In rural South Africa, Malawi, and Zambia, community health workers and indigenous healers will screen their neighbours for hernias, fractures, and other treatable surgical conditions and refer them to formal care. This matters because the AfroSurg network has documented that rural Africans are far less likely than urban residents to receive surgery when they need it, even though millions die or become disabled from conditions that are straightforward to operate on. The gap is not a lack of surgeons alone—it is a failure of awareness and referral. People often do not recognise their condition as treatable, or they cannot navigate the path to a hospital. The researchers will co-create screening tools, referral mechanisms, and training programmes with local practitioners and community members. If successful, these strategies could cut the delay between first symptoms and treatment, reduce preventable deaths and disability, and shrink the stark health inequality between rural and urban communities. The project is designed for scale: if the approach works in three countries, the team plans to roll it out across the full AfroSurg network of 16 Southern African nations.
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Millions of people worldwide get sick or die from conditions that are treatable by surgery, the majority of whom live in Africa. In our AfroSurg network we found that people living in rural areas are less likely than those in cities to get surgical care when needed; novel solutions are needed to reach those that need treatment. Indigenous practitioners and community health workers are members of rural communities who can potentially sensitise persons with surgical conditions about their disease and refer them into formal medical care. We propose to co-create strategies with these groups in AfroSurg countries, South Africa, Malawi, and Zambia, to improve access to surgical care for rural persons. We will build surgical community networks of stakeholders to discover reasons for delays to care, create screening tools and referral mechanisms, and develop trainings to address these issues. Our proposal is important because we will work directly with the community and front-line health workers to develop solutions together. Direct beneficiaries of improved access to surgical care will be communities, patients, healthcare providers, and policymakers in these countries. The proposal has the potential to improve health and well-being and reduce inequality between rural and urban communities leading to more productive and resilient societies. If solutions are judged to be transferable, we plan to assess how to scale-up amongst the rest of the AfroSurg network - which now spans 16 countries in Southern Africa - and maximise impact for patients, communities, and countries.
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