Transcript Training programs Education in Africa

Training Programs and
Education in Africa
Hannes Meyer 2015
Prof F E Smit
University of the Free State, Bloemfontein, South Africa
Background
1.1 billion people lives in Africa with 860 million in Sub Saharan
Africa ( World Bank 2013)
370 million below 15 years of age (43%) and 516,2 million under
25years (60%)
Under 5 mortality decreased from 90/1000 in 1990 to 48/1000 in 2013
Congenital disease 2,7 – 3,4 million born per year
48,1% of infants with congenital heart defects die
1,7 – 2,6 million children require surgery with 0,5 – 3,4 % having access
Health Expenditure in Sub Saharan Africa was 3,6% of GDP in 2013
Middle class expanded from 126 million (27%) in 1980 to 350 million
(34%) in 2013
Background
Changing epidemiology
Projected fatalities due to CVD to reach 20 million per
year in 2020 and 24 million per year by 2030
6,5 million men and 6,9 million females affected in
2000
Increased to 8,1 million men and 7,9 million women
in 2010
RHD - over 1 million in Sub Saharan Africa
Perspective
Cardiac Centers
Cardiac center per Million
Central Africa
1
1:132
East Africa
12
1:12.4
The Horn
2
1:54.4
West Africa
5
1:63.7
Southern Africa[c]
2
1:50.5
Southern Africa + RSA 37
1:2.7
North Africa
1:1.8
56
Funding Perspective - WHO 2012
USD per capita
per annum
Physicians per
1000 population
Hospital beds per
1000
populkation
World
1030
1,5
..
Euro zone
3884
3,7
5,6
High Income
4635
3,0
5,7
Low income
31
0,2
..
Middle Income
262
1,3
2,3
Sub Saharan
Africa
95
0,2
..
Funding
18
Health expenditure in Sub-Saharan African countries in 2012
16
14
Total % of GDP
12
10
8
6
4
2
0
Country
Challenges
National budgets - 15% of GDP Abaju target not reached
African funding needs to be seriously assessed and addressed self, insurance, donor and state
High percentage of state funding spend on salaries
Low operating budget, Low infra structure budget
Political will, responsibility and corruption
Outsourcing of high tech and expensive treatment to high
turnover regional units (to be identified and developed) will be
cheaper than low volume local units
Cardiac Training
Requirements
USA - 150 cases
Europe - 150 cases
Australia – 100 cases
Brazil – 100 cases
South Africa – 70 ( aiming at 100) cases
Africa – low volume units/undefined/impact of
missions on volumes
ADULT CARDIAC SURGERY - SERVICE DELIVERY AND STAFFING – 2010/11
Population
15-+80 yr
Public population
86%
GAUTENG
Pretoria Steve Biko
Medunsa
Wits
Baragwaneth
TOTAL
Activity
Per Million
8 254534
7 098899
FREE STATE
Universitas
Activity
Per Million
1 947 247
KWAZULU
NATAL
Albert Lethuli
Activity
Per Million
7 157 532
EASTERN CAPE
Port Elizabeth
Activity
Per million
4 586 976
WESTERN CAPE
Stellenbosch
UCT Groote Schuur
TOTAL
Activity
Per Million
3 749 757
NORTHERN
CAPE
MPHUMALANGA
NORTH WEST
LIMPOPO
TOTAL
764 437
2 468244
2 221010
3 624 752
TOTAL
Activity
Activity
34 774 489
Surgery Adult
Surgeons
Registrars
MO
Supernumerary
138
101
200
3
3
4
4
5
2
1
1
439
62
10
0.0014
1
11
0.0015
2
1
0.0001
0
1
0.001
0
384
0.2293
229
2
0.0012
1
2
0.0012
1
0
2
0.0012
1
418
10
68
2
2
0.0006
1
0
0.0006
1
1
0.0006
1
116
0.029
29.41
3
0.001
1
1
0.0003
0.25
2
0.001
0.5071
0
0.000
0.000
390
250
640
0.1985
199
3
6
9
0.0028
3
4
4
8
0.0025
2
0
0
0
0.000
0
2
2
0.006
1
1997
34
34
5
7
0.0668
66.7759
0.0011
1.1369
0.0011
1.1369
0.0002
0.1672
0.0002
0.2341
1 674 632
6 155 478
3 9447 99
3 224 791
657 416
2 122 690
1 910069
3 117 287
1
29 906 061
Service and development options
Private funding – medical insurance
State funding
Private Public Partnerships (PPP’s)
Donors – full or partial funding/subsidy
Out-sourcing surgery and interventions to regional
major centers and development of diagnostic
centers/expertise, peri-operative and long term care
Missions to missions +
Opportunities in the Developing
World
Cardiac Interventions – Cath lab based or surgery
Diseases - mitral stenosis, mitral regurgitation, coronary
artery disease, aorta valve, pericardial disease
Cardiac Interventionist – extended rotation in cardiology
Imaging expertise – echo- cardiography
Intensivist
Thoracic Surgery
Our Plan - 1
Training models – Team Sports, Formula 1, Airline Industry, Military
Models, Business Models
Maximum Output, highest possible level, competitive (at international
standard)
Management of Risk
Check lists
Communication skills and strategy
Personal Development (2013)
Simulators / Wet labs / Video linked wet labs
Systemic Challenges – Resource management
Our Plan - 2
Open hearts – 100 cases
More valves than coronaries – 70 /30
Use step wise training – open and close, CPB, dissection of mammary/veins
Learn to conduct the band ( integration) - check lists, communication, manage
Simulators and wet labs
Simple to complex
Monitor progress regularly – cannot catch up
Measure outcomes / International Benchmarking
Expand case volumes
Interim Actions
Political will to address health care per country determine
success. No will , no success, no sustainability.
Development of alternative funding models a priority
Medical tourism – Consider channeling to regional or
supra regional units with regional service, training,
research and development responsibility to ensure viability
Develop relationships with major units ( Regional or from
Industrialized World)
Support Missions to missions + with diagnostic and care
programs
Pre-Requisites
Standard project management/business management
principles apply (and cannot be done in isolation)
Clear Objectives – numbers /selection/service package
Training objectives and arrangements
Costs - actuarial analyses (requires information!)
Funding Mechanism and Sustainability
Ring fence funding
Strong Leadership
Planning and Execution
Perspective -1
Table 1
Regional distribution of cardiac centers with capability to perform regular open
heart operations in 2012 in North and sub-Saharan Africa
Regions
Cardiac centers (n) Cardiac center per million (n)
Africa[a]
113
1:8.5
Africa[b]
78
1:12.5
Sub‐Saharan Africa + RSA
57
1:15.1
Sub-Saharan Africa[c]
22
1:33.3
a Excluding Egypt and Sudan.
b Excluding Egypt, Sudan, and RSA.
Cardiac Surgeons (CTS Net)