Global Anesthesia Workforce Crisis: A Preliminary Survey Revealing Shortages Contributing to Undesirable Outcomes and Unsafe Practices

Abstract

BackgroundThe burden of disease, disability, and mortality that could be averted by surgery is growing. However, few low and middle income countries (LMICs) have the infrastructure or capacity to provide surgical services to meet this growing need. Equally, few of these countries have been assessed for key infrastructural capacity including surgical and anesthesia providers, equipment, and supplies. These assessments are critical to revealing magnitude of the evolving surgical and anesthesia workforce crisis, related morbidity and mortality, and necessary steps to mitigate the impact of the crisis.MethodsA pilot Internet-based survey was conducted to estimate per-capita anesthesia providers in LMICs. Information was obtained from e-mail respondents at national health care addresses, and from individuals working in-country on anesthesia-related projects.ResultsWorkers from 6 of 98 countries responded to direct e-mail inquiries, and an additional five responses came from individuals who were working or had worked in-country at the time of the survey. The data collected revealed that the per-capita anesthesia provider ratio in the countries surveyed was often 100 times lower than in developed countries.ConclusionsThis pilot study revealed that the number of anesthesia providers available per capita of population is markedly reduced in low and lower middle income countries compared to developed countries. As anesthesia providers are an integral part of the delivery of safe and effective surgical care, it is essential that more data is collected to fully understand the deficiencies in workforce and capacity in low and middle income countries.

Anesthesia Capacity in 22 Low and Middle Income Countries

“…Other studies have shown a disproportionate increase in death and disability due to these barriers [5][6][7][8]10]. What was surprising in our examination was the inherent complications to creating a global synopsis of anesthetic need; the vast variegations between countries and within countries call into question whether a checklist of essential equipment or a single top down approach to increasing anesthetic capacity is realistic.…”

“…In sub-Saharan Africa the majority of anaesthetics are provided by non-physician anaesthetic providers working alone, unsupervised, and with limited training [8]. The avoidable mortality rate attributable to anaesthesia in some countries is high (1:150 in Togo, 1:504 in on Central Hospital in Malawi and 1:1923 in another in Zambia) when compared to rates of 0.55 per 100,000 in the United States [9,10]. health organizations, health authorities, civil and professional societies, Non-Governmental Organizations (NGOs) and individuals committed to promoting global emergency, surgery and anesthesia care as part of primary care [11].…”

Applications of a Noninvasive Respiratory Volume Monitor for Critical Care Medicine

“…12,13 The second major concern is maintenance. 14 The RVM used works on a Microsoft (Redmond, Washington) Windows-based platform and provides an easy avenue for troubleshooting and fixing any malfunction. Additionally, technical support is available by telephone, and the practitioner may communicate via a wireless fidelity application without incurring telephone charges.…”

Taking Specialist Surgical Services to the Rural District Hospitals at One Forth Cost: A Sustainable ‘Return on Investment’ Public Health Initiative of Patan Hospital, Patan Academy of Health Sciences, Nepal

“…12 The 'insufficient, inequitable distributions' of resources in district hospital (DH) needs to be addressed to make 'ESASA' accessible to rural population. 13,14 The observation of 'operative capabilities of 78 DH in seven LMICs 'Bangladesh, Bolivia, Ethiopia, Liberia, Nicaragua, Rwanda, and Uganda' revealed alarming situation of "one surgeons and anesthetists serving up to 100,000 to one million population; inadequate infrastructure, and shortages of essential equipment".…”