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      SAFE Course Impact & Sustainability

      SAFE courses include monitoring and evaluation as standard. Further studies have evaluated the impact of SAFE courses and report improved and sustained knowledge and skills following SAFE course training, improved confidence and motivation of participants, and positive behavioural and workplace changes.

      Publications related to SAFE include:

      • Livingston P, Evans F, Nsereko E, Nyirigira G, Ruhato P, Sargeant J, Chipp M, Enright A. Safer obstetric anesthesia through education and mentorship: a model for knowledge translation in Rwanda. Can J Anaesth 2014; 61:1–12. 
      • Enright A, Grady K, Evans F. A New Approach to Teaching Obstetric Anaesthesia in Low-Resource Areas. J Obstet Gynaecol Can 2015;37(10):880–884 
      • Sharkey E, Boyd N, Burton Z, Tumukunde J, Nabukenya M, Sipuka N, Zyambo M, Rodney G, Mndolo S, Gemechu TB, Bould D, Evans F, Kiwanuka J, Ahmed A, White M, Walker I. Safe paediatric anaesthesia project: scaling-up paediatric anaesthesia training in east and central Africa. Arch Dis Child 2017;102:A1-A2. 
      • Boyd N, Sharkey E, Nabukenya M, Tumukunde J, Sipuka N, Walker I, Byrne-Davis L. The Safer Anaesthesia from Education (SAFE) paediatric anaesthesia course: educational impact in five countries in East and Central Africa. Anaesthesia 2019; 74: 1290-1297
      • White MC, Rakotoarisoa T, Cox NH, Close KL, Kotze J, Watrous A. A Mixed-Method Design Evaluation of the SAFE Anaesthesia Course at 4 and 12-18 months After Training in the Republic of Congo and Madagascar. Anesth Analg 2019; 129:1707-1714 
      • Lilaonitkul M, Mishra S, Pritchard N, Andhoga J, Olang’ P, Kibet EB, Walker IA, Hart J, Byrne-Davis L. Mixed methods analysis of factors influencing change in clinical behaviours of non-physician anaesthetists in Kenya following obstetric anaesthesia training. Anaesthesia 2020; 75:1331-1339
      • Moore J, Morriss W, Asfaw G, Tesfaye G, Ahmed A, Walker I. The impact of the Safer Anaesthesia from Education (SAFE) obstetric anaesthesia training course in Ethiopia: A mixed methods longitudinal cohort study. Anaesth Intensive Care 2020; 48(4); 297-305 
      • Dharni N, Byrne-Davis T, Sanga E, Hart J, Shrestha AB, Gurung T, Shrestha RR, Vaidya PR, Hossain A, Lilaonitkul M, Snell D, Barrett-Chapman A, Walker I, Bull ER. Using behavioural science to explore impact and implementation of obstetric anaesthesia training in Tanzania, Nepal and Bangladesh: a qualitative evaluation study with obstetric anaesthesia providers. Psychology & Health 2023 
      • Fernandes NL, Lilaonitkul M, Subedi A, Owen MD. Global obstetric anaesthesia: bridging the gap in maternal health care inequalities through partnership in education. IJOA 2023
      • Lilaonitkul M, Zacharia A, Law TJ, Saria P, Moore J. Evaluation of practice change following SAFE obstetric courses in Tanzania: a prospective cohort study. Anaesthesia 2023
      • Nabukenya MT, Newton MW, Gray RM, Kapoor I, Kuratani N, Moore J, Rai E, Evan FM. The role of collaboration in educating the global pediatric anesthesia workforce. Pediatric Anesthesia 2024


      Although SAFE courses can be run as standalone training, courses are often run in collaboration with national societies, educational institutions, health authorities, existing partnerships or as components of larger projects. This approach, along with the incorporation of the SAFE Train the Trainers course, contributes to building sustainability.

      Several courses have been locally driven and delivered independently. External support from international administration and faculty is offered to support local faculty in doing this when required or requested.

      As the SAFE initiative expands, further models of training are being developed and piloted to strengthen the impact and sustainability of SAFE. These include:

      • Adaptations to create context specific courses for delivery in specific regions or countries
      • SAFE course follow-up short refreshers and commitment to change workshops
      • SAFE on-site training and mentorship programs
      • Incorporation into national anaesthesia curricula or other training programmes
      • Combining SAFE modules or courses with other short courses
      • SAFE Online