Abstract
BackgroundSub-Saharan Africa (SSA) faces a severe shortage of Obstetrician Gynaecologists (OBGYNs). While the Lancet Commission for Global Surgery recommends 20 OBGYNs per 100,000 population, Botswana has only 40 OBGYNs for a population of 2.3 million. We describe the development of the first OBGYN Master of Medicine (MMed) training programme in Botswana to address this human resource shortage.MethodsWe developed a 4-year OBGYN MMed programme at the University of Botswana (UB) using the Kern’s approach. In-line with UB MMed standards, the programme includes clinical apprenticeship training complemented by didactic and research requirements. We benchmarked curriculum content, learning outcomes, competencies, assessment strategies and research requirements with regional and international programmes. We engaged relevant local stakeholders and developed international collaborations to support in-country subspecialty training.ResultsThe OBGYN MMed curriculum was completed and approved by all relevant UB bodies within ten months during which time additional staff were recruited and programme financing was assured. The programme was advertised immediately; 26 candidates applied for four positions, and all selected candidates accepted. The programme was launched in January 2020 with government salary support of all residents. The clinical rotations and curricular development have been rolled out successfully. The first round of continuous assessment of residents was performed and internal programme evaluation was conducted. The national accreditation process was initiated.ConclusionTraining OBGYNs in-country has many benefits to health systems in SSA. Curricula can be adjusted to local resource context yet achieve international standards through thoughtful design and purposeful collaborations.
Highlights
The learning outcomes, corresponding curriculum and assessment strategy for the Obstetrics and Gynaecology (OBGYN) Master of Medicine (MMed) programme was intensively prepared in three months and finalized by the OBGYN Department in March 2019 (Table 2)
The University of Botswana (UB) Senate and Council approved the programme in August and October 2019, respectively
Concurrent with the programme approval process, key faculty were recruited, including an Amercian gynaecologic oncologist as Head of Department, a South African professor to lead research training, and a Motswana OBGYN who had been sponsored by UB to train in South Africa, increasing total OBGYN specialist staff from 4 to 7
Summary
The global burden of maternal morbidity and mortality falls disproportionately on low- and middle-income countries (LMICs), and women bear the greatest burden of limited access to comprehensive health services [1, 2]. Surgical access for obstetric emergencies, reproductive health problems, and gynaecologic malignancies in LMICs falls far short of international targets [3]. One contributing factor to disproportionate access in sub-Saharan African countries is limited in-country specialty training opportunities [6, 7]. The Lancet Commission for Global Surgery recommends a ratio of at least 20 OBGYNs per 100,000 population [8]. When post-specialization employment opportunities exist, specialist retention enhances clinical care, improves local leadership, and for OBGYNs, contributes to maternal mortality reduction [11, 12]
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