Perioperative care capacity in East Africa: results of an Ethiopian national cross-sectional survey

Abstract

Background: Provision of safe surgery has gained focus recently. In 2015, the World Health Organization (WHO) called for the strengthening of surgical and anesthesia services as a universal health coverage component. The same year, the Ethiopian Ministry of Health (MOH) launched the “Saving Lives through Safe Surgery” initiative to prioritize and scale-up surgical services. This study provides an updated overview of perioperative facilities’ status to facilitate the identification of future focus areas. Methods: An online national cross-sectional survey was conducted in September–November 2020, incorporating elements from recognized surgical and anesthesia facility assessment tools to assess infrastructure, workforce, and availability of resources across Ethiopian government facilities. Results: Responses were received from 81/289 (28%) facilities, conducting a mean of 6.9 (range: 1–37) surgeries per day. All regions were represented. There were shortages in specialty surgical, obstetric, and anesthesiology workforce, functioning anesthesia machines, airway equipment, recommended monitoring devices, and capnography. Shortages of analgesia, anesthesia, and emergency medications were reported. Sixty-eight (84%) facilities had a postanesthetic care unit with a mean of 3.1 (range: 1–15) beds. The presence of trained nurses, oxygen, monitoring devices, equipment, medications, and postoperative care guidelines was minimal. Conclusions: This study provides an updated overview of surgical capacity in Ethiopia. Despite the expansion of surgical access, there are ongoing resource deficits. Expansion of surgical capacity should be accompanied by a similar expansion in the provision of adequately equipped and staffed postanesthetic care units and a focus on postoperative care.

Intensive Care in Sub-Saharan Africa: A National Review of the Service Status in Ethiopia

“…Defibrillators were available in 37 of 51 (73% [58-84]) of ICUs, only half (n = 26; 51% [37-65]) of ICUs had a resuscitation trolley and 9 (18% ) had access to a portable x-ray machine. Only 5 (10% [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]) had access to renal dialysis at the facility and no ICU had capacity for continuous hemofiltration. A summary of resources and equipment in facilities is shown in Table 2.…”

“…The design and structure of ICUs in Ethiopia vary; less than half (n = 23; 45% [95% CI, 31-60]) of units were located in proximity to operating, emergency, and imaging rooms. Only 3 (6% [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]) of the facilities with ICUs had a dedicated budget for critical care consumables, staffing, maintenance, and education. Around 3 quarters (n = 37; 73% [58-84]) of facilities had admission and discharge policies.…”

“…In other regions, not all ICUs had critical care physicians. Medical specialist staffing included 27 anesthesiologists (38% [26-50]), 13 (18% [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]) emergency and critical care physicians, 17 (24% ) neurologists, 6 (8% [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]) pulmonologists, 5 (7% [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]) intensivists, and 4 (6% [2]…”

“…23,24 There is an urgent need to address these shortcomings and increase the capacity of ICUs, at least to level 2 standards in each region. In the last decade, Ethiopia has made significant efforts to improve perioperative capacity 5 ; however, minimal effort has thus far been made to equip facilities with improved or level 3 critical care facilities to accompany the rise in surgical provision.…”

“… 3 , 4 To address the significant surgical burden, improvements in surgical access have been addressed through national programs, with a 10-fold increase in the number of surgeries per 100,000 people from 2012 to 2019. 5 An accompanying expansion of critical care services has not been demonstrated and there remains a paucity of data pertaining to the provision of critical care in Ethiopia, as in many low- and middle-income countries (LMICs).…”