Increasing and Retaining African Surgeons Working in Rural Hospitals: An Analysis of PAACS Surgeons with Twenty-Year Program Follow-Up
African surgical workforce needs are significant, with largest disparities existing in rural settings. Pan-African Academy of Christian Surgeons (PAACS), a primarily rural-based general surgery training program, has published successes in producing rural African surgeons; however, long-term follow-up data are unreported. The goal of our study was to define characteristics of PAACS alumni surgeons working in rural hospitals, documenting successes and illuminating strategies for trainee recruitment and retention.
PAACS’ twenty-year surgery residency database was reviewed for 12 programs throughout Africa regarding trainee demographics and graduate outcomes. Characteristics of PAACS’ graduate surgeons were further analyzed with a 42-question survey.
Among active PAACS graduates, 100% practice in Africa and 79% within their home country. PAACS graduates had 51% short-term and 35% long-term (beyond 5 years) rural retention rate (less than 50,000 population).
Our study shows that PAACS general surgery training program has a high retention rate of African surgeons in rural settings compared to all programs reported to date, highlighting a multifaceted, rural-focused approach that could be emulated by surgical training programs worldwide.
We appreciate PAACS and AIC Kijabe staff: Evelyn Mbugua, MD, Steve Doane, MD, Thomas Robey, MD and Carol Mwangi, acquiring data and performing survey. COSECSA data by Deirdre Mangaoang–RCSI/COSECSA Collaboration Program. Statistical support was made possible by James M. Scanlan, Providence Health and Services, USA and graphics from Kalie Wolfinger.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.PAACS: Our story. https://www.paacs.net/. Accessed 3 March 2018
- 4.Kodwavwala Y (2009) History of the association of surgeons of east Africa (ASEA) and the college of surgeons of east, central and southern Africa (COSECSA). http://www.cosecsa.org/sites/default/files/History%20of%20ASEA%20and%20COSECSA.pdf. Accessed 3 March 2018
- 5.What is COSECSA. http://www.cosecsa.org/. Accessed 3 March 2018
- 10.Smith D (2005) Barriers facing junior doctors in rural practice. Rural Remote Health 5:348Google Scholar
- 11.Bamighausen T, Bloom D (2011) Financial incentives for return of service in underserved areas: a systematic review. BMC Health Serv Res 4:617–625Google Scholar
- 17.United Nations population density and urbanization. https://unstats.un.org/unsd/demographic/sconcerns/densurb/densurbmethods.htm. Accessed 6 April 2018
- 18.USDA: Rural-urban commuting area codes. https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/. Accessed 6 April 2018
- 34.World Health Organization (2010) Increasing access to health workers in remote and rural areas through improved retention: global policy recommendations. http://www.who.int/hrh/retention/guidelines/en/. Accessed 3 March 2018
- 42.Rourke JT (1993) Politics of rural health care: recruitment and retention of physicians. CMAJ 148:1281–1284Google Scholar
- 45.Freitas D, Munthali J, Musowoya J et al (2017) Surgical registrars’ perceptions of surgical training and capacity in Zambia: results from three COSECSA affiliated training hospitals. Am J Surg 17:30812–30817Google Scholar
- 47.Ajao OG, Alao OO, Ugwu BT et al (2014) Factors determining the results of the examination of the West African college of surgeons. J West Afr Coll Surg 4:1–26Google Scholar
- 49.The WACS College History. http://wacsconferencegambia2018.org/history/. Accessed 3 March 2018
- 50.The College of Surgeons: Colleges of Medicine of South Africa. https://www.cmsa.co.za/view_college.aspx?collegeid=24. Accessed 3 March 2018