Establishing surgical policies in East Africa: results of the Easi-Delphi project

Purpose In East Africa, demand for surgical services is high: 400 surgeons provide care to a population of more than 200 million people. Given the paucity of official surgical policies in the region and the need for systematic regional planning to improve the delivery of surgical services in East Africa, as a start, basic surgical priorities needed to be identified. Methods Thirty-one members of the Association of Surgeons of East Africa (ASEA) participated in a Delphi process. The first stage consisted of a survey of surgical issues in East Africa. The results of the survey were circulated to the participants who were then asked to generate statements in response to the question, “What actions will most reduce the burden of surgical disease in East Africa by 2010?” Seventy-nine statements were received; after combining similar statements, 60 were returned to the group, who then scored the desirability and feasibility of each statement. Lower-scoring items were discarded and the remaining 25 statements were returned to the participants for ranking. The 10 statements with the highest mean scores and least variance were identified. Results Five of the top 10 priorities identified were to (i) improve opportunities for continuing medical education for practicing surgeons, (ii) introduce more surgical skills workshops for medical students and clinical officers, (iii) involve COSECSA in surgical training as well as curriculum development and certification of surgeons, (iv) provide a feedback system by which medical students and surgical trainees may evaluate their teachers, and (v) recruit and train more nurses and anesthetists. Conclusion If adopted and implemented, these priorities may help the ASEA, African Ministries of Health, surgical educators, hospital administrators and individual surgeons to reduce the burden of surgical disease in East Africa by the year 2010.