NOTSS in Low and MiddLE Income COntexts

Although NOTSS was initially developed, piloted, and implemented in high-income countries, its principles are wholly relevant to variable-resource contexts.  As surgical capacity and workforce continue to grow in low- and middle-income countries (LMICs), strategies to improve surgical education and surgical care are increasingly important worldwide. 

The original NOTSS system was initially piloted in Rwanda in 2013.  This pilot exposed a need to create a system which was more specific to contexts with variable resources.  Therefore, a novel, contextually-adapted version of NOTSS, NOTSS-VRC: Variable-Resource Contexts, was created to better address the challenges faced in Rwanda and other LMICs. 

This system was developed in Rwanda over 2013-2016 by surgeons at the University of Rwanda, in partnership with colleagues at the Center for Surgery and Public Health at the Brigham and Women’s Hospital and Harvard Medical School.  Through a rigorous process of interviews and iterations of teaching videos based on common challenges identified in Rwanda, this NOTSS system serves as a practical guide to surgeons practicing in variable-resource contexts. 

The curriculum was expanded to include all surgical team members with faculty development and training courses implemented in district general hospital sin Rwanda from 2017-2019 under funding from Johnson & Johnson/ Royal College of Surgeons of Edinburgh.

Current work is exploring methods to implement NOTSS in West Africa, and in hybrid format to scale implementation across Sub-Saharan Africa.