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Published in: World Journal of Surgery 3/2010

Open Access 01-03-2010

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

Authors: Gerald Dubowitz, Sarah Detlefs, K. A. Kelly McQueen

Published in: World Journal of Surgery | Issue 3/2010

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Abstract

Background

The 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.

Methods

A 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.

Results

Workers 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.

Conclusions

This 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.
Literature
2.
go back to reference Chen L, Evans T, Anand S et al (2004) Human resources for health: overcoming the crisis. Lancet 364:1984–1990CrossRefPubMed Chen L, Evans T, Anand S et al (2004) Human resources for health: overcoming the crisis. Lancet 364:1984–1990CrossRefPubMed
3.
go back to reference Conway MD, Gupta S, Khajavi K (2008) Addressing Africa’s health workforce crisis. McKinsey Quart 98–105 Conway MD, Gupta S, Khajavi K (2008) Addressing Africa’s health workforce crisis. McKinsey Quart 98–105
4.
go back to reference Crisp N, Gawanas B, Sharp I (2008) Training the health workforce: scaling up, saving lives. Lancet 371:689–691CrossRefPubMed Crisp N, Gawanas B, Sharp I (2008) Training the health workforce: scaling up, saving lives. Lancet 371:689–691CrossRefPubMed
5.
go back to reference Jamison DT (2006) World Bank. Disease and mortality in Sub-Saharan Africa. World Bank, Washington, DC Jamison DT (2006) World Bank. Disease and mortality in Sub-Saharan Africa. World Bank, Washington, DC
6.
go back to reference Ozgediz D, Galukande M, Mabweijano J et al (2008) The neglect of the global surgical workforce: experience and evidence from Uganda. World J Surg 32:1208–1215CrossRefPubMed Ozgediz D, Galukande M, Mabweijano J et al (2008) The neglect of the global surgical workforce: experience and evidence from Uganda. World J Surg 32:1208–1215CrossRefPubMed
7.
go back to reference Ozgediz D, Kijjambu S, Galukande M et al (2008) Africa’s neglected surgical workforce crisis. Lancet 371:627–628CrossRefPubMed Ozgediz D, Kijjambu S, Galukande M et al (2008) Africa’s neglected surgical workforce crisis. Lancet 371:627–628CrossRefPubMed
8.
go back to reference Ozgediz D, Riviello R (2008) The “other” neglected diseases in global public health: surgical conditions in sub-Saharan Africa. PLoS Med 5:e121CrossRefPubMed Ozgediz D, Riviello R (2008) The “other” neglected diseases in global public health: surgical conditions in sub-Saharan Africa. PLoS Med 5:e121CrossRefPubMed
9.
go back to reference Ozgediz D, Riviello R, Rogers SO (2008) The surgical workforce crisis in Africa: a call to action. Bull Am Coll Surg 93:10–16PubMed Ozgediz D, Riviello R, Rogers SO (2008) The surgical workforce crisis in Africa: a call to action. Bull Am Coll Surg 93:10–16PubMed
10.
go back to reference Jamison D (2006) World Bank. Disease control priorities project. Disease control priorities in developing countries. Oxford University Press/World Bank, Washington, DC Jamison D (2006) World Bank. Disease control priorities project. Disease control priorities in developing countries. Oxford University Press/World Bank, Washington, DC
11.
go back to reference Hodges SC, Mijumbi C, Okello M et al (2007) Anaesthesia services in developing countries: defining the problems. Anaesthesia 62:4–11CrossRefPubMed Hodges SC, Mijumbi C, Okello M et al (2007) Anaesthesia services in developing countries: defining the problems. Anaesthesia 62:4–11CrossRefPubMed
12.
go back to reference Conway MD, Gupta S, Prakash S (2006) Building better partnerships for global health. McKinsey Quart Conway MD, Gupta S, Prakash S (2006) Building better partnerships for global health. McKinsey Quart
13.
go back to reference Mullan F, Frehywot S (2007) Non-physician clinicians in 47 sub-Saharan African countries. Lancet 370:2158–2163CrossRefPubMed Mullan F, Frehywot S (2007) Non-physician clinicians in 47 sub-Saharan African countries. Lancet 370:2158–2163CrossRefPubMed
14.
go back to reference Ozgediz D, Jamison D, Cherian M et al (2008) The burden of surgical conditions and access to surgical care in low- and middle-income countries. Bull WHO 86:646–647PubMed Ozgediz D, Jamison D, Cherian M et al (2008) The burden of surgical conditions and access to surgical care in low- and middle-income countries. Bull WHO 86:646–647PubMed
15.
go back to reference Jochberger S, Ismailova F, Lederer W et al (2008) Anesthesia and its allied disciplines in the developing world: a nationwide survey of the Republic of Zambia. Anesth Analg 106:942–948 table of contentsCrossRefPubMed Jochberger S, Ismailova F, Lederer W et al (2008) Anesthesia and its allied disciplines in the developing world: a nationwide survey of the Republic of Zambia. Anesth Analg 106:942–948 table of contentsCrossRefPubMed
16.
go back to reference Hansen D, Gausi SC, Merikebu M (2000) Anaesthesia in Malawi: complications and deaths. Trop Doct 30:146–149PubMed Hansen D, Gausi SC, Merikebu M (2000) Anaesthesia in Malawi: complications and deaths. Trop Doct 30:146–149PubMed
17.
go back to reference Heywood AJ, Wilson IH, Sinclair JR (1989) Perioperative mortality in Zambia. Ann R Coll Surg Engl 71:354–358PubMed Heywood AJ, Wilson IH, Sinclair JR (1989) Perioperative mortality in Zambia. Ann R Coll Surg Engl 71:354–358PubMed
18.
go back to reference Ouro-Bang’na Maman AF, Tomta K, Ahouangbevi S et al (2005) Deaths associated with anaesthesia in Togo, West Africa. Trop Doct 35:220–222CrossRefPubMed Ouro-Bang’na Maman AF, Tomta K, Ahouangbevi S et al (2005) Deaths associated with anaesthesia in Togo, West Africa. Trop Doct 35:220–222CrossRefPubMed
19.
go back to reference Walker IA, Wilson IH (2008) Anaesthesia in developing countries—a risk for patients. Lancet 371:968–969CrossRefPubMed Walker IA, Wilson IH (2008) Anaesthesia in developing countries—a risk for patients. Lancet 371:968–969CrossRefPubMed
21.
go back to reference Ozgediz D, Dunbar P, Mock C et al (2009) Bridging the gap between public health and surgery: access to surgical care in low- and middle-income countries. Bull Am Coll Surg 94:14–20PubMed Ozgediz D, Dunbar P, Mock C et al (2009) Bridging the gap between public health and surgery: access to surgical care in low- and middle-income countries. Bull Am Coll Surg 94:14–20PubMed
23.
go back to reference African Medical Research and Education Foundation (2009) Shortage of personnel hurting delivery of anaesthesia in Africa. Available at www.amref.org. Accessed 15 July 2009 African Medical Research and Education Foundation (2009) Shortage of personnel hurting delivery of anaesthesia in Africa. Available at www.​amref.​org. Accessed 15 July 2009
24.
go back to reference Egger Halbeis CB, Schubert A (2008) Staffing the operating room suite: perspectives from Europe and North America on the role of different anesthesia personnel. Anesthesiol Clin 26:637–663 viCrossRefPubMed Egger Halbeis CB, Schubert A (2008) Staffing the operating room suite: perspectives from Europe and North America on the role of different anesthesia personnel. Anesthesiol Clin 26:637–663 viCrossRefPubMed
25.
go back to reference Walker I, Wilson I, Bogod D (2007) Anaesthesia in developing countries. Anaesthesia 62(suppl 1):2–3CrossRefPubMed Walker I, Wilson I, Bogod D (2007) Anaesthesia in developing countries. Anaesthesia 62(suppl 1):2–3CrossRefPubMed
26.
go back to reference Coghlan CJ, Towey RM (1979) Anaesthesia by medical assistants (clinical officers) 25 years experience in Kenya. East Afr Med J 56:244–247PubMed Coghlan CJ, Towey RM (1979) Anaesthesia by medical assistants (clinical officers) 25 years experience in Kenya. East Afr Med J 56:244–247PubMed
27.
go back to reference Fenton PM (1991) Anaesthesia training in Malawi. Trop Doct 21:156–158PubMed Fenton PM (1991) Anaesthesia training in Malawi. Trop Doct 21:156–158PubMed
28.
go back to reference Soyannwo OA, Elegbe EO (1999) Anaesthetic manpower development in West Africa. Afr J Med Sci 28:163–165 Soyannwo OA, Elegbe EO (1999) Anaesthetic manpower development in West Africa. Afr J Med Sci 28:163–165
29.
30.
go back to reference Zimmerman M, Lee M, Retnaraj S (2008) Non-doctor anaesthesia in Nepal: developing an essential cadre. Trop Doct 38:148–150CrossRefPubMed Zimmerman M, Lee M, Retnaraj S (2008) Non-doctor anaesthesia in Nepal: developing an essential cadre. Trop Doct 38:148–150CrossRefPubMed
31.
go back to reference Organization WorldHealth (2000) Guidelines for health care equipment donations. WHO, Geneva Organization WorldHealth (2000) Guidelines for health care equipment donations. WHO, Geneva
32.
go back to reference Walker IA (2009) Con: pediatric anesthesia training in developing countries is best achieved by out of country scholarships. Paediatr Anaesth 19:45–49CrossRefPubMed Walker IA (2009) Con: pediatric anesthesia training in developing countries is best achieved by out of country scholarships. Paediatr Anaesth 19:45–49CrossRefPubMed
33.
go back to reference Wilson IH (2009) Con: anesthesia for children in the developing world should be delivered by medical anesthetists. Paediatr Anaesth 19:39–41CrossRefPubMed Wilson IH (2009) Con: anesthesia for children in the developing world should be delivered by medical anesthetists. Paediatr Anaesth 19:39–41CrossRefPubMed
34.
go back to reference Faponle AF (2002) Anaesthesia as a career—the influence of undergraduate education in a Nigerian Medical School. Niger Postgrad Med J 9:11–12PubMed Faponle AF (2002) Anaesthesia as a career—the influence of undergraduate education in a Nigerian Medical School. Niger Postgrad Med J 9:11–12PubMed
35.
go back to reference Ozgediz D, Wang J, Jayaraman S et al (2008) Surgical training and global health: initial results of a 5-year partnership with a surgical training program in a low-income country. Arch Surg 143:860–865 discussion 865CrossRefPubMed Ozgediz D, Wang J, Jayaraman S et al (2008) Surgical training and global health: initial results of a 5-year partnership with a surgical training program in a low-income country. Arch Surg 143:860–865 discussion 865CrossRefPubMed
36.
go back to reference Walker IA, Morton NS (2009) Pediatric healthcare—the role for anesthesia and critical care services in the developing world. Paediatr Anaesth 19:1–4PubMed Walker IA, Morton NS (2009) Pediatric healthcare—the role for anesthesia and critical care services in the developing world. Paediatr Anaesth 19:1–4PubMed
Metadata
Title
Global Anesthesia Workforce Crisis: A Preliminary Survey Revealing Shortages Contributing to Undesirable Outcomes and Unsafe Practices
Authors
Gerald Dubowitz
Sarah Detlefs
K. A. Kelly McQueen
Publication date
01-03-2010
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 3/2010
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-009-0229-6

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