The first pediatric emergency and critical care fellowship in sub-Saharan Africa: investing in local leaders to build subspecialty capacity in low- and middle-income countries.

Nearly 7 million children die annually worldwide mostly in the global South predominantly from treatable conditions. Pediatric emergency and critical care (PECC) systems are critically underdeveloped across low- and middle-income countries (LMICs), where healthcare worker shortages, limited infrastructure, and delayed presentation contribute to high rates of early in-hospital deaths. Investment in locally trained PECC physician leaders is essential to building sustainable subspecialty capacity in the region. In 2019, the University of Nairobi (UoN), in partnership with Kenyatta National Hospital (KNH), AIC Kijabe Hospital (AIC KH), the University of Washington (UW), and Seattle Children's Hospital (SCH), established the first PECC fellowship program in sub-Saharan Africa (SSA). Curriculum development followed a modified Kern framework, contextualized for the East African setting. The two-year program integrates core clinical rotations, online asynchronous learning modules, virtual lectures from global faculty, quarterly in-person simulation-based intensive weeks, and training in research, quality improvement, and leadership. To date, 14 fellows from 5 countries have graduated. All graduates are practicing in SSA; 82% work in public facilities, and 64% are the only PECC-trained physicians at their institution. Fellow satisfaction surveys indicate strong ratings for clinical exposure, supervision, and leadership training. Both training sites have expanded their critical care infrastructure. The PECC-Kenya fellowship demonstrates that rigorous, locally anchored subspecialty training in PECC is achievable in a resource-limited setting through sustained global partnership. This model may serve as a replicable blueprint for building pediatric emergency and critical care capacity across SSA and other LMICs.