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Research Capacity Building Partnerships: Ptolemy and the EASI- Delphi Project
Research Capacity Building Partnerships: Ptolemy and the EASI- Delphi Project
Massey Beveridge, Office of International Surgery, University of Toronto
The Ptolemy Project and the upcoming East African Surgical Initiative Delphi Project, (EASI-Delphi) are partnerships involving the Association of Surgeons of East Africa (ASEA), the College of Surgeons of East Central and Southern Africa (COSECSA) and the University of Toronto (UofT) Office of International Surgery (OIS), that aim to build surgical research capacity in East Africa. Each addresses different aspects of research capacity building: Ptolemy provides access for African surgeons to the on-line journal and text holdings of the U of T library, and the EASI-Delphi project will draw African surgeons into a foresight exercise aimed at establishing priorities for surgical development over the next ten years in East Africa.
In Canada the surgical profession has lead the battle to reduce the burden of illness due to injury and surgical disease. We believe there is real potential to do the same in East Africa by providing African surgeons with the resources and forum they need to define and solve the problems they confront daily. Where health policy and resource allocations still focus on prevention, primary care and public health, it is up to the surgical profession to build regional surgical capacity through improved practice, teaching and research. Geographical and professional isolation, difficult communications and burden of practice have been barriers to such expansion but the current growth of internet access among African surgeons offers a new opportunity for them to engage in this process.
The Ptolemy Project provides access to contemporary, full-text medical information, both journals and texts, and a recently completed survey (to be presented at the upcoming ASEA meeting in Addis Ababa) shows that Ptolemy participants report it has made a strongly positively impact on their clinical practice, teaching and research activities. The Ptolemy model, of a large western university partnering with a professional group in the developing world and thus linking them with essential library resources, could easily be emulated by other groups and universities to help close the digital divide. A Delphi Process is a type of foresight exercise in three rounds by which a group of experts generate statements regarding the importance of issues within their fields in the first round, then in a scoring round they assess the statements for desirability and reliability, and finally in a ranking round they produce a final list of priorities. It is a widely used means of establishing research and funding priorities in healthcare research and capable of both building consensus and identifying areas of stable disagreement. We propose to combine such a Delphi process with a systematic survey of African surgeons in order to identify priorities for improving surgical care in East Africa. We hope to recruit about fifty from the membership of the ASEA, from the existing Ptolemy group and the group will include internationally regarded experts. All participants will be acknowledged in the final publication but their contributions will remain anonymous (except to the editors) to encourage free expression of ideas. The process will be conducted by email and is designed to promote ease of access with slow internet connections. We estimate that participation in this project will involve about 6 hours of participants’ time over a three-month period. Participants will receive no direct compensation but two Ptolemy Prizes will be awarded for the most valuable contributions to enable authors to travel to Toronto to attend the 2003 Bethune Round Table on International Surgery entitled, "Visions of the Future: International Surgery in 2010".
The Ptolemy Project appears already to be making a positive impact on the clinical, teaching and research work for the majority of participants. In the next year we hope to expend the service to include more participants, to make the information easier to access and to encourage other institutions to create similar partnerships to help build research capacity in Africa. The EASI-Delphi project will draw East African surgeons into a consultation process aimed at establishing priorities for surgical development in Africa over the next decade, and we hope the results will attract and direct international funding for partnerships aimed at reducing the burden of injury and surgical disease in Africa.
Priorities for Surgical Development in East Africa: Results of the East African Surgical initiative (EASI-) Delphi Process
Massey Beveridge, Kirsteen Burton, Ron Lett, Ricardo Barradas
Introduction
There is a need for systematic regional planning to improve the delivery of surgical services in east Africa where some 400 surgeons provide care to a population of more than 200 million people.
Methods
Members of the professional association representing surgeons in the region,
the Association of Surgeons of East Africa (ASEA) were recruited to participate
in a survey of practice and an iterative consensus-building exercise or
Delphi process in the attempt to identify priorities for surgical development
in the region. In the first stage a survey was sent to 31 registered participants
regarding surgical issues in East Africa. Nineteen participants completed
the entire process which involved four rounds and at least six hours work.
The results of survey were circulated to all participants who were then
asked to generate statements in response to the question, “What
actions will most reduce the burden of surgical disease in east Africa
by 2010?” Seventy-nine statements of priority were received and
after combining similar statements and eliminating frivolous comments,
60 statements were returned to the group who were asked to score both
the desirability and feasibility of each statement on a scale of one to
five. Low-scoring items were discarded and the remaining 25 statements
were returned to the participants for ranking on a scale of one to three.
The ten statements with the highest mean scores and least variance were
identified.
Results
Grouped by issue, the priorities identified were:
- Improve opportunities for continuing medical education (CME) for practicing surgeons.
- Introduce more surgical skills workshops for medical students and clinical officers.
- Involve COSECSA in surgical training as well as curriculum development and certification of surgeons.
- Provide a feedback system by which medical students and surgical trainees may evaluate their teachers.
- Recruit and train more nurses and anesthetists.
- Provide free HIV counselling and post-exposure prophylaxis for health care workers with occupational exposure
- Improve surgical resources in local hospitals so they can perform basic surgery.
- Provide or increase service and maintenance for current hospital equipment.
- Attract funding for surgical research into common diseases.
- Develop protocols and treatment logarithms for common conditions.
Conclusion
If adopted and implemented, these priorities may help the ASEA, Ministries of Health, surgical educators, hospital administrators and individual surgeons to reduce the burden of surgical disease in East Africa by 2010.