Decentralizing Burn Care: A Capacity-building Initiative For Rural District Hospitals In South Africa

Background: Burn injuries are a major global health concern in Sub-saharan Africa, with bigger central hospitals stretched beyond capacity and rural district hospitals often lacking the capacity and mandate to provide adequate care. The Basics of Burn Care Course, designed and implemented collaboratively, was developed as a pilot initiative to decentralize burn management by equipping district hospital teams with essential skills in resuscitation, wound care, and surgical procedures. This study evaluates the impact of the inaugural course and explores its potential for scalability. Methods: The first training was conducted from October 1-3, 2024, in Butterworth, Eastern Cape, in collaboration between the University of Cape Town's Division of Global Surgery, Global Surgery Amsterdam, The Burn care Trust and local district hospitals. The course featured interactive lectures, hands-on workshops, and small-group discussions in a rural hospital setting. Pre- and post-course tests measured knowledge acquisition, and feedback surveys assessed participant engagement and perceived impact. Results: Participants demonstrated a 20% increase in test scores, indicating significant knowledge gains. Feedback highlighted the course’s practical applicability, with 100% of attendees identifying an urgent need to improve burn care at their hospitals. Key challenges reported included limited resources, inadequate staffing, and referral barriers, with 60% of participants experiencing difficulty transferring burn patients to specialized centers. Additionally, 50% of district hospitals lacked essential equipment for advanced burn care. To support ongoing learning, a WhatsApp group was established for real-time case discussions with burn experts. Conclusion: The Basics of Burn Care Course successfully enhanced the skills and confidence of district hospital teams in burn management. Scaling the program through a train-the-trainer model and improved data management could further strengthen rural burn care services. This initiative provides a sustainable framework for expanding surgical training in low-resource settings, ultimately improving access to quality burn care as well as exploring innovative ways to decentralize surgical care in general.