Anesthetic Care in Mozambique

Lyon, Camila; Merchant, Amina; Schwalbach, T.; Pinto, Emilia; Jeque, Emilia; McQueen, Kelly

doi:10.1213/ane.0000000000001223

Cited by 13 publications

(9 citation statements)

References 10 publications

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“…The EDL implementation barriers reported include improper staff training to provide laboratory tests 96 and health workers’ knowledge gaps, and lack of training 97 . Similar education system-related barriers are reported in EML studies 35, 49, 66, 106, 116, 125, 134, 138, 179 . Other barriers unique to the EML included lack of specialized training 116, 125, 138 , lack of training in the use of economic evidence essential in the selection of medicines 66 , and lack of educators to train the health workforce 134 .…”

Section: Resultssupporting

confidence: 78%

“…Similar education system-related barriers are reported in EML studies 116,125,138,35,49,106,134,179,66,134 . Other barriers unique to the EML included lack of specialized training 116,125,138 , lack of training in the use of economic evidence essential in the selection of medicines 66 , and lack of educators to train the health workforce 134 .…”

Section: Education Systemsupporting

confidence: 75%

“…The accessibility of care related-enablers for the implementation of both the EDL 96, 98, 103 and EML 48, 50, 53, 57, 64, 68, 69, 79, 83–85, 87, 104, 128, 133, 134 , are opposite to the barriers listed above.…”

Section: Resultsmentioning

confidence: 93%

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Implementing essential diagnostics-learning from essential medicines: A scoping review

Nyanchoka

Mulaku

Nyagol

et al. 2022

Preprint

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Background The World Health Organization (WHO) model list of Essential In vitro Diagnostic (EDL) introduced in 2018 complements the established Essential Medicines List (EML) and improves its impact on advancing universal health coverage and better health outcomes. We conducted a scoping review of the literature on the implementation of the WHO essential lists in Africa to inform the implementation of the recently introduced EDL. Methods We searched eight electronic databases for studies reporting on the implementation of the WHO EDL and EML in Africa. Two authors independently conducted study selection and data extraction, with disagreements resolved through discussion. We used the Supporting the Use of Research Evidence (SURE) framework to extract themes and synthesized findings using thematic content analysis. We used the Mixed Method Appraisal Tool (MMAT) version 2018 to assess the quality of included studies where applicable. Results We included 172 studies reporting on EDL and EML after screening 3,813 articles titles and abstracts and 1,545 full-text papers. Most (75%, n=129) included studies were purely quantitative in design comprising descriptive cross-sectional designs (60%, n=104), 15% (n=26) were purely qualitative, and 10% (n=17) had mixed-methods approaches. There were no qualitative or randomised experimental studies about the EDL. The main barrier facing the EML and EDL was poorly equipped health facilities - including unavailability or stock-outs of essential in vitro diagnostics and medicines and inadequate infrastructure to enable health service delivery. Financial and non-financial incentives to health facilities and workers were a key enabler to the implementation of the EML however, their impact differed from one context to another. Fifty-six (33%) of the included studies were of high quality. Conclusions The EDL implementation at the national level can learn from health system interventions to improve the availability and supply of essential medicines such as financial and non-financial incentives in different contexts.

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Section: Resultssupporting

confidence: 78%

Section: Education Systemsupporting

confidence: 75%

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Implementing essential diagnostics-learning from essential medicines: A scoping review

Nyanchoka

Mulaku

Nyagol

et al. 2022

Preprint

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“…Notable exceptions include a small number of narrative accounts of specific programmes which provide insight into their designed or intended structure and curricula,7–9 and surveys of graduates which employed a quantitative approach to describe the efficacy of training in Ghana10 and Sierra Leone 11. Qualitative research in the field is even more scarce,12 13 although the potential of this approach has been recognised4 and may be particularly valuable in capturing unintended and latent outcomes of training14: for example, while some challenges to the provision of safe anaesthesia are now quite well documented (such as equipment scarcity), the reflections of NPAPs themselves on how they are trained have not so far been examined in depth.…”

Section: Introductionmentioning

confidence: 99%

Training non-physician anaesthetists in sub-Saharan Africa: a qualitative investigation of providers’ perspectives

et al. 2019

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ObjectivesTo explore the views of non-physician anaesthesia providers (NPAPs) and their colleagues regarding the effectiveness of NPAP training programmes in three contrasting sub-Saharan African countries.DesignThis was a qualitative exploratory descriptive study. Semistructured interviews were conducted online, recorded, transcribed and analysed thematically using NVivo.SettingParticipants’ homes or workplaces in Sierra Leone, Somaliland and Uganda.Participants15 NPAPs, physician anaesthetists and surgeons working in the countries concerned.ResultsThree major themes were identified: (1) discrepancy between urban training and rural practice, (2) prominent development of attitudes outside the curricular set during training, including approaches to learning and clinical responsibility and (3) the importance of interprofessional relationships developed during training for later practice.ConclusionsAnaesthesia providers in different cadres and very different country contexts in sub-Saharan Africa describe common themes in training which appear to be significant for their later practice. Not all these issues are explicitly planned for in current training programmes, although they are important in the view of providers. Subsequent programme development should consider these themes with a view to enhancing the safety and quality of anaesthesia practice in this context.

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“…The initial multidisciplinary team consisted of 2 anesthesiologists, 1 neurologist, 1 psychologist, 1 social worker, 2 nurses and 1 administrative officer. [10][11][12] In September 2019, the PC Service opened at the Pain Unit. Itarised in response to the progressive increase of the oncologic patients who needed total pain and suffering relief in our Pain Unit.…”

Section: The Pain Unit´s Historymentioning

confidence: 99%

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2021

HPMIJ

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In 1996, the World Health Organization established four necessary measures for the development of PC (you have already put short name) focusing on public health: 1) a government policy that ensures the integration of PC into the structure and financing of the National Health System; 2) an educational policy that responds to the training of volunteer, family caregiver, media, healthcare providers, trainees, palliative care experts, health professionals and the publiccurricula and courses; 3) a drug policy that ensures the availability of essential drugs for the management of pain and other psychological symptoms and disorders, in particular opioid analgesics and 4) a policy for research into assessing the needs for palliative care and identifying standards and models of service that work, particularly in limited resource settings. 1 Access to health care is a major challenge in low-and middleincome countries. According to the World Hospice and Palliative Care Alliance (WHPCA), the majority of people living with HIV/AIDS who need palliative care are in Africa with 78% of adult patients. 2 PC is limited in Africa, however countries such as Uganda, South Africa and Kenya top the list with the largest number of hospice specialistsand hospices. 3

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Anesthetic Care in Mozambique

Abstract: Mozambique has a strong health system design but few resources for surgery and safe anesthesia. At present, similar to other LICs, human resources, access to essential medicines, and safety monitoring limit safe anesthesia in Mozambique.

Cited by 13 publications

References 10 publications

Implementing essential diagnostics-learning from essential medicines: A scoping review

Implementing essential diagnostics-learning from essential medicines: A scoping review

Training non-physician anaesthetists in sub-Saharan Africa: a qualitative investigation of providers’ perspectives

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