In 1996, a Steering Committee of the Association of Surgeons of East Africa (ASEA), supported by visionary surgeons who would become the Foundation Fellows of COSECSA, recognised that the quality and quantity of surgical services available to people within the region was inadequate
Training of specialist surgeons in the region was restricted to the M.Med surgery programmes (or equivalent) in University Teaching Hospitals with only limited numbers and a variable training programme. Access to training in the UK was becoming restricted and the FRCS exam was being phased out.
A fundamental need was identified to formulate a common surgical training programme, which could be undertaken in designated training institutes in the region with a common exam and the award of an internationally recognised surgical qualification. The College of Surgeons of East & Central and Southern Africa (COSECSA) was formed to fulfill this need.
The following year, the Ministers of Health of the ECSA countries, the Deans of Medical Colleges and the Commonwealth Regional Health Community Secretariat approved the College. The Royal College of Surgeons of Edinburgh assisted in setting up the training programmes and the examinations of the College later in 1997. This was followed by the preparation and publication of the college constitution and an examination syllabus to coincide with the official inauguration of the College in Nairobi in December 1999.
In December 2000, at the first Annual General Meeting in Lusaka, the Council of the College was elected by the Foundation Fellows, and the name of the College was officially changed to the College of Surgeons of East Central & Southern Africa (COSECSA) at the request of the regional Health Ministers. The COSECSA Syllabus and Constitution were prepared at that meeting. The College logo was approved at the 2002 AGM and it was agreed that the first MCS examinations would take place in 2003. FCS Examinations first took place in 2004. COSECSA established annual MCS and FCS examinations thereafter. During this period COSECSA and ASEA ran parallel AGMs/meetings and it was agreed in 2007 that the two organisation would be merged to form a single entity. A new Constitution was developed accordingly. In 2008 the RCSI COSECSA Collaboration Programme commenced, a partnership which continues to this day. The COSECSA Secretariat was formally established in Arusha, Tanzania in 2009 (within the East, Central and Southern Africa Health Community) as the administrative hub of the organisation.