Advancing workforce capacity through collaborative surgical training in low and middle-income countries

The severe shortage of trained surgical, obstetric, and anesthesia (SOA) providers remains a fundamental barrier to safe surgical care in Low- and Middle-Income Countries (LMICs). This narrative review examines collaborative training interventions like North–South, South–South, digital, and task-sharing models for SOA providers in low-resource settings. It outlines the status of surgical training in LMICs, discusses major barriers to equitable workforce strengthening, and presents collaborative models for sustainable capacity development. The review draws on published literature and representative case studies to analyze the formation and effectiveness of surgical training partnerships. A total of 94 peer-reviewed studies (search window Jan 1, 2005–Mar 31, 2025; last search Apr 1, 2025) were included and critically appraised using the Joanna Briggs Institute (JBI) checklists. Where outcomes were reported, programs demonstrated measurable gains. For example, the College of Surgeons of East, Central, and Southern Africa (COSECSA), in collaboration with the Pan-African Academy of Christian Surgeons (PAACS), has demonstrated high regional retention rates, with PAACS reporting up to 95% retention of graduates, while task-sharing initiatives have expanded access to safe, essential surgical procedures in underserved areas. Beyond Africa, similar collaborative models have been implemented in other LMIC regions. In Asia, an India-based consortium successfully transferred a pediatric surgery training program to African partner institutions, exemplifying a South–South leadership and capacity development model. In Southeast Asia, the Association of Southeast Asian Nations (ASEAN) Surgical Consortium has worked to harmonize surgical training standards and resources across member states, reflecting regional efforts to strengthen workforce capacity. The future application of novel education tools, such as tele-mentoring, simulation, and virtual reality, is considered to overcome geographical and resource constraints. Case examples of collaborative surgical training initiatives are also discussed, including the College of Surgeons of East, Central, and Southern Africa (COSECSA); the Program in Global Surgery and Social Change (PGSSC); and the COST-Africa (Clinical Officer Surgical Training in Africa) and SURG-Africa programs. COST-Africa was implemented through collaboration between the Royal College of Surgeons in Ireland and national partners in Malawi and Zambia. SURG-Africa represents a broader multinational partnership involving the Royal College of Surgeons in Ireland, the Tanzania Surgical Association, the University of Malawi (College of Medicine), the Surgical Society of Zambia, Radboud University Medical Centre (Netherlands), the University of Oxford (UK), the East, Central and Southern Africa Health Community (ECSA-HC), COSECSA, and the Ministries of Health in Malawi, Tanzania, and Zambia. Some of the structural and ethical challenges highlighted in the review include power imbalances, donor dependence, absence of reciprocity, and brain drain. This review highlights the importance of context-sensitive policy integration, national surgical planning, and locally driven capacity building. It provides guidelines for enacting equitable governance structures, aligning partnerships with national health priorities, ensuring sustainability through local ownership, and monitoring training outcomes. In conclusion, sustainable surgical training in LMICs requires a shift from mission-based initiatives to inclusive, equitable, and long-term partnerships that enhance local health systems. Increasing surgical capacity in LMICs is integral to global health equity and should be included in national health strategies, supported by international collaboration and innovation.