The Norwegian team


CapacareSince 2009 a Norwegian team has been involved in surgical training at Masanga. After quite some preparations, discussions with key healthcare administrators at both District and Central Government level in Sierra Leone we were able to commence with our first two students in January 2011. The programme has been very well received and is conducted in collaboration with the Ministry of Health. Our objective is to increase the number of skilled healthcare staff at District Hospitals in Sierra Leone, who can perform life saving surgical and obstetrical procedures.

STP students at work

STP students at work

Our goal is to train 30 Medical Doctors (MDs) or Community Health Officers (CHOs) by 2017 and enable them to handle the most common surgical and obstetrical emergencies presenting at District Hospitals in Sierra Leone. We are using the well-accepted curriculum developed by the WHO – Integrated Management for Emergency & Essential Surgical Care.

Why increase surgical services in Sierra Leone

In 2011 a nationwide household study assessing the quantity of untreated surgical conditions found that 25 % of the respondents reported a surgical condition needing attention, while 25 % of all deaths of household members in the previous year might have been averted by timely surgical care[1]. In surgery and comprehensive emergency obstetric care, the human resource factor is an important aspect determining success or failure in the delivery of services.

The concept – surgical Task shifting

Task shifting is redistribution of tasks among health workforce teams. Specific tasks are moved, where appropriate, from highly qualified health workers to health workers with shorter training and fewer qualifications in order to make more efficient use of the available human resources for health[2].

Addressing the shortage of surgical skills

Addressing the shortage of surgical skills

A meta-analysis of six non-randomized controlled studies (16,018 women) evaluated the effectiveness of Non Physicians Clinicians carrying out caesarean section and found no significant differences compared to medical doctors for maternal- or perinatal death [3].

We believe it will be difficult to staff the District Hospitals in Sierra Leone with medical doctors. By also training non-physician clinicians we believe the chances of retention at District level will be higher. The CHOs we train have completed a three year medical training before they enter into the program and two years of work experience. The training lasts for 2 years followed by one year of housemanship. The surgical assistants will, by the time they are finished, have more than eight years of medical experience.


Exposure to acute surgical and obstetrical cases is essential when undertaking an on-the –job training initiative such as the Surgical Training Programme. To be able to utilize the scarce surgical and obstetrical resources in Sierra Leone as much as possible for capacity building we have made partners with other institutions with surgical and obstetrical resources available. Those are:

1.       Masanga Hospital, Masanga, Tonkololi

2.       Magbenthe Community Hospital, Makeni – Bombali

3.       Holy Spirit Hospital, Makeni – Bombali

4.       Gondama Referreal Center, Medecines Sans Frontieres – Bo

5.       St. John of God Hospital Magbesseneh, Lunsar – Port Loko

6.       Aberdeen Womens Clinic, Freetown

7.       Kamaqwie Presbytarian Hospital, Bombali

8.       Lion Heart Medical Center (LHMC) Yele

9.       Serabu Mission Hospital, Ärzte für die Dritte Welt – German Doctors – Bo

ResultsCapacare STP 8

Every 4 months we include 3 new students in the programme. Annually we organize 8-10 rotating teams with surgeons, anesthesiologists, obstetricians and radiologists to do short courses at Masanga Hospital. In between the rotations the students rotate between the partner hospitals where they can practice their skills under supervision of experienced colleagues.

Expected outcome

By 2017 complete training of 30 MDs/CHOs with theoretical and practical knowledge to handle 85 % of all surgical and obstetrical emergencies attending the District Hospitals in Sierra Leone outside the Western areas.

Evaluation of STP candidates

  1. Each candidate is evaluated every 6 months. The first 6 months is a trial period.
  2. On completion of the 2-year training, the candidates need to pass a written and oral exam with one internal examiner from CapaCare and two external examiners (1 surgeon and 1 gynaecologist) appointed by the MOHS.
  3. If the candidate passes the exam he or she will be offered 12 months houseman ship in Government Hospitals, covering surgery and obstetrics.

Evaluation of STP candidates

A 6-year research initiative on the outcomes of the training program is developed and funded by the Liaison Committee between the Central Norway Regional Health Authority (RHA) and the Norwegian University of Science and Technology (NTNU).

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1.            Groen, R.S., et al., Untreated surgical conditions in Sierra Leone: a cluster randomised, cross-sectional, countrywide survey. Lancet, 2012. 380(9847): p. 1082-7.

2.            World Health Organisation, Task shifting: rational redistribution of tasks among health workforce teams: global recommendations and guidelines, 2008: Geneva, Switzerland.

3.            Wilson, A., et al., A comparison of clinical officers with medical doctors on outcomes of caesarean section in the developing world: meta-analysis of controlled studies. BMJ, 2011. 342 (May13 1): p. d2600-d2600.