A cross‐sectional survey on surgeon retention in the COSECSA region after specialist training: Have things changed?

Abstract

BackgroundIncreasing surgical specialist workforce density in sub‐Saharan Africa is essential for improving access to surgical care. However, out‐migration creates a significant challenge to attaining provider targets. We aimed to determine the rates and trends of retention of surgeons in the College of Surgeons of East Central and Southern Africa (COSECSA) regions.MethodologyAn online, web‐based survey was distributed to COSECSA surgeons who graduated from 2004 to 2020. Current practice and migration patterns were visualized using descriptive analyses and logistic regression models.ResultsResponse rate was 48% (270/557). Most respondents trained as general surgeons and practiced in Ethiopia, Kenya, Zimbabwe, and Zambia. Majority practiced in public hospitals (74%), and were active in research (81%), teaching (84%) and leadership (55%). Overall country (85%), regional (92%) and Africa retention rates (99%) were high with 100% country retention in Rwanda, Botswana, Lesotho, and Namibia. Tanzania had the lowest retention (61%). Highest inter‐regional migration occurred from East to Southern Africa (26%), and continental out‐migration occurred from Zambia, Zimbabwe, and Kenya. On bivariate analysis, out‐migration from training country and region was associated working with a non‐governmental organization (p = 0.002 and 0.0003) or a specialized hospital (p = 0.046 and 0.011). A multiple regression model with type of institution and leadership was a poor fit (McFadden R2 = 0.055; p = 0.082).ConclusionRetention rates of surgeons trained by COSECSA in the region remain remarkably high. This can be taken as an indicator of success of the training model to increase surgical workforce density, however, contributory factors need to be qualitatively explored.

Retention of locally trained specialist surgeons in sub‐Saharan Africa

“…Discussions around the problems of health workforce brain drain and sustainable solutions for retention and reversal of the trend have been topical for decades. The report by Bekele et al 1 on retention of COSECSA trained surgeons is quite timely and informative, at a time of increasing focus on increasing access to safe, timely and quality surgical care in sub-Saharan Africa (SSA). Coming against the background of recent large migration of highly trained surgical workforce from SSA, their findings provide some encouragement and comfort.…”

“…Bekele et al 1 report that 50% of the retained surgeons practiced in urban capitals and only 8.5% at district hospitals. A previous report from Nigeria, a WACS region country, found that 74% of surgical trainees preferred to work in tertiary hospitals which are located in urban areas.…”

“…As emphasized by Bekele et al 1 investing in surgical training programs within Africa is crucial to expanding the surgical workforce on the continent. However, the numbers currently being trained is too small to significantly expand the workforce density to the recommended 20 specialist surgeons, anesthesiologists, and obstetricians (SAO)/100,000 population.…”