Lessons from developing, implementing and sustaining a participatory partnership for children’s surgical care in Tanzania

Abstract

Global surgery is an essential component of Universal Health Coverage. Surgical conditions account for almost one-third of the global burden of disease, with the majority of patients living in low-income and middle-income countries (LMICs). Children account for more than half of the global population; however, in many LMIC settings they have poor access to surgical care due to a lack of workforce and health system infrastructure to match the need for children’s surgery. Surgical providers from high-income countries volunteer to visit LMICs and partner with the local providers to deliver surgical care and trainings to improve outcomes. However, some of these altruistic efforts fail. We aim to share our experience on developing, implementing and sustaining a partnership in global children’s surgery in Tanzania. The use of participatory methods facilitated a successful 17-yearlong partnership, ensured a non-hierarchical environment and encouraged an understanding of the context, local needs, available resources and hospital capacity, including budget constraints, when codesigning solutions. We believe that participatory approaches are feasible and valuable in developing, implementing and sustaining global partnerships for children’s surgery in LMICs.

Global health is more than just ‘Public Health Somewhere Else’

“…6 7 There are examples of global health research and interventions where countries and communities have worked collaboratively and shared expertise, cultural knowledge and other resources to develop appropriate and effective solutions. [8][9][10] Moreover, while global health is considered one of the multiple branches of public health, the literature does suggest there are differences among them. 11 For example, global health tends to have a broader focus (ie, health for all worldwide), a greater emphasis on health inequities, more interdisciplinarity 2 and more 'bridging' between cultures and communities.…”

The start-up phase of a non-specialist paediatric surgical service by outreach focused on capacity building at the Consolata Hospital Ikonda, Makete District, Tanzania

“…Although an academic paediatric surgical curriculum and training started in Tanzania since 2002 supported by international academic partnerships to fill the gap through various modalities (short courses, informal training for medical students, formal master-level training), 4 , 5 the country has still a small paediatric surgical workforce. It was estimated to be, in 2019, only 12 surgeons working in two tertiary centres for a population of about 22 million under 15 years old.…”

“…Most paediatric cases risk so far falling under the coverage of general surgeons not exposed to paediatric surgery as a specialist field during their undergraduate training and internship. 4 They may be not always prepared to recognise that most of the paediatric diseases that they observe and treat are specific to this age group and pose quite separate problems of management. The quality of care may be severely affected.…”

“…1 If paediatric surgery is a wellrecognised speciality in high-income countries (HICs) and specific standards and professional skills have been defined, 2 the number of specialists in low-income countries (LICs) is still far to meet the needs. 3 Although an academic paediatric surgical curriculum and training started in Tanzania since 2002 supported by international academic partnerships to fill the gap through various modalities (short courses, informal training for medical students, formal master-level training), 4,5 the country has still a small paediatric surgical workforce. It was estimated to be, in 2019, only 12 surgeons working in two tertiary centres for a population of about 22 million under 15 years old.…”

“…3 Most paediatric cases risk so far falling under the coverage of general surgeons not exposed to paediatric surgery as a specialist field during their undergraduate training and internship. 4 They may be not always prepared to recognise that most of the paediatric diseases that they observe Background: The need for paediatric surgeons in Tanzania is largely unmet. Twelve in two main urban centres (0.06 for 100 000 population under 15 years of age) are far lower than the recommended workforce size.…”