Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Irish-led research to bring safe surgery to rural populations in Africa

12 January 2017
Major new RCSI-led research programme awarded €6 million under European Commission's Horizon 2020 Programme

RCSI (Royal College of Surgeons in Ireland) is leading a major new research programme that will help bring life-saving surgery to neglected families and communities in Africa. The SURG-Africa consortium, led by RCSI, along with three African and two other European institutions, has been awarded €6 million in research funding by the European Commission's Horizon 2020 Programme.

SURG-Africa - Scaling up Safe Surgery for District and Rural Populations in Africa - will undertake research to underpin national programmes for the delivery of essential, elective and emergency surgery in Malawi, Zambia and Tanzania; countries with a combined population of 85 million. It will develop and evaluate models for enabling the scarce resource of qualified surgeons in Africa to meet the needs of those in rural areas, through supervising general medical doctors and non-physician clinicians to delivery emergency and basic elective surgery at district hospitals.

"Conditions managed by surgery, including emergencies in childbirth, are among the biggest causes of avoidable illness and death in Africa. However, more than 90 per cent of the population lack access to such care. Our project, which aims to scale up rural surgical services country-wide in Malawi, Zambia and Tanzania, is ambitious but feasible" says Professor Ruairi Brugha, Head of the Department of Epidemiology and Public Health Medicine at RCSI, the international coordinator of the project. "We already have strong links with ministries of health in these countries; and will work with national surgeons to support their ministries to develop models for making safe surgery available in rural areas in seven other African countries, potentially reaching 250 million people".

Professor Ruairi Brugha
Professor Ruairi Brugha, Head of the Department of Epidemiology and Public Health Medicine at RCSI and international coordinator of the SURG-Africa project 

At the heart of SURG-Africa is a multi-disciplinary programme of research that will implement and evaluate these new models. Surgeons will be trained to become mentors of non-physician clinicians, delivering in-service training and supervision through a combination of visits to district hospitals and IT (mainly mobile phone) remote-support. Training of district hospital clinicians, both clinical officers and general medical doctors, who are the cornerstone of surgery in rural areas in many African countries, will include surgical skills training, hospital management, professionalism and quality assurance processes. District hospital managers will be trained to be champions and enablers of essential surgical services.

SURG-Africa builds on COST-Africa (, an earlier project funded by the European Commission in Malawi and Zambia, led by Professor Brugha, which demonstrated the feasibility, cost-effectiveness and impact of training non-physician clinicians to deliver basic and emergency surgery in rural hospitals. It also builds on the platform of an eight-year Irish Aid-funded collaboration between RCSI and the College of Surgeons of East, Central and Southern Africa (COSECSA), which supports the education and training of surgical specialists within Africa. "Together, these global surgery initiatives epitomise RCSI's growing commitment to making essential surgical services available to some of the poorest people, world-wide", according to Professor Brugha.

SURG-Africa will conduct epidemiological and economic studies to demonstrate the health outcomes and cost-effectiveness of the new supervision and hospital management models. It will also support ministries of health to put in place and evaluate national surgical information systems to collect surgical data in an affordable manner. Lack of reliable health data is one of the main obstacles to assessing and responding to the healthcare needs of the population in the region.

"Underpinning these studies will be a participatory, implementation research component, from community to national policy level", according to Professor Brugha. "This will identify the enablers and obstacles to delivering safe surgery, ensuring the four-year research programme results in sustainable, ministry of health-led models for making safe surgical services accessible in Africa, especially for rural women who need better access to emergency obstetrical surgery".

SURG-Africa has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 733391. COST-Africa was funded by the European Commission under its Seventh Research Framework Programme under grant agreement ECGA266417.

RCSI is ranked in the top 250 institutions worldwide and joint 1st place in the Republic of Ireland in the Times Higher Education World University Rankings (2016-2017). It is an international not-for-profit health sciences institution, with its headquarters in Dublin, focused on education and research to drive improvements in human health worldwide.