Task Specific Credentialing and Training for the Rural Surgical Workforce: A Proposal


One of the major problems in rural surgical facilities is getting qualified staff. The nursing and technical staffs do not wish to work in rural areas unless they are from the particular village or place. Their expectations in terms of salaries and perks are high and the rural surgical facilities do not have sufficient turnover to pay for them. Also the rural patients do not pay as much as the urban patients. Hence the rural surgical facilities use locally trained, insufficiently qualified personnel at their facilities. This causes legal problems and also interferes with accreditation to provide high quality surgical care.

In addition to the fact that the locally trained person is less qualified, they are often better in the tasks they perform. The surgeons prefer working with them as they have trained them and often both can learn together with the experience.

One way of encouraging the rural surgical facilities to improve the quality would be to legalize the workforce by giving them task specific training and credentialing. We describe a suggested proposal for such training and credentialing.


1. THE TRAINING AND CREDENTIALING AGENCY [T & C AGENCY]: This could be a separate agency, organization or be formed by contributions from stakeholders like the rural surgery associations like the Association of Rural Surgeons of India [ARSI]. International Federation of Rural Surgeons [IFRS], Association of Rural Surgical Practitioners of Nigeria [ARSPON]. The agency should also have association with Universities that can give the certification which is valid legally. Larger International organizations like World Health Organization [WHO] and Lancet Commission on Global Health, Bethune Round Table in Canada, etc. can also be involved or give accreditation to the agency.

The agency consists of surgeons with experience in working with rural areas who are interested and are capable of training other rural surgeons and other similar nursing and technical surgical workforce. There should be technical experts from teaching institutions who are well trained in training and certification programs too. There could be a mix of full time and part time staff in the agency.

2. THE COURSES DEVELOPMENT: This is a very important part of the program where relevant sets of short courses are prepared. This would need comprehensive survey of the rural surgical facilities and feedback of what types of training are required by the rural surgical workforce. These should be approved by Universities, organizations such as Medical Council of India and the legal boards in the various countries. If the legal system is difficult and corrupt then well known Universities and organizations like WHO and Lancet Commission on Global Health can give the approvals. Involvement by rural surgeons, teaching institutions and international organizations like WHO would be necessary for the courses to be useful.

3. THE TRAINING COMPONENTS: The training can have three components. The first could be an online training program where the theory is taught. Many of the rural work-force knows only the regional language and the local rural surgeon or someone delegated by him should take the responsibility of teaching the online course.

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