Anesthesia Capacity in Ghana: A Teaching Hospital’s Resources, and the National Workforce and Education

Abstract

While important limitations to capacity exist in Ghana, the overall situation is good compared to other LMICs. Many of the challenges encountered resulted from insufficient PACU and CCU provisions and few providers. Inadequate outcomes reporting made analysis and resolution of problem areas difficult. While many shortcomings stemmed from limited funding, strengthening physician commitment to overseeing care, ensuring oxygen supplies are uninterrupted, keeping ventilators in working order, and making vital signs monitors ubiquitously available are feasible ways to increase patient safety with the tools currently in place.

Benefits and Barriers to Increasing Regional Anesthesia in Resource-Limited Settings

“…In some areas, such as parts of India and Sri Lanka, the percentage of surgery done under spinal anesthesia is reportedly greater than in some HRCs, but there are still many areas of Sub-Saharan Africa and Southeast Asia where neuraxial anesthesia would be appropriate but is not performed. 8 , 13 This is especially surprising since the basic equipment required is simple and less expensive than what is required for most general anesthetics ( Figure 1 ). The frequent lack of access to functioning anesthetic machines, basic airway equipment, capnography, neuromuscular function monitors, and even oxygen in LRCs has been well documented.…”

“…43 The crisis in human resources for anesthesia care in many LRCs is contributed to by the low standing that the profession has, especially in Sub-Saharan Africa, and the resulting problems with recruitment and retention of practitioners at all levels. 13 Encouraging a change of attitude towards the anesthesia profession is a complex problem that will take a multipronged approach and time. Collaborative assistance by international organizations and universities can help develop the educational infrastructure in LMICs to fill the provider pipeline and build capacity.…”

“…Collaborative assistance by international organizations and universities can help develop the educational infrastructure in LMICs to fill the provider pipeline and build capacity. 13 , 44 In the meantime, small steps can be made by the current workforce to make anesthesia more accessible, more rewarding, and therefore more attractive to new recruits. Greater use of regional anesthesia can be one way to safely increase anesthesia access and create enthusiasm for the field at the same time.…”

“…51 Anesthesia training has had a very low priority for many decades in LMICs, and there is a severe shortage of both medical students interested in anesthesia and trained anesthesiologists available to teach. 13 The number of medical schools and anesthesia residency programs is slowly increasing, but it will take many years to graduate enough anesthesiologists for quality subspecialty training to be possible. Task shifting with non-physician anesthetists helps with the clinical burden.…”

“Anesthesia-focused sonography”: first analysis of transferring a training from Germany to Ghana

“…10,319 anesthesia cases were performed at KATH in the year 2015, 54% of which were general anesthesia (GA) and 42% neuraxial procedures. Local infiltration anesthesia was used in 3% and RA blocks in 1%, only [18]. In the 7 months following our seminar, the number of ultrasound-assisted peripheral nerve blocks increased by 50% compared to the same period before the seminar.…”