Challenges of Pediatric Anesthesia Services and Training Infrastructure in Tertiary Care Teaching Institutions in Pakistan: A Perspective From the Province of Sindh

Abstract

BACKGROUND: Pakistan is a lower middle-income country located in South Asia with a population of nearly 208 million. Sindh is its second largest province. The aim of this survey was to identify the current setup of pediatric services, staffing, equipment, and training infrastructure in the teaching hospitals of Sindh. METHODS: The survey was conducted between June 2018 and September 2018. A questionnaire was designed with input from experts and pretested. One faculty coordinator from each of 12 of the 13 teaching hospitals (7 government and 5 private) completed the form. Information was exported into Statistical Package for the Social Sciences (SPSS) version 22. Frequency and percentages were computed for all variables. Confidentiality was ensured by anonymizing the data. RESULTS: Anesthesia services are provided by consultants with either membership or fellowship in anesthesia of the College of Physicians and Surgeons of Pakistan (CPSP). All drugs on the World Health Organization (WHO) essential medication list were available, although narcotic supply was often inconsistent. Weak areas identified were absence of standardization of practice regarding premedication, preoperative laboratory testing, pain assessment, and management. No national practice guidelines exist. Pulse oximeters and capnometers were available in all private hospitals but in only 86% and 44% of the government hospitals, respectively. Some training centers were not providing the training as outlined by the CPSP criteria. CONCLUSIONS: Several gaps have been identified in the practice and training infrastructure of pediatric anesthesia. There is a need for national guidelines, standardization of protocols, provision of basic equipment, and improved supervision of trainees. One suggestion is to have combined residency programs between private and government hospitals to take advantage of the strengths of both. Recommendations by this group have been shared with all teaching hospitals and training bodies. (Anesth Analg 2022;134:653-60) KEY POINTS• Question: What are the service and training infrastructure facilities for pediatric anesthesia in Sindh province of Pakistan? • Findings: We have identified and documented several gaps in service provision and training of residents in this area. • Meaning: These data can be used to plan improvement both in service and residency training in pediatric anesthesia in the surveyed institutions.

Anaesthesia provision challenges in public hospitals of Pakistan’s Punjab province: a qualitative study of expert perspectives

“…However, anaesthesia is less visible -described by several participants as "behind the curtain" and faces major staffing shortages even in urban areas. Inter-specialty discrepancies are evident in Pakistan, as in many LMICs, which affect anaesthesia staffing and equipment investments and thus reduce quality and safety (4,5,26). This is worsened in peripheral areas as non-physician anaesthetists are not allowed to practice due to insufficient legislation and ongoing biases (39,40).…”

“…In Pakistan, surgeries are only provided in secondary and tertiary health facilities, so anaesthesia professionals only work in Tehsil (township), District, and teaching hospitals (4) in Anaesthesiology, only providing clinical services (5). Teaching hospitals train residents for degrees in anaesthesia including the two-year DA or MS in Anaesthesiology, or two-year MCPS or 4/5-year FCPS.…”

Anaesthesia provision challenges in public hospitals of Pakistan’s Punjab province: a qualitative study of expert perspectives

“…(1) academic consultant, with master of science (MS) or fellowship of the college of physicians and surgeons (FCPS) training in anaesthesia and clinical, teaching, research and administrative duties, and (2) clinical, with diploma in anaesthesiology (DA) or membership of the college of physicians and surgeons (MCPS) in anaesthesiology, only providing clinical services. 8 Teaching hospitals train residents for degrees in anaesthesia including the 2-year DA or MS in anaesthesiology or 2-year MCPS or 4/5-year FCPS. A few institutes also offer non-physician anaesthesia training.…”

“…In Pakistan, surgeries are only provided in secondary and tertiary health facilities, so anaesthesia professionals only work in tehsil (township), district and teaching hospitals 7. Anaesthesiologist are recruited in two cadres: (1) academic consultant, with master of science (MS) or fellowship of the college of physicians and surgeons (FCPS) training in anaesthesia and clinical, teaching, research and administrative duties, and (2) clinical, with diploma in anaesthesiology (DA) or membership of the college of physicians and surgeons (MCPS) in anaesthesiology, only providing clinical services 8. Teaching hospitals train residents for degrees in anaesthesia including the 2-year DA or MS in anaesthesiology or 2-year MCPS or 4/5-year FCPS.…”