Building Trauma Care Capacity in Ethiopia: A 5-Year Assessment of the Hawassa University and Multi-Institutional American College of Surgeons Health Outreach Program for Equity in Global Surgery Partnership

BACKGROUND: Traumatic injury is a significant global cause of mortality and disability with a particularly high burden in southern Ethiopia. Hawassa University Comprehensive Specialized Hospital (HUCSH) partnered with the American College of Surgeons Health Outreach Program for Equity in Global Surgery to improve access to surgical care, including trauma care. This study evaluates changes in trauma care capacity during the first 5 years of this collaboration. STUDY DESIGN: A comprehensive trauma capacity assessment was conducted at HUCSH in 2019 and repeated in 2024 using a 481-item tool designed for low-resource settings. The tool evaluates 5 major domains of trauma care: provider knowledge, infrastructure, human resources, supplies, and hospital processes, plus injury-specific and administrative categories. Each item was scored on a 0 to 3 ordinal scale during detailed hospital walkthroughs. Paired item-level comparisons were made with Wilcoxon signed-rank tests with Hodges-Lehmann estimates of change. Qualitative feedback was collected by direct observation and staff interviews. RESULTS: Scores improved in provider knowledge, infrastructure, supplies, and hospital processes, driven in part by the development of a prehospital system. Human resources showed no change and remained the lowest-scoring domain in 2024. Although administrative and process improvements were substantial, measured gains in clinical care for specific injury types were limited. Qualitative feedback aligned with these quantitative findings. CONCLUSIONS: Trauma care capacity at HUCSH, as measured by this assessment, improved during 5 years of a multi-institutional international partnership. Opportunities exist for investment in hospital infrastructure, workforce retention, and standardized clinical protocols. This model may guide capacity-building efforts in other low-resource settings, serve as a framework for iterative trauma capacity assessment, and monitor progression toward National Surgical, Obstetric, and Anesthesia Plans.