Anesthesia Capacity of District-Level Hospitals in Malawi, Tanzania, and Zambia: A Mixed-Methods Study

Abstract

The Ministry of Health, Community Development, Gender, Elderly and Children is charged with improving the health and welfare of all Tanzanian citizens. In considering the high burden of disease due to surgically treatable conditions in the country, the MOHCDGEC in collaboration with partners has developed the first National Surgical, Obstetric and Anaesthesia Plan (NSOAP) 2018-2025, to address challenges in access to high quality surgical, obstetrics and anaesthesia (SOA) services in Tanzania. Access to safe, timely and affordable SOA care is limited for a significant proportion of Tanzanians especially those in rural areas. This lack of access is in large part due to human resources challenges. At present, of the recommended 20 physician surgeons, obstetricians and anaesthesiologists per 100,000 population, there are only a total of 0.46 per 1000,000 Tanzanians in the country making widespread access impossible. Additionally, there are factors such as limited access to surgical and anaesthesia equipment, supplies, medicines, blood and blood products and essential utilities like clean water, oxygen and electricity which exacerbate this situation. Strengthening the Tanzanian SOA system is imperative to reducing surgically preventable mortality and morbidity. Currently about 19.3% of deaths and 17 % of Disability-Adjusted Life Years (DALY) in Tanzania are attributable to diseases amenable to surgery. Surgical, Obstetric, and Anaesthesia services are critical in reducing the unacceptably high levels of maternal mortality, one of the key sustainable development goals, by making Caesarian sections, post-partum hemorrhage, uterine rupture, ectopic pregnancy and retained products of conception amongst other conditions safer for mothers. Surgery and anaesthesia is also essential in preventing deaths resulting from road traffic accidents, also one of the key sustainable development goals. Additionally, as outlined in the LCoGS, the economic benefits from preventing lives lost and averting disabilities from surgically treatable conditions will be substantial and promote economic development of our Country. The high costs of seeking and receiving surgical care often places patients at the risk of being impoverished as a result of seeking or receiving surgical care. Currently, about 66% of Tanzanians risk catastrophic expenditure and 86% risk impoverishing expenditure from seeking surgical care. Addressing all components of SOA access, including risk of impoverishment, is crucial to achieving Tanzania Vision 2025, the Global Sustainable Development Goals (SDGs) and Universal Health Coverage. This NSOAP lays out the necessary steps to improve each of the 6 major domains of the surgery, anaesthesia and obstetric health system: (a) service delivery, (b) infrastructure, (c) workforce, (d) information management and technology, (e) finance and (f) governance. It will be key to act synergistically across all of these health system building blocks to guarantee an impact. This NSOAP is designed to align with and complement existing ...

Economic Costs of Providing District- and Regional-Level Surgeries in Tanzania

“…The absence of one anaesthetist for instance could render a battalion of doctors redundant. 16 Secondly, having large numbers of clinicians at the DHs without the requisite skills induces inefficiencies. While the DHs employed several AMOs/MOs (18 at Meru, 11 at Oltrumet), only very few of them performed surgeries other than emergency CS cases encountered during on-call hours; such that less than 10% of all the surgeries at the DHs were non-CS.…”

Not a “first world problem”—Care of the anesthetist in East and Southern Africa

“…6 African anesthesia providers have unique challenges, not only in terms of human resources for health but also in terms of availability of essential drugs and equipment. [7][8][9][10][11] Outcomes differ too: Surgical patients in Africa are twice as likely to die after surgery than the global average, despite patients being younger with a lower risk profile. 12 Anesthesia-related mortality is highest in countries that have the lowest Human Development Index.…”

“…Most countries in the region have both physician and nonphysician anesthesia providers, with much diversity in terms of training: Data from 51 African countries showed 30 different pathways to become an anesthesia provider based on the point of entry to the training program, time in training, and the ultimate qualification awarded 6 . African anesthesia providers have unique challenges, not only in terms of human resources for health but also in terms of availability of essential drugs and equipment 7–11 . Outcomes differ too: Surgical patients in Africa are twice as likely to die after surgery than the global average, despite patients being younger with a lower risk profile 12 .…”

Mapping physical access to health care for older adults in sub-Saharan Africa and implications for the COVID-19 response: a cross-sectional analysis

“…Although many hospitals in sub-Saharan Africa are not able to provide mechanical ventilation, 8 , 9 other important components of care for those with severe COVID-19, such as haemodynamic support, supplemental oxygen therapy, and treatment of co-infections (eg, bacterial pneumonia), are more readily available. 10 , 11 , 12 Second, physical access to a health-care facility of any type will probably affect whether and when during the disease course individuals with COVID-19 contact the health-care system. These care-seeking decisions, in turn, have important ramifications for whether the health system is notified of COVID-19 cases and, thus, for monitoring of the pandemic, particularly in settings that are unable to carry out large-scale community-based testing for SARS-CoV-2 infections.…”