The Use of a Theory of Change Model to Guide the Implementation of a Comprehensive Surgical Specialty Training Program in Equatorial Guinea

Robert Memba; Juan Carlos Puyana; Martha Grayling; Carme Climent; Patrícia Martínez; Eunice Blanco; Jordi Rigueiro; David Suárez; Guillem Viscasillas; Emma Fortea; Olga Roman; Daniel Gracia; Francesc Feliu; Silvano Nve; Rosa Jorba

doi:10.5334/aogh.4477

The Use of a Theory of Change Model to Guide the Implementation of a Comprehensive Surgical Specialty Training Program in Equatorial Guinea

Ann Glob Health. 2024 Jul 16;90(1):43. doi: 10.5334/aogh.4477. eCollection 2024.

Authors

Robert Memba^{1

2

3}, Juan Carlos Puyana^{4

5}, Martha Grayling¹, Carme Climent^{1

6}, Patrícia Martínez^{1

7}, Eunice Blanco^{1

8}, Jordi Rigueiro^{1

9}, David Suárez¹, Guillem Viscasillas^{1

10}, Emma Fortea^{1

11}, Olga Roman^{1

12}, Daniel Gracia¹, Francesc Feliu^{2

3}, Silvano Nve¹³, Rosa Jorba^{2

3}

Affiliations

¹ Más Que Salud (More than Health), Non-Governmental Organization, Spain.
² General Surgery Department, University Hospital of Tarragona Joan XXIII, Spain.
³ Rovira i Virgili University (URV), Pere Virgili Institute for Health Research (IISPV).
⁴ Global Health Surgery Department, University of Pittsburgh, US.
⁵ Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin.
⁶ Pediatrics Department, University General Hospital of Catalonia, Spain.
⁷ Orthopedics and Trauma Surgery Department, Parc Taulí University Hospital, Spain.
⁸ Social Work Department, Vall d'Hebron University Hospital, Spain.
⁹ INnGEAUDIO (Innovation and Engineering for Hearing), Spain.
¹⁰ Otorhinolaryngology Department, Althaia Manresa University Healthcare Network, Spain.
¹¹ Dentistry Department, Dentalògic Dental Clinic, Spain.
¹² Gynecology and Obstetrics Department, Manacor Hospital, Spain.
¹³ Anesthesiology Department, Bata General Hospital, Equatorial Guinea.

Abstract

Background: Equatorial Guinea (EG) is located on the African west coast, with only 0.4 trained physicians per 1,000 resident population. The country has one medical school and there is no specialist training program. From 2000 to 2022, 524 doctors have received their medical degree. However, the number of national surgical specialists in the entire country is currently 42. Objective: Formación Especializada Sanitaria en Guinea Ecuatorial (FES Guinea) is a program specifically aimed at designing and implementing a long-term national surgical specialist training program. Methods: Más Que Salud (+QS), which means "More than Health" in Spanish, is a nonprofit organization leading the FES Guinea program. We used the theory of change (ToC) framework to evaluate the work accomplished and implement subsequent phases. The initial phase (A) included a needs assessment and mapping of available resources. An intermediate phase (B) started with a memorandum of understanding to implement a Train the Trainer program. The consolidation phase (C) consists of educational interventions and future advanced training projects. Findings: The ToC model allowed us an analyses of initial and intermediate phases. The needs assessments and resources mapping were executed while several scientific meetings and workshops were given. Scholarships to support specialist training abroad benefited six physicians in a diverse set of surgical disciplines. A regulatory commission to implement the FES Guinea program and the National Medical Council of EG were created. Working directly with the EG Ministry of Health, +QS codesigned a National Health Development Plan that began implementation in 2021 to continue until 2025. Conclusions: The ToC model allowed us to predict the current and future potential effects of FES Guinea on surgical workforce development in EG. This is a unique surgical training program, which combined effective initiatives spearheaded initially by an NGO that successfully incorporated both local health and academic authorities, ensuring sustainability.

Keywords: global surgery; specialist training program; surgical education; surgical trainees.

MeSH terms

Equatorial Guinea
Humans
Needs Assessment
Program Development
Program Evaluation
Specialties, Surgical* / education