Assessment of the impact of the new paediatric surgery unit and the COSECSA training programme at Mbarara Hospital, Uganda

Abstract

Background

This study aimed to assess the impact of a new pediatric surgical unit (PSU) established upcountry in a unique way in a govern­ment hospital with a non-governmental organization as the main stakeholder. The unit is run by one pediatric surgeon trained through COSECSA. It is the second PSU in the country. This PSU brought pediatric surgical services and training closer to the Mbarara community.

Methods

The study was conducted at Mbarara regional referral hospital (MRRH). It was a cross-sectional mixed design study. For the qual­itative arm, Key Informant interviews were done with the main stakeholders who established the PSU. Impact on training was assessed using a questionnaire to former postgraduate trainees (Alumni). Quantitative arm assessed number of surgeries by a historical audit of hospital operating room registers comparing volume of surgeries before and after the establishment of the unit.

Results

Six main stakeholders were interviewed and confirmed that collaborations between the Government and private partners are fea­sible and sustainable. The number of pediatric surgeries nearly tripled after the establishment of the pediatric surgical department. Patients no longer had to travel to the capital city to access services. A total 2,732 pediatric surgical operations were performed within the 8 years of our evaluation. Of these, 736 (26∙9%) was performed four years before the unit was established and 1,996 (73∙1%) were performed after PSU establishment.

Overall, alumni that rotated in Mbarara had higher ratings than those in Mulago PSU on all aspects of the rotation, that is teaching, theatre hand-on-experience, mentorship, and skills attained (p=0.0028).

Conclusions

The pediatric surgical unit has contributed significantly to patient care and postgraduate medical education in Mbarara. This kind of model is sustainable and can be replicated.