for member and fellowship examinations.  We will then be looking at developing an examination question bank, and we hope to run the first MCQ examinations in September 2020, followed by a viva exam in December 2020.

This is a significant project, which encompasses the aims and objectives of the Global Partnerships Strategy and we look forward to updating you as the programme progresses.

[1] Meara, J. G., Leather, A. J. M., Hagander, et al.  (2015). Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. The Lancet, 386(9993), 569–624. https://doi.org/10.1016/S0140-6736(15)60160-X

[2] WHA resolution 68.15

[3] World Anaesthesiology Workforce Map https://www.wfsahq.org/workforce-map