Pioneering urogynecology fellowship training in a low resource setting, East- Africa, and its short- term impact: A mixed- methods implementation and program evaluation study

Abstract

Objective: This study describes the establishment and assesses the early outcomes of a novel urogynecology fellowship training program in a low- resource setting at Mbarara University of Science and Technology (MUST), with the aim of informing similar efforts in other low- resource settings. Methods: We conducted a mixed- methods implementation and program evaluation study. Quantitative service delivery indicators were assessed using a quasi- experimental before–after design, and qualitative data were derived from descriptive trainee narratives. The intervention consisted of a competency- based 2- year, part- time modular fellowship integrating supervised clinical and surgical apprenticeship. It blended local and international didactic instruction that required scholarly output. Fellows' competencies were assessed using the Performance- Based Assessment method from the FIGO Global Competency- Based Fistula Surgery Training Manual. Primary outcomes included changes in fellows' competencies, urogynecology surgical volumes, geographical service coverage, and research output. Quantitative outcomes were summarized descriptively, and qualitative data were analyzed using inductive thematic analysis. Results: Five fellows (four from Uganda and one from South Sudan) were selected from 22 applicants. At evaluation, fellows had completed 25% of the curriculum. Performance- based assessments demonstrated progressive improvement in fellows' clinical and surgical competencies. Training sites expanded from four to 11, and annual urogynecology surgical volume increased from 300 procedures in 2024 to 548 in 2025. Program- associated research output rose from two to eight peer- reviewed publications. Infrastructure upgrades were achieved at some of the training sites. Conclusion: The MUST urogynecology fellowship demonstrates that partnerships enable establishment of subspecialty training programs addressing workforce gaps and improving access to specialized surgical care in low- resource settings.