Virtual surgical mentorship: a cost-efficient solution for building workforce capacity in resource limited settings

Access to safe and affordable surgical care remains a significant challenge in low-resource settings, largely due to workforce shortages and capacity constraints. In response, Jhpiego, in partnership with the World Federation of Societies of Anesthesiologists and the Makueni County Department of Health, layered a new virtual technology into its existing Obstetric Safe Surgery (OSS) Program. This combined in-person training with a digital platform (Proximie) that uses augmented reality (AR) overlays for real-time virtual mentorship and asynchronous case reviews to support both elective and emergency caesarean section (CS) procedures. To evaluate the feasibility, acceptability, and cost-efficiency of an AR-enabled digital platform for surgical mentorship to strengthen obstetric care in Kenya. A mixed methods pilot study was conducted in 2022 across five high-volume hospitals in Makueni County implementing OSS initiatives. Data were gathered through analysis of digital platform usage, structured surveys among 88 surgical team members—mentors, mentees, ICT personnel, and facility leaders—and post-CS mothers. Additional data were collected through direct observation of CS procedures and structured provider feedback to assess adherence to best practices. Economic evaluation was conducted using deterministic cost comparison and return on investment modeling to compare virtual and in-person mentoring costs over five years. The digital platform supported 180 CS procedures, with 125 cases reviewed for adherence to safe surgical standards. All mentees and mentors perceived improvements in surgical performance and teamwork; 98% of mentees perceived enhanced patient safety, and 92% reported that the platform was easy to use. Mentors had the perception that the platform strengthened the OSS mentorship model. Direct observation described variable adherence to selected to best-practice standards, highlighting areas that may warrant further quality improvement efforts. Post CS mothers showed a high level of satisfaction with 89% indicating they would recommend it to other mothers. Deterministic cost comparison and return on investment modeling showed that virtual mentoring costs were 8.31 times lower than in-person mentoring, yielding a cost-benefit ratio of 1:8.81, largely due to reduced travel and time costs. Implementation of an AR-enabled digital platform is feasible, acceptable to both providers and patients, and cost-efficient in Kenya. Although clinical effectiveness outcomes were not assessed, hybrid training models have the potential to strengthen surgical capacity in similar contexts.