A. Costas1,2,4, J. Kreshak2,3,4, G. Ntakiyiruta4, P. Kyamanywa4, R. Riviello2,3,4 1Children’s Hospital Boston,Department Of Plastic Surgery,Boston, MA, USA 2Harvard School Of Medicine,Brookline, MA, USA 3Brigham And Women’s Hospital,Surgery,Boston, MA, USA 4National University Of Rwanda,Surgery,Kigali, NONE, Rwanda
Introduction: There is an estimated shortage of approximately 7.2 million health care workers worldwide, with critical shortages in sub-Saharan Africa. These shortages are largely due to lack of sufficient quality medical education programs, limited faculty and infrastructure, and difficulty retaining trained professionals. This deficit is particularly noticeable in surgery, which is often forgotten in global health discussions. Surgical missions, isolated trainings by surgical volunteers, and task shifting have played important roles as short-term solutions. However, these vertical programs are unable to fill the workforce gap in resource-limited countries. For these countries to sustainably manage the volume of their unmet surgical need, an emphasis needs to be placed on capacity building.
Methods: Instead of small-scale cooperative efforts between stand-alone academic institutions or isolated individuals, the Human Resources for Health (HRH) program was created in Rwanda in 2012 as a long term plan to increase the quality and quantity of health care professionals in the country. The HRH program is a seven-year partnership between the Rwandan Ministry of Health, the United States federal government, and a consortium of 23 US institutions (USI) dedicated to building sustainable health care capacity. USI faculty are recruited to work full-time for one year in Rwanda and are partnered directly with Rwandese colleagues. Since August 2012, 10 USI surgeons a year (including general, plastics, orthopedic and pediatric surgery) have been active participants in surgical clinical and didactic teaching, curriculum and residency program development, research support and trainee mentorship.
Results:The HRH program is unique in many ways but perhaps none more so than its attention to surgical education as a critical component of a thriving health care delivery system. The HRH faculty have been instrumental in the improvement of education practices including clinical bedside and operative teaching, establishing protected didactic time, regular educational lectures and conferences such as morbidity and mortality, and research mentoring. Greater appreciation has developed as well for surgery as a complex system and the importance of the many components needed to run a successful surgical program. HRH surgeons have thus assisted in the creation of separate specialty surgical services, streamlining operating room efficiency, procuring necessary and adequate instruments, providing teaching to ancillary staff, and highlighting the importance of having adequate radiology and pathology services.
Conclusion:The HRH Program surgical faculty, in partnership with their Rwandan colleagues, have provided formal surgical instruction and mentoring in Rwanda since 2012. In doing so, they are helping to improve the quality and capacity of the Rwandese surgical workforce so that it may comprehensively and sustainably meet the country’s future healthcare needs.