COLLEGE OF SURGEONS OF EAST, CENTRAL AND SOUTHERN AFRICA STRATEGIC PLAN 2021-2025

COSECSA SECRETARIAT ARUSHA, TANZANIA COSECSA.ORG OCTOBER 2020 COLLEGE OF SURGEONS CENTRAL OF EAST, AND SOUTHERN AFRICA CONTACT DETAILS LIST OF ACRONYMS DEFINITION OF TERMS The College of Surgeons of East, COSECSA – College of Surgeons of the “The Council” means the Council of the Central and Southern Africa (COSECSA) East, Central and Southern Africa college of surgeons of East, Central and 157 Olorien, Southern Africa as established under CPD – Continuous Professional Njiro Road ECSA-HC Chapter 3 Article 6 of the Constitution Development P.O. Box 1009 “Fellow” – A Fellow of the College of Arusha, Tanzania. CRs – Country Representatives surgeons of East Central and Southern Tel: +255 27 254 9362 ECC – Examination and Credentials Africa, who may be a Foundation Fellow, +255 27 254 9365 Committee Ordinary Fellow or Honorary Fellow. Fax: +255 27 254 9324 ECSA – East, Central and South African “Member States” – means Botswana, +255 72 254 9392 Burundi, Ethiopia, Kenya, Malawi, ESRC – Education, Scientific and Research Email: [email protected] Mozambique, Namibia, Rwanda, the Committee Web: www.cosecsa.org United Republic of Tanzania, the Republics FCS – Fellowship of the College of of Zambia, Zimbabwe, South Sudan, Twitter: @cosecsa Surgeons Sudan, Uganda and any other country LinkedIn: https://www.linkedin.com/ granted membership to the existing school/cosecsa/ ICT – Information, Communication Technology Community; Facebook: https://www.facebook.com/ “Member” – A Member of the College COSECSA-1476132912684891/ KPIs – Key Performance Indicators is a Medical Practitioner who has LMIC – Lower-and Middle-Income satisfactorily completed their Basic countries Surgical Training and has passed the MCS – Membership of the College of prescribed College of Surgeons of East Surgeons Central and Southern Africa Membership exam NSOAP – National Surgical Obstetric and Anaesthesia Plans “Non-surgeon” – means health professionals such as a physician, general RCSI – Royal College of Surgeons Ireland practitioner (GP), diagnostician or nurse SAO – Surgical, Anaesthesia, Obstetric that carry out non-surgical procedures. SDGs – Sustainable Development Goals “Region” – means the area of Africa North and South of the Equator falling TORs – Terms of Reference under the East, Central and Southern TOTs – Training of Trainers Africa. TWG – Technical Working Group “Secretariat” – means the Secretariat as established underChapter 3 Article 3 of YoY – Year-Over-Year the Constitution “Surgical Professional” – is an individual who has attained a technical surgical qualification and has been accredited

THANK YOU Photographer: Niraj Bachheta To the teams at Tenwek Hosptial and Moi Teaching and Referral Hospital, Kenya College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

Message from the President 04 COSECSA PLAN 21 Foreword from the CEO 05 Strategic Plan and Implementation COSECSA Council 2020 06 Framework 21 Executive Summary 09 Strategic Plan Background 21 Strategic Plan Context 22 OUR ORGANISATION 10 Specific Objectives 22 Background 10 Goals, Strategies & Core Activities 24 Mission, Vision and Core Values 12 Organisational structure 13 Log Frame of Implementation Strategy 00 COSECSA existing training and examination structures 14 MONITORING 42 COSECSA ANALYSIS 16 Monitoring and Evaluation Framework 42 Situational Analysis 16 Critical success factors 42 COSECSA trend of graduates by Risk Factors 42 country and speciality (2016-2019) 17 Evaluation and Reporting 43 SWOT Analysis 18 Mid-term review and lessons learnt 43 Stakeholder Analysis 19 CONCLUSION 45

ANNEXES 46 Annex i: Monitoring & Evaluation framework for implementation of COSECSA Implementation Policy and Strategy 46 Annex ii: Gantt Chart 47

3 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

MESSAGE from the PRESIDENT ~ Professor Godfrey Muguti ~ ...A BOLD PLAN THAT SEEKS TO STRENGTHEN THE COLLEGE AND MAKE IT AN ALL-ENCOMPASSING SURGICAL INSTITUTION...

As President of COSECSA, I am very pleased to present the Strategic Plan for 2021-2025. Last year marked 20 years of the existence of COSECSA and as this plan will take us into the year when we celebrate our Silver Jubilee, it is a bold plan that seeks to strengthen the College and make it an all-encompassing surgical institution. Above all, our vision is to position COSECSA as a world class surgical professional training organisation with excellent training, standards and research, in the sub-Saharan region and beyond.xcellent training, standards and research, in the sub-Saharan region and beyond.

From its inception, COSECSA has been focused on quality surgical care and practice and is Professor Godfrey Muguti committed to building and strengthening quality surgical care for all patients regardless of their President, COSECSA status. Access to quality surgical care is a vital component of universal health coverage and an effective means of realizing many of the United Nations (UN) Sustainable Development Goals (SDGs). As such, COSECSA would like to build on the gains of the previous years by focusing on three major Strategic Goals; (i) Achieve Excellence in Training and Research and Maintain Best Practice in Examinations and Assessment, (ii) Quality in surgical care and (iii) Build Organizational Excellence and Financial Sustainability.

The COVID -19 pandemic has presented the biggest challenge to the delivery of surgical services across the globe in our times. In response to this pandemic, COSECSA in conjunction with some of its collaborating Partners has been at the forefront in providing guidance to the surgical fraternity through publications and webinars. Our understanding of the impact of COVID-19 on the surgical ecosystem in Sub-Saharan Africa will be enhanced by a number of research projects currently underway in the COSECSA region. The College will continue to monitor how the pandemic unfolds in Sub-Saharan Africa and adapt its operations accordingly.

As a “College without Walls” we also need to ensure that we use our resources in the most effective manner possible. COSECSA looks forward to working collaboratively and in partnership with national governments, like-minded institutions and partners who share our vision.

I take this opportunity to thank the Royal College of Surgeons in Ireland (RCSI) who have supported the development of this document and whom we continue to work in collaboration with.

Respectfully Submitted, Professor Godfrey Muguti President, COSECSA

4 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

FOREWORD from the COO ~ Ms. Stella Itungu ~ ...TO REASSERT OUR VISION AND TO SET FUTURE GOALS...

I am delighted to present to you the COSECSA STRATEGIC PLAN 2021–2025, which outlines the strategic goals and initiatives identified in order to realize the full potential of the College and better fulfil its mission of promoting excellence in Surgical Care, Training and Research in the East, Central and Southern Africa community and beyond.

The process of formulating a new Strategic Plan has given us the opportunities to take stock on past successes and challenges, to reassert our vision and to set future goals in the light of challenges ahead. It has also allowed us to draw development strategies for our institution not only in response to the changing needs, but also as a dynamic institution geared towards Ms. Stella Itungu fostering Quality Surgical Care. Chief Operating Officer, In implementing its strategic objectives, COSECSA will attain sustainable excellence in Training COSECSA and Research, Examination as well as Organizational Excellence and Financial Sustainability.

The Strategic Plan represents the concerted efforts of COSECSA stakeholders, whose valuable input has been incorporated in this document. Let me take this opportunity to thank all of them for their efforts during the consultation process. I would like to thank, in particular, the Council for approving the Strategic Plan and taking up the responsibility for overseeing and monitoring its implementation.

Sincerely, Ms. Stella Itungu Chief Operating Officer, COSECSA

5 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

COSECSA COUNCIL 2020 ~

Prof Godfrey Muguti Dr Jane Fualal Prof Eric Borgstein Prof Laston Chikoya Prof Krikor Erzingatsian President Vice President Secretary General Ass. Secretary General Registrar

Prof Pankaj Jani Prof Abebe Bekele Dr Wakisa Mulwafu Prof Russell White Dr Kitugi Samwel Nungu Immediate Past Chair Education, Chair Finance and Chair Education, Treasurer President (ex-officio) Examinations and General-Purpose Scientific and Research Credentials Committee Committee Committee

Prof Gabriel Ndayisaba Dr Vénérand Barendegere Dr Hanna Getachew Dr Dereje Gulilat Dr Mathenge Nduhiu CR Burundi CR Burundi CR Ethiopia CR Ethiopia CR Kenya

Dr Michael Mwachiro Dr Carlos Gomes Varela Dr Tiyamike Chilunjika Dr Sergio Salvador Dr Vanda Amado CR Kenya CR Malawi CR Malawi CR Mozambique CR Mozambique

6 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

COSECSA COUNCIL 2020 ~

Celestine B Mbangtang Dr Akutu Munyika Dr Georges Ntakiyiruta Dr Emmy Nkusi Dr Frederick Tawad CR Namibia CR Namibia CR Rwanda CR Rwanda CR South Sudan

Prof Mayen Achiek Dr Paul Kisanga Dr Paul Marealle Dr Johashaphat Jombwe Dr Joel Kiryabwire CR South Sudan CR Tanzania CR Tanzania (RIP) CR Uganda CR Uganda

Dr Michael Mbambiko Dr Seke Kazuma Dr Kuseweni Nduku Dr Bothwell Prof. Sherry M Wren CR Zambia CR Zambia CR Zimbabwe Mbuwayesango Overseas Rep CR Zimbabwe

Steve Mannion Overseas Rep

7 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

~ TO PROMOTE EXCELLENCE IN SURGICAL CARE, TRAINING AND RESEARCH

8 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

EXECUTIVE SUMMARY ~ COSECSA HAS 125 ACCREDITED HOSPITALS IN 14 MEMBER-COUNTRIES AND 303 COSECSA ACCREDITED TRAINERS DISTRIBUTED ACROSS THE REGION, PROVIDING ACCESS TO TRAINING IN URBAN AND RURAL LOCATIONS.

The College of Surgeons of East, and Partnership; Institutional Agility skills development for practicing surgeons Central and Southern Africa (COSECSA), and Entrepreneurism; Stewardship and and other health professionals involved in incorporating the Association of Surgeons Service; Accountability; Gender Equity; surgical care in the region for sustainable of East Africa (ASEA), is a professional Credibility; and Professionalism. skills development in the surgical care body that fosters postgraduate education consistent with international standards. As part of the pursuit of the College’s in surgery and provides surgical training Vision, the College in collaboration COSECSA is dedicated to scaling throughout the East, Central and with other stakeholders focuses on up surgical services and care within Southern Africa region. The college quality surgical care and practice and is the ECSA region by increasing the was founded in 1999. It is a non-profit committed to building and strengthening number of appropriately trained, well making body that currently operates in quality surgical care for the neglected qualified surgeons and supporting 14 Countries in the sub-Saharan region: patient. This is with a view that Access to the development of the anaesthesia, Burundi, Botswana, Ethiopia, Kenya, quality surgical care is a vital component perioperative nursing and obstetrics Malawi, Mozambique, Namibia, Rwanda, of universal health and an effective way of workforces. Where appropriate to the Tanzania, Zambia, Zimbabwe, South realizing many of the United Nations (UN) national context, COSECSA will engage Sudan, Sudan and Uganda. Sustainable Development Goals (SDGs). with basic surgical training of non-surgeon The primary objectives of the College are cadres. COSECSA has also significantly In line with Sustainable Development to advance education, training, standards engaged the initiative of WiSA (Women Goal 4; Ensure inclusive and equitable of practice and research in surgical in Surgery Africa) as a sub-group which quality education and promote lifelong care in this region. COSECSA shapes offers support and mentorship in pursuing learning opportunities for all, COSECSA and leads the training, examination their surgical career. Due to the huge provides a comprehensive Membership and accreditation of surgeons in the burden of surgical disease, scaling up Programme in Basic Surgery and East, Central and Southern Africa basic surgical services is crucial to health Fellowship Programmes in Orthopaedics; (ECSA) region. The College delivers a system strengthening. 6.5% of the global Otorhinolaryngology; Urology; Paediatric common surgical training programme burden of disease is amenable to surgery. Surgery; Neurosurgery; Plastic Surgery; with a common examination and an To effectively meet healthcare needs, the General Surgery; Cardiothoracic Surgery; internationally recognised surgical existing surgical workforce would need to and Paediatric Orthopaedic Surgery. qualification. be doubled in the next 15 years. COSECSA has 124 accredited hospitals in The Vision of COSECSA is to be the COSECSA therefore, expects to graduate 12 member-countries and 303 COSECSA reference surgical body in the region an additional 800-1,000 surgeons by Accredited trainers distributed across of East, Central and Southern Africa 2025, which will bring the total number of the region, providing access to training and beyond, and the Mission is to graduates to over 1,500 with an estimated in urban and rural locations. COSESCA promote excellence in Surgical Care, budget of USD 6.4M in addition to the therefore, envisions a dynamic and Training and Research. COSECSA’s core developmental cost ($2.5M) of COSECSA professional Education and Training values are Transparency; Quality and Laki Laki Land situated in Arusha- Program consistent with global standards. Continuous Improvement; Learning Tanzania. This strategic plan also includes high- and Development; Institutional Integrity quality, lifelong learning and sustainable

9 COSECSA

College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

The COSECSA ORGANISATION ~ AS OF JUNE 2020, COSECSA HAS OVER 760 TRAINEES ENROLLED IN COSECSA TRAINING PROGRAMMES. THE COLLEGE IS PROUD TO HAVE GRADUATED OVER 450 SPECIALIST SURGEONS SINCE 2004.

BACKGROUND As has been documented, while there are COSECSA registered significant progress often shortfalls in equipment, supplies towards achieving the Goals, Strategies Following the resolution (10) at the 25th and hospital infrastructure, the number of and Core Activities of the 2016-2020 Regional Health Ministers Conference fully trained Surgeons, Anaesthesiologists Strategic Plan. Key achievements of the held in Mauritius in November 1996 and Obstetrician physician providers is the previous Strategic Plan include but are concrete steps were taken to set up the main driver for the volume of surgeries not limited to; College. At the subsequent 26th Regional performed1. Additional COSECSA Member Health Ministers Conference held again a. Countries in Mauritius in November 1997 resolution COSECSA has made significant strides 31 reconfirmed the decision to establish towards addressing the surgical workforce b. Increased number of specialist the College of Surgeons for the East, shortage in this region. This is highlighted surgeons successfully graduated and Central Africa (COSECA). This was by the exponential annual increase of c. Increased number of Accredited changed to COSECSA with inclusion of the number of trainees and graduates. Hospitals Southern a year later. As of June 2020, COSECSA has over 760 d. Increased number of Trainees, Trainers trainees enrolled in COSECSA training and Master Trainers There exists a global inequity in the programmes. The College is proud High rate of retention of surgeons in burden of surgical conditions and the e. to have graduated over 450 specialist Country of Training comparative access to surgical and surgeons since 2004. COSECSA is now anaesthetic care between high-income f. Increased number of female trainees the leading body in surgical training in countries and low-income countries. as well as Women Surgeons the region, producing more surgeons The Lancet Commission on Essential g. Additional online short course than the combined national university Surgery (2015) estimates that worldwide h. Numerous operations registered on training programmes. COSECSA’s 140 million people need an operation to the Surgical Electronic Logbook training programme is unique in that save their lives or to prevent long term Recognition of COSECSA Program in it is primarily undertaken in a trainee’s i. disability, but lack access to surgical care. the region country of origin. Locally led and delivered Over a million more are impoverished training improves surgeon retention, with because of the high cost of surgical approx. 90% of graduates remaining in treatment. In May 2015, health ministries the COSECSA region post-qualification. from across the world approved the first This is contrary to the prevailing myth that World Health Assembly (WHA) resolution there is a brain drain of surgeons from the proposed by Zambia on Surgical Care region2. and Anaesthesia - MOH/WHO/EB136. By doing so, WHO formally committed itself to scaling up surgical care and training. The aim being to improve patient outcome and seeks to improve the lives of some of the most vulnerable in society.

10 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

The core activities are embedded in COSECSA objectives Cognizant of the shortage of well-trained surgical health which are to; professionals in the region, challenges facing the surgical a. To promote the honour and dignity of the surgical and profession such as shortage of equipped clinical training allied health professions and to ensure that the highest sites in hospitals, multiple surgical training institutions ethical standards in the practice of surgery are maintained in the region with which COSECSA needs to cooperate throughout the region. and co-exist and the necessity to grow in the region b. To organize a common training program in recognised and beyond, COSECSA strategy is focused on training, institutions and to organise examinations of candidates for examination, sustainability and professional excellence. admission to the College in the various disciplines of Therein, the Strategy aims to serve as the major Strategic surgery; Instrument through which the COSECSA seeks to execute c. To promote and encourage postgraduate education and its mandate in a more focused, effective and results- research in surgery which is relevant to theregion; and oriented manner over the Planned period (2021 – 2025). d. To organise workshops, seminars, lectures, and conferences which regularly bring together Members and Fellows of the College to advance the science and practice of surgery in the region.

1. Albutt et al. BMC Health Services Research (2019) 19:104 https://doi.org/10.1186/ s12913-019-3920-9 2. Avril Hutch, Abebe Bekele, Eric O’Flynn, Andrew Ndonga, Sean Tierney Jane Fualal, Christopher Samkange, Krikor Erzingatsian. The Brain Drain Myth: Retention of Specialist Surgical Graduates in East, Central and Southern Africa, 1974–2013 World Journal of Surgery. DOI 10.1007/s00268-017-4307-x. Published online 16 October 2017

11 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

The COSECSA ORGANISATION ~

VISION CORE VALUES To be a leading surgical body in terms of training, standards The core principles to guide the College Education and Training and research, in our region and beyond. This Vision is focused program are: on positioning COSECSA as a world-class surgical training and a. Transparency; Managing and conducting trainings, research institution in the East, Central and Southern Africa and examinations and accreditation in an honest and utmost beyond. open manner. b. Accountability; Taking full responsibility of the decisions and MISSION actions for the overall probity of programmes and To promote excellence in surgical care, training and research in partnerships. order to increase accessibility of surgical services, especially to c. Quality and Continuous Improvement; COSECSA strives for African rural populations by standardizing and widening access quality in all it does and practices continuous improvement in to surgical training, skills and knowledge. all areas according to international best practice. d. Learning and Development; COSECSA is a trainee-centred institution that provides high quality educational training and research experiences. It is flexible and continuously embraces emerging trends. MISSION e. Institutional Integrity and Partnership; Demonstrates integrity based on honesty, fairness and respect, in all its dealings with its members and Partners. f. Institutional Agility and Entrepreneurism; Conducts business in a lean and cost-effective manner. g. Stewardship and Service; Demonstrates responsible stewardship of all its resources and reliable services in all its activities. h. Gender Equity: COSECSA promotes allocation of resources, programmes and decision making fairly to both men and VISION women without any discrimination and aims to address any VISION imbalances in its undertakings. i. Credibility: Constantly build and maintain trust in the COSECSA training programme. j. Professionalism: Strictly adhering to the code of conduct and standards.

12 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

The COSECSA ORGANISATION ~

STRUCTURE The Council is responsible for the overall supervision and organisation of the College. The Council is composed of the President, Vice-President, Secretary General, Assistant Secretary General, Treasurer, the three Chairs of the Standing Committees, Registrar, two Country Representatives elected from each member country, Overseas Fellows Representative, the Editor of the East and Central African Journal of Surgery (ECAJS) and the immediate Past President in the year following their presidency.

The Executive Committee (EC) manages the affairs of the College, is elected by Council and reports to and is accountable to Council. The EC is composed of the President, Vice-President, Secretary COUNCIL General, Assistant Secretary General, the three Chairs of the Standing Committees, Journal Editorial the Registrar and co-opted fellows Executive appointed by Council. Board

The standing committees are the Education, Scientific and Research Committee (ESRC), the Finance and Finance and Education, Exams and General Scientific General Purposes Committee (FGPC) Credentials COO Pupose and Research and the Examinations and Credentials Committee Committee Committee Committee (ECC).

The Secretariat manages the day-to-day affairs of the College under the leadership Secretariat Country Journal Staff of the Chief Operating Officer (COO) who Team Coordinators (remote) is appointed by Council and is answerable to Council through the Secretary General

An Annual General Meeting comprising the College Fellowship and Membership is convened annually. The Members consider any motions brought forward by Council or any individual Fellow

13 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

The COSECSA ORGANISATION ~

COSECSA EXISTING (i) Registrar: The role of the Registrar is to oversee College matters in respect to TRAINING AND Accreditation, Certification, Examiners, Examinations, Graduation and Scholarships. EXAMINATION (ii) Examination and Credentials Committee (ECC); This committee organizes STRUCTURES examinations and examines credentials of all candidates, deal with other academic matters such as reciprocal arrangements, recognition of hospitals, setting up of COSECSA already has an institutional panels, examiners, election of Fellows and Members. framework on which the regional training program is anchored. The framework (iii) Education, Scientific and Research Committee (ESRC); this committee meets creates the following bodies to carry out regularly to deal with education, training and research issues. This body is also training and examinations mandate; responsible for improving the course content based on the research done on the completed courses, the quality assurance for training at national level, and training oversight. (iv) Country Representatives (CRs): These form part of the Council and they handle and Coordinate all College activities at Member State level, each Member State has two CRs who are also COSECSA fellows. (v) Program Directors (PDs); COSECSA has established Program Directors at every COSECSA accredited facility/hospital. These ensure a smooth training programme at Member State level (vi) Country Coordinators: The College established Country Coordinators in all member states to coordinate and to ensure smooth running of the activities of the college as well as coordination and administration of examinations at the national level. (vii) Secretariat: The Secretariat, under the leadership of Chief Operating Officer (COO) manages the day-to-day affairs of the College. It provides regional Coordination and Administrative support of the entire COSECSA program aiming towards achieving the College objectives.

14 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

~ COSECSA HAS 125 ACCREDITED HOSPITALS IN 14 MEMBER-COUNTRIES

15 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

COSECSA ANALYSIS ~ TO BE A LEADING SURGICAL BODY IN TERMS OF TRAINING, STANDARDS AND RESEARCH, IN OUR REGION AND BEYOND.

SITUATIONAL ANALYSIS TABLE 1: Population Per Surgeon Key Statistics; Surgeons Per 100,000 The regional surgical workforce in the COUNTRY POPULATION SURGEONS RATIO SURGEONS past years has represented less than 4% PER 100,000 of the equivalent number in developed Burundi 10,395,931 19 547,154 0.18 countries indicating the magnitude of the surgical professional workforce challenge Ethiopia 96,633,458 337 286,746 0.35 to be addressed. Kenya 45,010,056 543 82,891 1.21 However, over the years, COSECSA with support from Collaboration Partners Malawi 17,377,468 41 423,841 0.24 (RCSI, Irish Aid, PAACS, ECSA-HC, Royal College of Surgeons of Edinburgh, Mozambique 24,692,144 57 433,196 0.23 CMSA, American College of Surgeons, Rwanda 12,337,138 49 251,778 0.40 Japanese Surgical Society, Safe Surgery, Smile Train, Re-Surge International, 2nd Tanzania 49,639,138 177 280,447 0.36 Chance and WACS) has played a major Uganda 35,918,915 259 138,683 0.72 role in addressing this challenge and has experienced significant growth in Zambia 14,638,505 85 172,218 0.58 surgical care. Zimbabwe 13,771,721 123 111,965 0.89 These tables provide trend of trainees that have engaged and graduated in TOTAL 320,414,474 1690 various COSECSA Programmes ultimately Regional population ratio 189,594 increasing the numbers of well trained Surgeons and qualified surgeons in the region. Regional This move has also increased the number per 100,000 population 0.53 surgeons of COSECSA accredited hospitals that advance the objective of COSECSA at Source; (World Journal of Surgery, 2016) Member States level. These efforts have gradually increased the total number of surgeons as of 2019.

16 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

COSECSA TREND OF GRADUATES BY COUNTRY AND SPECIALITY (2016-2019)

TABLE 2: Cosecsa Graduates By Country (2016-2019)

COUNTRY 2016 2017 2018 2019 TOTAL 291

Burundi - 1 - 2 3

Cameroon 1 3 1 4 9

Ethiopia 2 9 18 27 56

Gabon 3 - 1 4 8

Kenya 21 13 16 21 71

Madagascar - - 1 - 1

Malawi 3 - 7 9 19 TABLE 3: Trend of Cosecsa Graduates Mozambique 1 3 - 1 5 (2016-2019)

Niger - - 1 1 2 102

Rwanda 3 6 10 5 24 85

Tanzania 1 1 7 10 19 55 49 Uganda 3 4 4 8 19

Zambia 6 3 11 4 24

Zimbabwe 5 12 8 6 31 2016 2017 2018 2019

TOTAL 49 55 85 102

TABLE 4: Cosecsa Graduates By Country (2016-2019)

COUNTRY 2016 2017 2018 2019 TOTAL 291

Cardiothoracic - - - 1 1

General Surgery 27 19 27 42 115

Neurosurgery 1 5 10 2 18

Otorhinolaryngology - - 3 2 5

Orthopaedic Surgery 12 14 24 32 82

Paediatric Surgery 3 4 4 6 17

Paediatric Orthopaedic 1 2 6 4 13

Plastic Surgery 1 6 6 6 19

Urologic Surgery 4 5 4 8 21

TOTAL 49 55 85 102

17 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

COSECSA ANALYSIS ~

SWOT ANALYSIS Surgical care has the potential to make a significant contribution to the health sector and social welfare in the region. COSECSA`s objective is to enhance surgical care in the region and in the process address the existing challenges in the region. However, in the development and implementation of the Education and Training program a number of strengths exist which can be exploited while a number of weaknesses can give rise to challenges. There are also opportunities and threats. These are summarized below

TABLE 5: Swot Analysis

STRENGTHS WEAKNESSES • Common language: English is commonly used in the region. • Skills gap especially technological, financial analytics and • Similarities in culture: There are many communities along inadequate number of qualified and experienced common borders who share the same cultures. professionals • Large/Young population: The average age is still low and • Lack of awareness leads to low penetration levels. productivity for this group is high. • Lack of funds to implement the activities of COSECSA • Goodwill from the Professionals: A significant number are • Lack of trust with surgical care providers (poor history of inclined towards increasing surgical care in their surgery). respective countries. • Lack of unified legislation • Low staffing levels THREATS • Lack of specialised equipment • Low income levels: most of the populace is either • Inadequate funding: currently, surgical training is financed by unemployed or earning low incomes to afford the surgical individuals, and in some cases by employers care costs. • Limited incentives to attract surgical professionals • Low surgical professional penetration rate is a challenge • Lack of national surgical care policies in some Member States • Reliance on informal surgical care providers • Lack of training; there exist skills gap in the surgical OPPORTUNITIES care in the region. As a result, there is need for affordable • Low level of penetration gives massive opportunities for and flexible in training delivery methods growth • Lack of drugs required to conduct a successful operation • Support from Partners in enhancing capacity and creating • Inability to raise funds to equip the existing hospitals demand for professional services • Poor state of health facilities and equipment. There is • Strong COSECSA programme coordination limited training infrastructure in the region and most Member States do not have adequate professional surgical • Limited numbers of institutions which offer surgical trainers specialization provides room for COSECSA • Poor geographical access • Potential for enrolment of a large student population into • Governments in the region do not have Continuous education and training programs Professional Development (CPD) programmes • Information communication and technology advancements • Although face to face training methodology exists in the • Existing efforts of COSECSA region, the most preferred methodology is a mixture of face • Dedicated Professionals via Associations, Members and to face and E-Learning Fellows • COSECSA Governance Structures

18 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

COSECSA ANALYSIS ~

STAKEHOLDER MINISTRIES OF HEALTH ASSOCIATIONS ANALYSIS • Liaison between the various • Supervise adherence to Codes of government organs to implement Conduct (self-regulation). In order for the Training Program to be policy directives. successfully implemented; the following • Register Members to associations key stakeholders were identified: • In charge of compliance. • Marketing the Program • Advisory role. a. COSECSA Secretariat • Curriculum review • Licensing of different players. b. Member States • Awareness • Public awareness. c. Academic Institutions • Supervision of the surgical care TRAINEES d. Ministries of Health sector. • Students available for training. Trainers e. • Provide funds for the program • Observing codes & regulations. f. Private Clinics sustainability. GENERAL PUBLIC g. Trainees • Provide and offer financial support • Embrace Surgical Care culture. h. General Public ACADEMIC INSTITUTIONS AND • Awareness i. Collaboration Partners TRAINERS • Offer appropriate basic training on COLLABORATION PARTNERS COSECSA SECRETARIAT Surgery • Provide technical support • Spearhead implementation of the • Support COSECSA with curriculum • Provide funding program. development and review • Collaboration with the COSECSA. • General oversight of the Program • Quality assurance (fund-raising, coordination, • Marketing the Program administration, etc) • In liaison with COSECSA provide a • Implementation of policies. pool of examiners • Quality assurance. PUBLIC AND PRIVATE HOSPITALS/ • Promoting the Program CLINICS • Offer employment opportunities MEMBER STATES • Provide trainers and trainees • Enactment and enforcement of relevant laws to operationalize the • Provide financial support to their policies professional staff • Creation of enabling environment • Membership and technical support to the surgical association bodies. • Infrastructural support. • Develop new products and relate them • Offer funding. to emerging trends. • Legislation which promotes the • Awareness uptake of surgical care.

19 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

~ OUR STRATEGY IS FOCUSED ON TRAINING, EXAMINATION, SUSTAINABILITY, AND PROFESSIONAL EXCELLENCE.

20 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

COSECSA PLAN ~ TO PROMOTE EXCELLENCE IN SURGICAL CARE, TRAINING AND RESEARCH

STRATEGIC PLAN AND STRATEGIC PLAN We asked these Fellows about their IMPLEMENTATION BACKGROUND interest in further professional training and research and have taken their feedback FRAMEWORK In 2019, a formal Business Assessment into consideration in this plan. The COSECSA Secretariat developed of COSECSA was undertaken by an a Strategic Plan 2016-2020 which independent consultant. This involved a Additionally, we carried out a survey implemented four goals; (i) Graduate 500 wide engagement with Council, Executive, with current COSECSA Country Surgeons by 2020, (ii) Achieve Excellence Fellows, Trainees and Trainers. The Representatives and COSECSA trainees to in Training and Research, (iii) Maintain Best consultant also carried out several in- gauge their experience of the programme Practice in Examination Assessment and depth interviews and a group interview. and the administration of COSECSA in (iv) Build to Organisational Excellence and COSECSA is satisfied that the consultation their country. The substantial feedback Financial Stability. was thorough and comprehensive and they have shared has been taken on board have taken the recommendations on in preparing this strategy. The current Strategy, like its predecessor board for this strategic plan. seeks to implement the relevant activities In 2020, the COSECSA President wrote to achieve the desired. The strategy is, In 2020, COSECSA carried out a survey of to key external partners inviting them thus, aimed at giving strategic impetus recent Fellows who graduated between to input into the development of this and direction to the work of the COSECSA 2017-2019. We were pleased to see that strategic plan. Their views have been over the next 5-year period. Therein, over 91% of respondents are working as taken into consideration and we greatly the Strategy aims to serve as the major surgeons in Africa, and overwhelmingly appreciate the time they took to respond Strategic Instrument through which the in the country in which they did their to us. COSECSA seeks to execute its mandate Fellowship training. in a more focused, effective and results- oriented manner over the Planned period (2021– 2025).

In view of the foregoing, the current Strategy must in all aspects be in tandem with the 2016-2020 Strategy. In particular, it must seek to produce results that are in line with the broader regional development goals.

21 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

COSECSA PLAN ~

STRATEGIC PLAN SPECIFIC OBJECTIVES KEY STRATEGIC ISSUES CONTEXT The Surgical Education and Training is to a. Inadequate professionals in the COSECSA has taken stock of its inform development of a program that region: The shortage of well-trained leadership position in surgical training will enable greater access to surgical care surgical health professionals to meet and accreditation in the region. This was across the region and beyond. The overall the high demand in the surgical done considering the findings of the vision is professionals’ ability to deliver health care in the region. The number Lancet commission and World Health quality services in any one of the Member of qualified professionals in all Assembly resolution 68.15 emphasizing States. To this end, COSECSA focuses on Member States is still very low which that surgical care is a vital component of various activities that are structured under calls for more focused training in order universal health coverage. In considering specific objectives namely. to have more qualified personnel. our priorities for the next years we are b. Shortage of equipped clinical a. Be a leading surgical training cognisant of following key strategic issues: training sites in hospital institution, as measured by its ability to attract and retain high-quality c. Limited institutional capacity of the students within the COSECSA region. hospitals of IT facilities: to compliment online learning and b. Be a leading surgical research body and hub for surgical information, as training platforms measured by the quality and impact of d. The multiplicity of surgical training research output. institutions in the region: with which COSECSA needs to cooperate and c. Have engaged several new avenues of funding. co-exist Inadequate trainers and resource d. Have a mobile and multiplatform e. college, accessible and responsive to materials: The number of qualified all. surgical trainers is low in some of the Member States coupled with e. Produce well trained graduates who limited resource materials. are highly sought after for their ability to contribute to their societies. f. Inadequate funding: To both the College to advance its activities and f. Be a fully inclusive ‘Meritocratic- the funding of surgical training which Diverse-Elite’ college supporting all is a challenge to those professionals those with the ability to benefit from who would wish to enrol into the COSECSA experience regardless COSECSA training program but of social class, race, gender, religion. cannot afford. g. Award the pre-eminent qualification of g. Lack of data: Inadequate data surgical competence and performance pertaining the landscape of surgical in the region. care in the region is another challenge. h. Promote the highest ethical standards Most of the study depend on self – in practice. reported information, WHO and i. Advocate for surgery across the region Lancet datasets and beyond.

22 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

COSECSA PLAN ~

h. Public Awareness: Literacy levels The comparative advantage of the COSECSA training model over other surgical training including surgical care awareness is bodies is threefold. Firstly, it is a low-cost model, utilizing pre-existing human resources low across all Member states. This has and infrastructure. Secondly, the greater geographic spread of the COSECSA model affected the uptake of the training as allows trainees to train (and remain) close to home, thus improving distribution of well as access to surgical care. the surgical workforce. Thirdly, the greater numbers in the COSECSA model allow for i. The necessity to grow in the region innovations such as a bespoke electronic logbook and e-learning platform, and quality and beyond to ensure future improvements such as examiner training, which would not be practical with lower sustainability numbers. We view our future growth as contingent on our ability to expand our regional presence and maintain our reputation of excellence in surgical training. Our strategy is focused on training, examination, sustainability, and professional excellence.

23 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

COSECSA PLAN ~

GOALS, STRATEGIES STRATEGIES & CORE ACTIVITIES To achieve the above goals, below are the strategies and their initiatives that COSECSA Through consultations with Council seeks to undertake. Members, Partners and stakeholders a. Grow a model of practice-based training in the surgical community as well as b. Expand and enhance COSECSA training program extensive consideration of the SWOT c. Establish Continuous professional development (CPD) Programme analysis, COSECSA identified three major Build research capacity within COSECSA goals. d. Benchmark examination against international best practice GOAL 1: Achieve Excellence in e. Training & Research, and Maintain f. Develop state of the art centres for exams in each member country Best Practice in Examinations and g. Track and analyse trainee operative experience Assessment h. Ensure predictable diversified funding model GOAL 2: Quality in surgical care i. Ensure good governance, transparency and accountability GOAL 3: Build Organizational j. Engage in advocacy and policy development Excellence and Financial Sustainability k. Ensure Gender Equity l. Build comprehensive sustainable partnerships m. Monitoring & Evaluation n. Quality assurance in training and examinations o. Organizational Excellence and Financial Sustainability

24 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

GOAL 1: GOAL 2: GOAL 3: Achieve Excellence in Training & Quality in surgical care Build Organizational Excellence Research, and Maintain Best Practice in Position COSECSA as a world and Financial Sustainability Examinations and Assessment class surgical professional training Ensure predictable diversified funding, Build practice-based training, establish organisation with excellent training, ensure good governance, transparency continuous professional development standards and research, in the sub- and accountability, engage in advocacy (CPD) programme and build research Saharan region and beyond and policy development and ensure capacity within COSECSA a. Collaborate with allied health Gender Equity a. Graduate 1000 Surgeons by 2025 professions engaged in surgical care a. Implement a communication strategy and training b. Increase the number of accredited b. Secure resources for constructing new hospitals by 30 b. Increase the number of non-surgeons Secretariat Headquarters trained in basic surgery c. Increase the number of trainers by 100 c. In the interim fence COSECSA Laki Participate in the development d. Develop award framework of Honorary c. Laki Land of national surgical plans in member Lectureships to recognise Trainers’ d. Develop and Implement a fundraising/ countries and Programme Directors’ Resource Mobilisation strategy contribution to COSECSA’s training d. Participate in all relevant global health e. Increase internal and external advocacy and policy making platforms model resources by 50% Increase the number of female trainees e. f. Grow membership and fellowship to to 20% 3,000 Review online accreditation status of f. g. Secure annual government funding hospital specialties every five years from member states equal 1/3 of g. Gain recognition for CPD courses income across Member Countries h. Develop a COSECSA gender policy Obtain Pub-Med indexing for the East h. i. Build Administrative capacity of and Central African Journal of Surgery Women in Surgery Africa (WiSA) Ensure quality of the training i. j. Ensure all partnerships contribute to programme through e-logbook COSECSA’S strategic goals monitoring and progression Invest in IT and subscription of online assessment and ensure e-logbook k. platforms use is universal and accurately supports training programmes l. Secure funds to construct COSECSA Headquarters j. Conduct one online multiple-choice question writing workshop per year Monitoring and Evaluation k. Conduct one clinical case writing a. Measure the success of the training workshop per year programme l. Organize examiner exchange b. Report the Progress of the Training programme for six examiners per year programme m. Train and Improve on regional c. Review of the implementation examiners, certify and appoint them Strategy/strategic plan n. Revise and Implement examination standard operating procedures o. Ensure recognition of COSECSA qualification in all countries p. Strengthen Court of Examiners

25 COSECSA Secretariat, Ministries of Health Academic Institutions Associations National Surgical Development Partners Country Representatives Country Coordinators COSECSA Secretariat Court of Examiners Panel Heads Directors Program COSECSA Secretariat Directors Program COSECSA Secretariat COSECSA Secretariat Country Coordinators Member Countries RESPONSIBLE INSTITUTION • • • • • • • • • ECC • ESRC • • • • • ECC • ESRC • • • ESRC • ECC • • • HR Finance Budget: USD 720,000 HR Finance Budget: USD 455,000 HR Finance Budget: USD 100,000 HR Finance Budget: USD 15,000 HR Finance Budget: USD 15,000 RESOURCES • • • • • • • • • • • • • • • TIMELINES 2021-2025 2021-2025 2021-2025 2021 2021-2022 ~ COSECSA syllabi and curricula are serving the needs Trainees of Trainers, and the patients in the region Updated Curriculum OUTPUT/OUTCOMES OUTPUT/OUTCOMES 1000 additional in the region surgeons accredited New Trainers and certified • • and Approval Implementation of training Manuals / guidelines COSECSA recognised CPD courses for anaesthetists surgeons, and allied health in each professions Member Country Curricula and syllabi for all and revised are programmes to reflect updated regularly best practice and feedback the training programmes from Curriculum Review Conference PERFORMANCE INDICATORS PERFORMANCE INDICATORS graduate At least 250 surgeons each year On average, 20 new trainers and certified each year; accredited Programmes the Trainer 3 Train each year • • Manual/guidelines Developed for CPD courses Gain recognition Member Countries across LOG FRAME OF IMPLEMENTATION STRATEGY LOG FRAME OF IMPLEMENTATION Graduate 1000 by 2025 Surgeons the number Increase of trainers by 100 Annual Curriculum Reviews to Revise and update COSECSA syllabi and curricula, including sub- Develop and Implement the manual Training Dialogue with the authority appropriate in each Country to gain CPD Courses Develop a CPD for Fellows Program Examiners’ Workshop to Develop & Review the Curriculum

TARGET/ACTIVITIES a. b. c. specialties d. e. guidelines f. recognition g.

26 STRATEGIES Build practice- based training, establish continuous professional development (CPD) and build programme capacity research within COSECSA GOAL 1 : ACHIEVE EXELLENCE IN TRAINING AND RESEARCH; (BUDGET USD 1,655,000) COSECSA Secretariat COSECSA Secretariat Coordinator Research COSECSA Secretariat Panel Heads Court of Examiners RESPONSIBLE INSTITUTION • ESRC • IRB • • ESRC • IRB • • • ECC • ESRC • ECC • ESRC • • • HR Finance Budget: USD 5,000 HR HR HR Finance Budget: USD 40,000 RESOURCES • • • • • • • • TIMELINES 2021-2025 2021-2025 2021-2022 2021 Survey Report Access to online Developed Research Methodology Course uploaded on the SfS undertake Trainees and complete the Analysis Report New set of questions for Part I and II exams OUTPUT/OUTCOMES OUTPUT/OUTCOMES • • materials • • RMC ECAJS has higher readership • • Survey conducted No of Subscribed and free online materials for trainees and fellows RMC Manual undertake the 50-100 Trainees Methodology Course Research each year Convene a meeting to review the questions after 2020 Part 1 and II exams PERFORMANCE INDICATORS PERFORMANCE INDICATORS • • • • Full application for indexing is submitted in 2021 Findings and recommendations • Conduct a Survey to assess the current online content of the online access Avail materials for reading of approach through Build Research Capacity within of the Introduction Methodology Course to enhance/improve skills of the research COSECSA trainees Obtain Pub-Med indexing for the East and Central African Journal of Surgery Conduct an analysis of in-depth problems of exams and offer solutions; Clinical Part II examinations. Revisit the questions after the conclusion of each year Part I and Part II exams

TARGET/ACTIVITIES h. training i. partners j. COSECSA; Research k. l. m.

STRATEGIES Build practice- based training, establish continuous professional development (CPD) and build programme capacity research within COSECSA 27 GOAL 1 : ACHIEVE EXELLENCE IN TRAINING AND RESEARCH; (BUDGET USD 1,655,000) Panel Heads Court of Examiners Panel Heads Court of Examiners Panel Heads Court of Examiners Panel Heads Court of Examiners COSECSA Secretariat RESPONSIBLE INSTITUTION • ECC • ESRC • • • COSECSA • ECC • ESRC • • • ECC • ESRC • • • ECC • ESRC • • • HR Finance Budget: USD 60,000 HR Finance Budget: USD 20,000 HR HR Finance Budget: USD 80,000 RESOURCES • • • • • • • • • • TIMELINES 2021-2022 2021 2021-2025 2021-2025 Quality assurance Joint Committee COSECSA Executive, CRs, and Panel Heads receive on quarterly reports training programme at hospital level – this informs decisions on training programme. Support given to hospitals that need it. OUTPUT/OUTCOMES OUTPUT/OUTCOMES • system • established • COSECSA Court of Examiners is strengthened MCS Exam has bank of questions to use FCS Exams have banks of cases to use appointing internal/local/ and quality reviewers regional assurance assessors to support distant external teams. for the Joint Committee ToRs regularly are Trainers Evaluations, completing Trainee regularly are and Trainees Post ompleting Training Evaluations on school for Timesurgeons. limits are applied to trainees entering data to the Logbook. PERFORMANCE INDICATORS PERFORMANCE INDICATORS • • developed • for Court of Examiners are ToRs and specific training is revised, held in line with best practice One (1) MCQ workshop is conducted per year One (1) Case writing workshop is conducted alignment of Examinations to quality Strong assurance checks during training Establishment of a joint committee of national and COSECSA to supervise the exam ensuring to ensure examination quality. Conduct online multiple-choice question writing workshop per year Conduct clinical case writing workshop per Ensure quality of the Ensure training programme e-logbook through monitoring and Court of Strengthen Continuous

TARGET/ACTIVITIES n. COSECSA International Standards. o. p. q. r. s. t. year progression assessment Examiners

28 STRATEGIES Build practice- based training, establish continuous professional development (CPD) and build programme capacity research within COSECSA GOAL 1 : ACHIEVE EXELLENCE IN TRAINING AND RESEARCH; (BUDGET USD 1,655,000) Panel Heads Court of Examiners COSECSA Secretariat Panel Heads Court of Examiners COSECSA Secretariat Panel Heads Court of Examiners COSECSA Secretariat COSECSA Secretariat COSECSA Executive COSECSA Secretariat Country Representatives Country Coordinators RESPONSIBLE INSTITUTION • ECC • • • • ECC • • • • ECC • • • • RCSI • • • • • HR Finance Budget: USD 25,000 HR Finance Budget: USD 100,000 HR Finance Budget: USD 20,000 HR HR RESOURCES • • • • • • • • • • • TIMELINES 2021-2025 2021-2025 2023-2025 2021-2022 2023-2025 OUTPUT/OUTCOMES OUTPUT/OUTCOMES COSECSA gains knowledge of exam conduct and format the world across COSECSA has a pool of trained examiners at MCS ad FCS level that and gender is regionally, balanced All COSECSA exams conducted to a high are -academically standard and logistically Revised Pedagogical material on the SfS tool All COSECSA Fellows and able recognised are to work in their specialty in each member country SfS tool comprehensively SfS tool comprehensively developed to offer: Relevant Pedagogical material (courses, books, videos) PERFORMANCE INDICATORS PERFORMANCE INDICATORS Six COSECSA examiners serve exams each in other College’s six year; COSECSA receives other Colleges. examiners from All participants submit reports. Examiner training is conducted – one OSCE and regularly held each year workshop are VIVA with Fellows invited to attend of Examination An annual revision SOPs takes place • COSECSA undertakes a gap by specialty analysis of recognition gaps. addresses and country, additional specialty is Ensure recognised • Organize examiner Organize for six programme examiners per year and Improve Train examiners, regional certify and appoint Revise & Implement examination standard operating procedures Consolidate the School for Surgeons platform & mobilize stakeholders relevant by speciality of recognition Ensure qualification in all

TARGET/ACTIVITIES u. exchange v. them w. x. y. COSECSA countries STRATEGIES Build practice- based training, establish continuous professional development (CPD) and build programme capacity research within COSECSA

GOAL 1 : ACHIEVE EXELLENCE IN TRAINING AND RESEARCH; (BUDGET USD 1,655,000) 29 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

~ COSECSA HAS 303 COSECSA ACCREDITED TRAINERS

30 COSECSA Secretariat Country Representatives Country Coordinators COSECSA Council Executive Committee COSECSA Secretariat Country Representatives Country Coordinators COSECSA Council COSECSA Committees (FGPC, ECC & ESRC) Executive Committee COSECSA Secretariat RESPONSIBLE INSTITUTION • COSECSA • CANECSA • ECSACOG • ECSACON • • • • • • • • • • • • HR Finance Budget: USD 150,000 HR Finance Budget: USD 150,000 HR Finance Budget: USD 28,000 HR Finance Budget: USD 50,000 RESOURCES • • • • • • • • • • • • TIMELINES 2021-2025 2021-2025 2021-2025 2021-2025 Participation of at least 2 Council Members in at least 2 Global Health Forums each year strategy COSECSA’s in global is reflected health advocacy and policy making OUTPUT/OUTCOMES OUTPUT/OUTCOMES Patients have better- care quality surgical beyond the procedure and itself. Women better- girls receive quality obstetrics and gynaecological care. Patients in rural areas have access to better- care quality surgical The NSOAPs are by inclusion of improved evidence- COSECSA’s based contribution • • PERFORMANCE INDICATORS PERFORMANCE INDICATORS COSECSA builds on existing with CANECSA joint project to build the Anaesthesia COSECSA engages workforce; with ECSACOG and ECSACON. invited to are Representatives meetings and trainings where and opportunities appropriate and research for joint project explored collaborations are COSECSA supports Essential for non-surgeon Training Surgical courses in member countries, particularly in rural areas COSECSA representative participates in the key NSOAP meeting in member countries; he/ research she has evidence from and business insights to make material contribution COSECSA conducts assessment of which advocacy and policy-making platforms to engage with based on alignment with COSECSA strategy; a Council Member is per delegated representative platform. He/she has evidence and business research from insights to make material contribution. Participate in Collaborate with allied health engaged professions and care in surgical the number Increase of non-surgeons (such as General Medical Officers) trained in basic Actively participate in Countries’ policy making, specifically NSOAPS for COSECSA inclusion on matters of surgery plans and surgical A(h)

TARGET/ACTIVITIES e. training f. surgery g. g. global health relevant advocacy and policy making platforms

STRATEGIES Position COSECSA as a world class surgical training professional with organisation excellent training, and standards in the sub- research, and Saharan region beyond 31 GOAL 2 : QUALITY IN SURGICAL CARE; (BUDGET USD 1,680,500) COSECSA Secretariat Facilities Training Country Representatives Directors Program COSECSA Secretariat COSECSA Committees (FGPC, ECC & ESRC) COSECSA Secretariat Country Representatives Country Coordinators COSECSA Secretariat Societies Surgical Country Representatives Country Coordinators RESPONSIBLE INSTITUTION • ESRC • ECC • FGPC • • ECC • • • • • • • • Fellows • • • • FGPC • ESRC • • • Fellows HR Finance Budget: USD 200,000 HR Finance Budget: USD 150,000 HR Finance Budget: USD 352,500 HR Finance Budget: USD 40,000 RESOURCES • • • • • • • • • • • • TIMELINES 2022-2023 2021-2025 2021-2022 OUTPUT/OUTCOMES OUTPUT/OUTCOMES of Excellence 2 Centres established are exchanged 3 Trainees training in different facilities 15 Fellows trained under this programme Operational Protocols and guidelines/ Surgical Guidelines developed and implemented Concept Notes developed for of Excellence the No of Centres Criteria and guidelines for establishing CoEs developed PERFORMANCE INDICATORS PERFORMANCE INDICATORS • • exchanged No of Trainees 3 Fellows facilitated per year to attend training Development of protocols and guidelines/No of Surgical guidelines and best practices Establishment of Excellence of Centres in various surgical fields at the COSECSA training Develop criteria and guidelines for the of CoEs that nature COSECSA requires Exchange Programs Rotations; trainees undertake rotational the trainings across for a period of region 3 months Advocacy on Fellowship and Post Fellowship for a Programmes maximum period of 8 months within the ECSA region Develop Surgical In protocols, referral line with WHO Safety List, Surgical audits – Surgical of near reviews adverse events, Data collection protocols of – standardization operating theatre books and Infection guidelines for control

TARGET/ACTIVITIES i. sites j. k. l. Membership; m. miss/surgical surgery

32 STRATEGIES Position COSECSA as a world class surgical training professional with organisation excellent training, and standards in the sub- research, and Saharan region beyond GOAL 2 : QUALITY IN SURGICAL CARE; (BUDGET USD 1,680,500) COSECSA Secretariat Country Representatives Country Coordinators Directors Programme COSECSA Secretariat Country Representatives Country Coordinators COSECSA Secretariat RESPONSIBLE INSTITUTION • ESRC • ECC • FGPC • • ESRC • • • Fellows • • • RCSI • COSECSA • • • HR Finance Budget: USD 200,000 HR Finance Budget: USD 30,000 HR HR RESOURCES • • • • • • • • TIMELINES 2022-2023 2021-2025 2021-2025 2021-2025 Presentation of Presentation Papers at Research Papers Research written articles are and Published OUTPUT/OUTCOMES OUTPUT/OUTCOMES of Excellence 2 Centres established are • Forums • Conduct EST in other COSECSA Countries are COSECSA Trainees mentored Concept Notes developed for of Excellence the No of Centres Criteria and guidelines for establishing CoEs developed No of Fellows pooled for work research to No of grants provided COSECSA Fellows PERFORMANCE INDICATORS PERFORMANCE INDICATORS • • • • No of Countries added on the EST Programme referral training Clearly identified mentors’ groups Research for decision Research making at the country level; Research Promote among COSECSA Fellows and establish a Pool of Fellows for and provide research Grants Research extending Explore the EST training to other COSECSA Member Countries Collaborate with partners to create enhance evidence based surgical guidelines and disseminate best practices and Establish Mentorship

TARGET/ACTIVITIES n. o. p. q. implementing standards Groups

STRATEGIES Position COSECSA as a world class surgical training professional with organisation excellent training, and standards in the sub- research, and Saharan region beyond 33 GOAL 2 : QUALITY IN SURGICAL CARE; (BUDGET USD 1,680,500) Collaboration Partners RESPONSIBLE INSTITUTION • • COSECSA • WiSA HR Finance Budget: USD 450,000 RESOURCES • • • TIMELINES 2021-2025 COSECSA graduates real-world reflect gender balance Gender Policy Developed, and Approved COSECSA has gender greater balance at all levels of the College

OUTPUT/OUTCOMES OUTPUT/OUTCOMES • • Implemented • Increasing proportion of proportion Increasing women trainees at both MCS and FCS levels Gender Policy developed COSECSA gender policy is College’s developed reflecting commitment to gender equity PERFORMANCE INDICATORS PERFORMANCE INDICATORS • • Increase the number Increase of women trainees to Develop a COSECSA gender policy Build Administrative capacity of Women Africa in Surgery Collaborate with and WiSAstrengthen on that programmes women promote mentorship, and role model activities

TARGET/ACTIVITIES r. 25% s. t. (WiSA) u. leadership,

34 STRATEGIES Position COSECSA as a world class surgical training professional with organisation excellent training, and standards in the sub- research, and Saharan region beyond GOAL 2 : QUALITY IN SURGICAL CARE; (BUDGET USD 1,680,500) Collaboration Partners RESPONSIBLE INSTITUTION • • COSECSA • WiSA HR Finance Budget: USD 450,000 RESOURCES • • • TIMELINES 2021-2025 COSECSA graduates real-world reflect gender balance Gender Policy Developed, and Approved COSECSA has gender greater balance at all levels of the College

OUTPUT/OUTCOMES OUTPUT/OUTCOMES • • Implemented • Increasing proportion of proportion Increasing women trainees at both MCS and FCS levels Gender Policy developed COSECSA gender policy is College’s developed reflecting commitment to gender equity PERFORMANCE INDICATORS PERFORMANCE INDICATORS • • Commission a Study as to why COSECSA needs women in Build Administrative Capacity of WiSA Build a mentorship and coaching Improve and build on Improve scholarships tailored for women only forums for Organise Surgeons Women Align with global organizations, surgery movements and alliances/coalitions that have a bias for female leaders the concept Promote of “ask her to stand” college deliberately seeks out women and pursuing surgery asks them, proactively, to become involved as in college affairs examiners, educators, and holders of office

TARGET/ACTIVITIES v. Surgery w. x. program y. z. aa. bb.

STRATEGIES Position COSECSA as a world class surgical training professional with organisation excellent training, and standards in the sub- research, and Saharan region beyond 35 GOAL 2 : QUALITY IN SURGICAL CARE; (BUDGET USD 1,680,500) College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

~ COSECSA’S VISION IS TO BE A LEADING SURGICAL BODY IN TERMS OF TRAINING, STANDARDS AND RESEARCH

36 Country Representatives Country Coordinators COSECSA Secretariat Executive Committee COSECSA Council COSECSA Council COSECSA Executive COSECSA Secretariat Collaboration Partners COSECSA Secretariat Country Coordinators Societies Surgical COSECSA Council COSECSA Executive Country Representatives COSECSA Secretariat Country Coordinators Grant Writer/Resource Mobilization Specialist COSECSA Secretariat COSECSA Executive COSECSA Secretariat RESPONSIBLE INSTITUTION • • • • • • FGPC • • • • • • Fellows • • • FGPC • • • • • • FGPC • • • FGPC • • HR Finance Budget: USD 62,400 HR HR HR Finance Budget: USD 15,000 HR Finance Budget: USD 2,000 HR Finance Budget: USD 30,000 RESOURCES • • • • • • • • • • • • • • TIMELINES 2021-2025 2021-2025 2021-2025 2021-2025 2021 2023 & 2025 OUTPUT/OUTCOMES OUTPUT/OUTCOMES COSECSA engaged Governments and gained both political and public support to achieve its strategic goals COSECSA has the to resources financial achieve its strategic goals COSECSA has a wide membership and fellowship base within and overseas. region COSECSA has the to resources financial achieve its strategic goals Fundraising strategy is developed, approved and implemented the Meeting to review Strategy No of Countries Contributing to COSECSA budget Annually government Income from funding is 1/3 of all income each year PERFORMANCE INDICATORS PERFORMANCE INDICATORS Implementation of the Communication Strategy by 10% on YoY Income increases 2020 baseline; balance increase between internally-generated income and other Membership and Fellowship by 600 each year; numbers grow membership and income from fellowship subscriptions increases • • Development of the Resource Mobilization Strategy Evaluate the implementation of the strategic plan Implement the Strategy and increase COSECSA visibility internal and Increase by external resources membership Grow and fellowship to annualSecure government funding member states from equal 1/3 of income Develop and implement a Mobilisation Strategy Review of the implementation Status of the Strategic

TARGET/ACTIVITIES a. Communication b. 50% c. 3,000 d. e. Resources f. Plan

STRATEGIES Establish predictable diversified funding, good ensure governance, and transparency accountability, and engage in advocacy and policy development 37 : BUILD ORGANISATIONAL EXELLENCE AND FINANCIAL SUSTAINABILITY; (BUDGET USD 5,567,664) EXELLENCE AND FINANCIAL SUSTAINABILITY; GOAL 3 : BUILD ORGANISATIONAL COSECSA Council COSECSA Executive COSECSA Secretariat COSECSA Champions Country Representatives COSECSA Secretariat Country Coordinators COSECSA Champions Country Representatives COSECSA Secretariat Country Coordinators COSECSA Council COSECSA Executive COSECSA Secretariat RESPONSIBLE INSTITUTION • FGPC • • • • Fellows • Members • • • • • Fellows • Members • • • • • FGPC • • • HR Finance Budget: USD 40,500 HR Finance Budget: USD 100,000 HR Finance Budget: USD 84,000 HR Finance Budget: USD 25,000 RESOURCES • • • • • • • • • • • • TIMELINES 2021-2025 2021-2025 2021-2025 2021-2025

COSECSA has the resources financial to achieve its strategic goals 7 additional to 3000 Increase Pool of Fellows and Members established 2 Champions per Member State 4 Schools/ Institutions visited per year Member Visibility in COSECSA medical schools intake Increased Dialogues at country- level with Universities

OUTPUT/OUTCOMES OUTPUT/OUTCOMES • • Collaboration Partners • • • • State • • • All partnerships are entered All partnerships are into only if the cost-recovery basis is evident at the outset No of additional Collaboration Partners and MoUs signed Cumulative number of Fellows and Members No of COSECSA Fellows and Members in a pool No. of Champions per Member No of Medical Schools or Higher Institutions of learning Number of additional trainees these visits per year from MOUs with universities Number of grant applications

PERFORMANCE INDICATORS PERFORMANCE INDICATORS • • • • • State • visited • • • Strategic Partnerships: all partnerships ensure contribute to strategic COSECSA’S goals and a majority of signed MoUs attract monetary value membership Grow and fellowship COSECSA advocacy on fellowship and Establish a pool of COSECSA Fellows and Members Establish a team of Ambassadors who will be facilitated to visit COSECSA Member States medical schools or institutions of higher learning and run COSECSA to attract programmes traineesmore Collaborate with local universities to COSECSA strengthen surgical and improve

TARGET/ACTIVITIES g. support h. i. membership. j. k. COSECSA Champions sensitization l. care

38 STRATEGIES Establish predictable diversified funding, good ensure governance, and transparency accountability, and engage in advocacy and policy development : BUILD ORGANISATIONAL EXELLENCE AND FINANCIAL SUSTAINABILITY; (BUDGET USD 5,567,664) EXELLENCE AND FINANCIAL SUSTAINABILITY; GOAL 3 : BUILD ORGANISATIONAL COSECSA Executive COSECSA Secretariat COSECSA Executive COSECSA Secretariat RESPONSIBLE INSTITUTION • FGPC • ECC • RCSI • • • FGPC • ECC • RCSI • • HR Finance Budget: USD 75,000 HR Finance Budget: USD 75,000 RESOURCES • • • • • • TIMELINES 2021 2021 COSECSA Invests secure in reliable, for infrastructure of Improvement COSECSA has lean, systems appropriate to meet the challenges of this strategic plan COSECSA Invests secure in reliable, for infrastructure of Improvement COSECSA has lean, systems appropriate to meet the challenges of this strategic plan OUTPUT/OUTCOMES OUTPUT/OUTCOMES • technological systems • online-first management • technological systems • online-first management PERFORMANCE INDICATORS PERFORMANCE INDICATORS conducts COSECSA Secretariat needs assessment of management systems and scopes out future needs conducts COSECSA Secretariat needs assessment of management systems and scopes out future needs Invest in IT and online of subscription Partner with IT companies or other partners to develop innovative solutions greater towards capacity and additional technology required infrastructure for online the Explore technology and needed infrastructure to support virtual including the use of virtual simulation and define business short-term Explore training and

TARGET/ACTIVITIES m. platforms n. implementing connectivity examinations. o. examinations requirements p. certification opportunities

STRATEGIES Establish predictable diversified funding, good ensure governance, and transparency accountability, and engage in advocacy and policy development 39 : BUILD ORGANISATIONAL EXELLENCE AND FINANCIAL SUSTAINABILITY; (BUDGET USD 5,567,664) EXELLENCE AND FINANCIAL SUSTAINABILITY; GOAL 3 : BUILD ORGANISATIONAL COSECSA Council COSECSA Executive COSECSA Secretariat Societies Surgical COSECSA Council COSECSA Executive COSECSA Secretariat COSECSA Council COSECSA Executive COSECSA Secretariat Country Representatives Country Coordinators Directors Programme COSECSA Secretariat General Secretary COSECSA Secretariat COSECSA Council COSECSA Executive COSECSA Secretariat RESPONSIBLE INSTITUTION • FGPC • • • • FGPC • Members • Fellows • • • • • FGPC • • • • Registrar • • • • • Registrar • FGPC • • • ESRC • FGPC • IRB • FGPC • • • HR Finance Budget: USD 3,000 HR Finance Budget: USD 30,000 HR HR Finance Budget: USD 70,000 HR HR HR Finance Budget: USD 2,500,000 RESOURCES • • • • • • • • • • • • • • • TIMELINES 2021 2023 2025 2022-2025 2022-2025 2022 2021-2025 OUTPUT/OUTCOMES OUTPUT/OUTCOMES Set up a fund to donations from receive friends and Alumni of COSECSA Substantial Funds raised in New Fee Structure 2025 Assessment Report COSECSA is well positioned to secure national or bilateral scholarship programmes A pool/team of is Researchers established funds to Secured construct COSECSA Headquarters PERFORMANCE INDICATORS PERFORMANCE INDICATORS Develop the foundation for donations Joint Fundraising event organised every 5 years Review the Structure No of District Hospitals assessed for suitability of COSECSA Accreditation Engagement with MoH and Higher Academic Institutions COSECS Attract and Interest Fellows and Directors, Program for policy Members to do research making and for COSECSA Income to Funding Proposals Write potential donors 5-Year COSECSA Fee 5-Year Situation Analysis of potential COSECSA district income Explore research through Register a charity in the UK and Develop the foundation for Pilot test joint fundraising strategy with key project partners over a period of 5 Years Development of a strategy for eligibility of national or bilateral resources Secure for constructing new Secretariat

TARGET/ACTIVITIES q. r. s. review t. hospitals u. v. opportunities partnerships/ collaborations w. donations scholarship programmes Headquarters

40 STRATEGIES Establish predictable diversified funding, good ensure governance, and transparency accountability, and engage in advocacy and policy development : BUILD ORGANISATIONAL EXELLENCE AND FINANCIAL SUSTAINABILITY; (BUDGET USD 5,567,664) EXELLENCE AND FINANCIAL SUSTAINABILITY; GOAL 3 : BUILD ORGANISATIONAL COSECSA Council COSECSA Executive COSECSA Secretariat General Secretary COSECSA Secretariat RESPONSIBLE INSTITUTION • FGPC • • • • • FGPC • HR Finance Budget: USD 115,000 HR Finance Budget: USD 2,400,764 RESOURCES • • • • • • TIMELINES 2021 2021-2025 Governance and Policy management Capacity Improved and of Staff Programme Efficient OUTPUT/OUTCOMES OUTPUT/OUTCOMES COSECSA Laki for Land is safeguarded development • COSECSA • enhanced Administrative Procedures • Management Governance Meetings (December Council Meeting- AGM and Examination) Half Council Meetings, Executive Operation Costs (office expenses, Audit fees, bank capacity and staff charges Personnel Cost (Staff, Officer Research Coordinators, and Assistant Editor Meetings held as planned and COSECSA Programme and is efficient Coordination PERFORMANCE INDICATORS PERFORMANCE INDICATORS construction Phased approach implemented • Meetings, • development • • effective Fence off the Fence off COSECSA Laki Land in the interim COSECSA Administrative and

TARGET/ACTIVITIES x. y. Programme Coordination Capacity Development

STRATEGIES Establish predictable diversified funding, good ensure governance, and transparency accountability, and engage in advocacy and policy development 41 : BUILD ORGANISATIONAL EXELLENCE AND FINANCIAL SUSTAINABILITY; (BUDGET USD 5,567,664) EXELLENCE AND FINANCIAL SUSTAINABILITY; GOAL 3 : BUILD ORGANISATIONAL College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

MONITORING ~ STANDARDIZING AND WIDENING ACCESS TO SURGICAL TRAINING, SKILLS AND KNOWLEDGE

MONITORING AND EVALUATION CRITICAL SUCCESS FACTORS FRAMEWORK a. Budgetary provision: COSECSA, Development Partners and An effective Monitoring and Evaluation (M&E) framework is respective Governments to provide sufficient funds required instituted as a review mechanism to monitor the progress and to implement the set objectives assess the level of attainment of specific targets as compared b. Sustainability: a key target of the strategic objectives is to to the planned specific objectives. This involves identification ensure longevity of the program of the key performance indicators (KPIs) and specification of the c. Partnerships and strategic alliances: Partnering with performance tracking system for measuring achievements of strategic alliances will assist in increasing membership and milestones and targets on a periodic basis. making the programme more visible and accessible. The responsibility for the monitoring and evaluation of d. Enacting the necessary legal and regulatory frameworks the Implementation Strategy is vested with the COSECSA by the Member States: Once the policy is signed as a Secretariat, Member States, ECC, ESRC, Country Representatives protocol, it is important that the same is included in each (CRs), the Executive Committee and other stakeholders. partner state’s national policy frameworks The Performance evaluation involves carrying out of surveys e. Marketing and buy-in from stakeholders: marketing of the and assessments to track progress made in implementation of program to drive membership and enrolment the strategy and inform any need for adjustments that may be f. Employability of graduates: this is a key indication of the required on the strategy. relevance of the program and will make it more marketable The M&E Framework provides key bases for the measurement g. Adequate capacity of trainers and facilities: the capacities of the success of the COSECSA strategic plan, to be reported to should be adequate and always be kept abreast with the Executive responsible for the oversight of the Strategic Plan. emerging trends. It is an integral part of the implementation plan for the following: h. Adequacy of curriculum and content: to ensure that the a. COSECSA Secretariat to systematically track activities to content is comprehensive and remains relevant. assess implementation progress. b. COSECSA Secretariat to collect and analyse data on RISK FACTORS implementation of the Program from all Member States to a. Budgetary constraints: Inadequate financial resources would inform decision making. significantly hamper the implementation of the programme c. Reporting to be done periodically by the ECC, ESRC, b. Competition from other similar programs: there are long Secretariat and CRs. established institutions in Member States that offer d. Undertake surveys to monitor employment of COSECSA the same programmes/specialties. professionals c. Commitment and goodwill to implement the programme in e. Mid-term and end-term review of the implementation the Member States. strategy - evaluation of the implementation strategy to be d. Sector variances amongst Member States: Harmonizing carried out will address issues of: - implementation of the programme amongst Member • Effectiveness (Impact). States who may be at varying levels of economic and sectoral • Sustainability, challenges, lessons learnt and development could pose a major challenge. • Mitigation measures.

42 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

MONITORING ~

EVALUATION AND REPORTING MID-TERM REVIEW AND There will be need to monitor the Key Performance Indicators and set timelines in line LESSONS LEARNT with the critical success factors as summarized below: Mid-term review will be done in the third year. Depending on progress: CRITICAL SUCCESS FACTOR MEASURE (i) If implementation is below target establish why and lessons learnt to Budgetary provision 100 percent budget provision and inform a change in strategy or action utilization points; and Sustainability of the programme Number of graduates per each (ii) If implementation is on or above professional level. target, establish the success factor and Partnerships and strategic alliances • Partnerships identified, signed MOUs adopt the key lessons learnt for • Developed Programs with the Partners. success.

Enacting the necessary policy Policy Frameworks put in place to anchor Annex 1 hereto presents a high-level frameworks by the Member States. the programme framework to be used in Monitoring and Employability or marketability of Carrying out a comprehensive survey to Evaluation of the status of execution of graduates establish the career progress of graduates. the Implementation Strategy from time to time. Adequate capacity of training institutions • Availability of requisite training infrastructure. Meanwhile, Annex 2 hereto presents • Enrolment capacity of the institutions; a Gantt chart which summarises all and required activities for execution of the • Quality of training offered. Implementation Strategy and provides the envisaged time frames for each. Adequacy of Curriculum and content • Peer review materials with other institutions This will inform planning of the specific • Update curriculum content regularly to initiatives for implementation of the incorporate changes in policies and Strategic Plan market practice.

43 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

44 College of Surgeons of East, Central and Southern Africa STRATEGIC PLAN 2021-2025

CONCLUSION ~ SUCCESSFUL IMPLEMENTATION OF THIS PLAN WILL FACILITATE THE ESTABLISHMENT OF A DYNAMIC AND PROFESSIONAL COSECSA PROGRAM CONSISTENT WITH GLOBAL STANDARDS.

45 Planned Action planned[Outline the going forward]action planned[Outline the going forward]action Etc. As per above Remarks On Remarks On Implementation Status implementation [State and reason(s) for status status, where applicable] implementation [State and reason(s) for status status, where applicable] Etc. As per above Current EVALUATION DATE EVALUATION [Insert CUR-RENT perfor-mance SCORE and apply color scheme] [Insert CUR-RENT perfor-mance SCORE and apply color scheme] Etc. [Insert Score] Average Previous Implementation Progress [Insert PREVIOUS perfor-mance SCORE and apply color scheme] [Insert PREVIOUS perfor-mance SCORE and apply color scheme] Etc. [Insert Score] Average ” ” means “ NOT INITIATED ” means “ Initiated & Achieved 25% ” means “ Initiated & Achieved 50% ” means “ Initiated & Achieved 75% ” means “Fully implemented 100%” Score of “ 1 Score of “ 2 Score of “ 3 Score of “ 4 Score of “ 5 Score Time Frame & Time Frame & Responsibility time frame the [State activity 1st the for as described in the Implementation Strategy]. time frame the [State 2nd activity the for as described in the Implementation Strategy]. Etc. ENDING ON ENDING ON Performance Performance Output Measure/ performance the [State or output measure activity 1st the for as described in the Implementation Strategy]. performance the [State or output measure 2nd activity the for as described in the Implementation Strategy]. Etc. State Policy State Objective (as described COSECSA in the Strategy Policy Implementation Targets/Activities activity/ 1st the [State this strategy for Target as described in the Implementation Strategy]. 2nd activity the [State this strategyfor as described in the Implementation Strategy]. Etc. of this Policy ObjectiveOverall of Implementation Evaluation MONITORING & EVALUATION FRAMEWORK FOR IMPLEMENTATION FRAMEWORK FOR IMPLEMENTATION MONITORING & EVALUATION POLICY AND STRATEGY OF COSECSA IMPLEMENTATION IMPLEMENTATION PROGRESS – PROGRESS – IMPLEMENTATION SCORING AND COLOUR SCHEME: 46 Policy Objective No: FOR THE PERIOD EVALUATION ON STARTING Strategies strategy[State as described in the Implementation Strategy] scoresThe be applied during should evaluation following of implementation Strategy: Policy of the Implementation implementation ANNEX 1 : 2015 2024 2025 2022 2021 ACTIVITIES At least 40 Candidates per year obtain scholarships workshops per year the Trainer 3 Train 1 Annual Curriculum Conference 3 Meetings to develop the manual to develop CPD Program Workshops Access to online materials undertake the Research 50-100 Trainees Methodology Course each year Coordinator Support to the Research revised, for Court of Examiners are ToRs and specific training is held in line with best practice for the Joint to develop ToRs Workshop Committee Specific training held in line with best practice One (1) MCQ workshop is conducted per year One (1) Case writing workshop is conducted per year Six COSECSA examiners serve in other exams each year; COSECSA receives College’s other Colleges. six examiners from STRATEGIES funding for scholarships to trainees Secure per year 20 new Trainers Annual Curriculum Review Manual/guidelines development Training for fellows Develop a CPD Program online materials for Subscribed and free trainees and fellows Methodology Course Developed Research uploaded on the SfS and undertaken by trainees Full application for indexing is submitted in 2021 Revisit the questions after conclusion of each year Part I and II exams Establish a joint committee of national and COSECSA to supervise the exam ensure examination quality ToRs Court of Examiners; revise Strengthen MCQ workshop is conducted per year Case writing workshop is conducted COSECSA examiners serve in other College’s six exams each year; COSECSA receives other Colleges. examiners from GANTT CHART

OBJECTIVES OBJECTIVES by 2025 Graduate 1000 Surgeons by 100 the number of Trainers Increase Curriculum Review Develop the training manual authority in Dialogue with the appropriate each Country to gain CPD Courses recognition materials online access for reading Avail Capacity within COSECSA Build Research Obtain Pub-Med indexing for the ECAJS Conduct an in-depth analysis of the problems solutions; Clinical Part II of exams and offer examinations Continuous alignment of COSECSA Training and Examinations to International Standards Conduct online MCQ writing workshop per year Conduct clinical case writing workshop per year for examiner exchange programme Organize six examiners per year 47 ANNEX 2 : PLAN TIME FRAME FOR ACTIVITIES ENVISAGED UNDER THE COSECSA STRATEGIC GOAL 1 : ACHIEVE EXCELLENCE IN TRAINING AND RESEARCH 2015 2024 2025 2022 2021 ACTIVITIES workshop held each one OSCE and VIVA year with Fellows invited to attend Examination SOPs to review Workshop Pedagogical material Develop relevant (Course, Books, Videos) Gap Analysis STRATEGIES Examiner training is conducted regularly of Examination SOPs takes Mid-term revision place developed SfS tool comprehensively COSECSA undertakes a gap analysis by specialty and country, of recognition additional specialty is gaps. Ensure addresses recognised

48 OBJECTIVES examiners, certify regional and Improve Train and appoint them Revise and Implement examination standard operating procedures platform Consolidate the School for Surgeons stakeholders by and mobilize relevant speciality of COSECSA qualification recognition Ensure in all countries GOAL 1 : ACHIEVE EXCELLENCE IN TRAINING AND RESEARCH 2015 2024 2025 2022 2021 ACTIVITIES invited to meetings and are Representatives and opportunities appropriate trainings where collaborations and research for joint project explored are each year for EST non 2 Workshops in Member Countries’ rural areas surgeons Participation in the key NSOAP meetings Member Countries Assessment of which advocacy and policy- making platforms to engage with based on alignment with COSECSA strategy Participation of 2 Council Members in atleast Global Health Forums each year Concept Notes developed and establishment of Excellence of 2 Centres training exchanged in different 3 Trainees facilities 3 Fellows facilitated per year to attend training and Conduct meetings to develop Protocols Safety List SOPs in line with WHO Surgical Grants and facilitation of fellows to Research papers attend forums and present Conduct EST in other COSECSA Countries STRATEGIES with COSECSA builds on existing joint project CANECSA to build the Anaesthesia workforce; COSECSA engages with ECSACOG and ECSACON. Training COSECSA supports Essential Surgical courses in member countries, for non-surgeon particularly in rural areas participates in the COSECSA representative key NSOAP meeting in Member Countries Conduct an assessment of which advocacy and policy-making platforms to engage with based on alignment with COSECSA strategy Council Member is a delegated representative per platform. Develop riteria and guidelines for establishing CoEs trainings across undertake rotational Trainees for a period of 3 months the region for a maximum Post Fellowship Programmes period of 8 months within the ECSA region Collaborate with implementing partners to evidence-based surgical create/enhance guidelines and disseminate best practices standards and Establish a Pool of Fellows for research of Grants, Presentation Research provide Papers at Forums and Research Research written and Published Papers/articles are Countries to the EST Programme Add more training mentors’ learly identified referral groups

OBJECTIVES OBJECTIVES Collaborate with allied health professions and training care engaged in surgical (such the number of non-surgeons Increase trained in basic as General Medical Officers) surgery Actively participate in Countries’ policy making, specifically NSOAPS for COSECSA and surgical inclusion on matters of surgery plans global health advocacy Participate in relevant and policy making platforms of Excellence in Establishment of Centres fields at the COSECSA training various surgical sites Exchange Programs/Rotations Advocacy on Fellowship and Membership; In line with protocols, referral Develop Surgical audits Safety List, Surgical WHO Surgical among COSECSA Fellows Research Promote extending the EST training to other Explore COSECSA Member Countries Establish mentorship groups 49 GOAL 2 : QUALITY IN SURGICAL CARE 2015 2024 2025 2022 2021 ACTIVITIES Conduct a Study of the need for women in and barriers to women in Surgery Surgery for and build on Scholarships tailored Improve Scholarships per 15 Women women: Provide year forum per Surgeons’ one Women Organise year in collaboration with WiSA STRATEGIES Conduct a Study of the need for women in and barriers to women in Surgery Surgery of women trainees at proportion Increasing both MCS and FCS levels Develop COSECSA Gender Policy; Organise Build a Surgeons; forums for Women Establish a mentorship and coaching program; pool of COSECSA women graduates; Increase No of women leaders in the College Affairs

50 OBJECTIVES Commission a Study as to why COSECSA needs women in Surgery to Trainees the number of Women Increase 25% Build Administrative Capacity of WiSA GOAL 2 : QUALITY IN SURGICAL CARE 2015 2024 2025 2022 2021 ACTIVITIES Implement the Communication Strategy and COSECSA visibility increase membership and fellowship income from subscriptions increases Liaise with COSECA Country Representatives to follow up with and Country Coordinators Ministries of Health for support the respective the Strategy Meeting to review Workshops and End Term Mid Term meetings with atleast three Engage and secure (3) additional potential donors a forum for COSECSA Alumni Organise 4 Schools/ Institutions visited per year Member State by 2 champions in each Country Dialogues at country-level with Universities Support and systems automation Technical STRATEGIES visibility of COSECSA through Increase Branding and Communication attract as onto the programme professionals more financial sustainablity well as increase by Membership and Fellowship numbers grow 600 each year; government funding is 1/3 of all Income from income each year Mobilization Development of the Resource additional funds from Strategy to secure Collaboration Partners Evaluate the implementation of strategic plan 7 Additional Collaboration Partners Establish a pool of COSECSA Fellows and Members; Establishment of an active COSECSA Alumni Establish a team of COSECSA Champions/ Ambassadors who will be facilitated to visit COSECSA Member States medical schools or institutions of higher learning and run to attract COSECSA sensitization programmes trainees more MOUs with universities and grants collaborations conducts needs COSECSA Secretariat assessment of management systems and needs and also explore scopes out future needed to the technology and infrastructure support virtual examinations including the use of virtual simulation and define business requirements

OBJECTIVES OBJECTIVES diversified funding, predictable Ensure and good governance, transparency ensure Engage in advocacy and policy accountability, development by internal and external resources Increase 50% annual government funding from Secure member states equal 1/3 of income Develop and implement a Resources Mobilisation Strategy Review of the implementation Status Strategic Plan all partnerships Strategic Partnerships: ensure strategic goals and contribute to COSECSA’S a majority of signed MoUs attract monetary value support COSECSA advocacy on fellowship and membership. Establish a team of COSECSA Champions/ Ambassadors who will be facilitated to visit COSECSA Member States medical schools or institutions of higher learning and run to attract COSECSA sensitization programmes trainees more Collaborate with local universities to surgical COSECSA and improve strengthen care Invest in IT and subscription of online platforms; Automation of COSECSA operation systems and up running onine examination systems 51 : BUILD ORGANIZATIONAL EXCELLENCE AND FINANCIAL STABILITY GOAL 3 : BUILD ORGANIZATIONAL 2015 2024 2025 2022 2021 ACTIVITIES in collaboration with other Organise partners short-term training in different specialties donations from Set up a fund to receive friends and Alumni of COSECSA a fundraising event Organise in 2025 New Fee Structure Assess the suitability of district hospitals for COSECSA Accreditation Engage with MoH and Higher Academic Institutions COSECS Program Attract and Interest Fellows and Members to do Directors, for policy making and COSECSA research Income funding to construct COSECSA Secure Headquarters construction of the Do phased approach Fence Capacity Development, Administrative Support, STRATEGIES Establish modalities of running short courses for certification Develop the foundation for donations every 5 years Review the Structure Hospitals the number of Accredited Increase COSECSA is well positioned to secure Ensure national or bilateral scholarship programmes Establish a Pool of COSECSA Researchers to potential donors Funding Proposals Write Fencing of COSECSA Laki Land for proper Enhance the capacity of Secretariat of COSECSA Programme coordination

52 OBJECTIVES short-term training and certification Explore opportunities Register a charity in the UK and Develop foundation for donations with Pilot test joint fundraising strategy project key partners over a period of 5 Years COSECSA Fee review 5-Year Situation Analysis of potential COSECSA district hospitals Development of a strategy for eligibility national or bilateral scholarship programmes income opportunities through Explore partnerships/collaborations research Construction COSECSA Secretariat Headquarters COSECSA Laki Land Safeguard Administrative COSECSA Secretariat Capacity Coordination and Programme Development : BUILD ORGANIZATIONAL EXCELLENCE AND FINANCIAL STABILITY GOAL 3 : BUILD ORGANIZATIONAL THE COLLEGE OF SURGEONS OF EAST, CENTRAL AND SOUTHERN AFRICA (COSECSA)

PROMOTING EXCELLENCE IN SURGICAL CARE, TRAINING AND RESEARCH

250,000 SURGICAL PATIENTS TREATED! COLLEGE OF SURGEONS Trainees across sub-Saharan Africa collectively passed th OF EAST, CENTRAL a milestone in August 2020Complex when Major 9% the 250,000 operation & SOUTHERN AFRICA was recordedMajor 31% in the COSECSA eLogbook. Intermediate 35% Minor 25% AGES 6% under 1 year old 27% Kenya COUNTRIES OF PATIENTS 23% 1-15 years 14% Zambia WHERE THE PATIENTS 23% 16-30 years 12% Ethiopia WERE TREATED 22% 31-45 years 10% Zimbabwe 14% 46-60 years 8% Malawi top 10% 61-75 years 7% Rwanda 14

65% 35% 3% 76 - 90 years 6% Uganda Male Female 5% Tanzania

PATIENT 2% Namibia COMPLEXITY GENDER Complex Major 9% 2% Cameroon + Major 31% 2% Burundi Intermediate 35% Minor 25% 701 1% Congo Robert 1% Botswana TRAINEES IS THE MOST COMMON RECORDED TRAINEE 1% Niger OPERATIONS FIRST NAME

TYPES of 35% OPERATIONS TYPE Emergency RECORDED Surgeries , SURGERY 2 700 65% Elective 38% General Surgery TOP 5 MOST Surgeries 30% Orthopaedic Surgery COMMON OPERATIONS 9% Paediatric Surgery

SPECIALTY 4% Wound - debridement / haematoma / delayed closure 8% Urology

3% Hernia inguinal - adult 7% Plastic surgery

4% Neurosurgery 3% Appendicectomy (all types)

1% Otorhinolaryngology 2% Diaphyseal femur fracture intramedullary nailing

1% Cardiothoracic Surgery 2% Exploratory laparotomy (no other procedure) The College of Surgeons of East, Central and Southern Africa (COSECSA) 157 Olorien, Njiro Road ECSA-HC P.O. Box 1009, Arusha, Tanzania. Tel: +255 27 254 9362 / +255 27 254 9365 Fax: +255 27 254 9324 / +255 72 254 9392 Email: [email protected] Web: www.cosecsa.org Twitter: @cosecsa LinkedIn: https://www.linkedin.com/school/cosecsa/ Facebook: https://www.facebook.com/COSECSA-1476132912684891/