Anesthesia Health System Capacities in Public Hospitals of Punjab, Pakistan

Shahbaz, Sumbal; Zakar, Rubeena; Fischer, Florian

doi:10.1177/00469580211059740

Cited by 5 publications

(11 citation statements)

References 32 publications

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“…No sources covered any country fully and consultants in most countries were concentrated in city centres [ 26 ]. Thus, the situation was likely worse in rural, hard-to-reach, and insecure or conflict-affected areas [ 6 ].…”

Section: Resultsmentioning

confidence: 99%

Anaesthesia delivery systems in low and lower-middle-income Asian countries: A scoping review of capacity and effectiveness

Shahbaz,

Howard

2024

PLOS Glob Public Health

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Literature on anaesthesia systems in low and lower middle-income countries is limited, focused on the Africa region, and provides minimal data on anaesthesia or associated disciplines within intensive care, pain management and emergency medicine. We thus conducted a scoping review of primary and secondary research literature on capacity and effectiveness of anaesthesia delivery in low and lower middle-income countries in the Asia region from 2000–2021, to clarify existing knowledge, important gaps, and possible subsequent steps. We applied Arksey and O’Malley’s scoping literature review method to search five databases (i.e. EMBASE, CINAHL, Medline, Scopus, Web of Science), screen, extract, and synthesise data under three themes: (i) availability and type of anaesthesia workforce; (ii) anaesthesia system infrastructure, equipment, and supplies; and (iii) effectiveness of anaesthesia provision. We included 25 eligible sources of 603 identified. Only ten (40%) were published in the last 5 years and Asian lower-income countries were primarily represented in 15 multi-country sources. Fifteen (60%) sources used quantitative methods and provided limited information on data collection, e.g. sampling criteria or geographic areas included. No sources included countrywide data, despite anaesthesia delivery and resources differing significantly sub-nationally (e.g. central versus rural/remote, or insecure areas). Data on anaesthesiology delivery were limited, with findings including insufficiencies in workforce, supplies, training, and skills-building of anaesthesia personnel, along with the lack of consistent strategies for overcoming maldistribution of resources and improving anaesthesia delivery systems in the region. This review, a first attempt to synthesise existing data on anaesthesia delivery systems in low and lower-middle-income Asian countries, shows the anaesthesia literature is still limited. Findings highlight the urgent need for additional research and collaboration nationally and regionally to strengthen anaesthesia delivery and surgical facilities in resource-constrained settings.

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Section: Resultsmentioning

confidence: 99%

Anaesthesia delivery systems in low and lower-middle-income Asian countries: A scoping review of capacity and effectiveness

Shahbaz,

Howard

2024

PLOS Glob Public Health

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“…The copyright holder for this preprint this version posted April 17, 2023. ; https://doi.org/10.1101/2023.04.13.23288520 doi: medRxiv preprint robust internal systems, but the lack of follow-up and external accountability is worrisome (4,33). Quality is a two-way process, and practicing anaesthetists must feel empowered to report it to HCC for necessary actions if quality is not maintained by hospitals, as this will affect their patients (34).…”

Section: (Which Was Not Certified By Peer Review)mentioning

confidence: 99%

“…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).…”

Section: Discrepancies Between Specialitiesmentioning

confidence: 99%

“…This is worsened in peripheral areas as non-physician anaesthetists are not allowed to practice due to insufficient legislation and ongoing biases (39,40). Although allied health professionals have participated effectively in anaesthesia provision elsewhere, their numbers in Punjab are negligible (4).…”

Section: Discrepancies Between Specialitiesmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Shahbaz

Zakar

Howard

2023

Preprint

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Background Anaesthesia delivery in Pakistan remains limited to conventional intraoperative procedures, with research showing ongoing challenges in quality and resourcing. We aimed to identify systemic challenges in the delivery of quality anaesthesia services for surgical support in Pakistan’s Punjab province. Methods This qualitative study included 22 semi-structured interviews with purposively selected anaesthesia system experts in Punjab province, including heads of teaching hospital anaesthesia departments, healthcare commission representatives, and health department officials. We analysed data thematically, using deductive and inductive coding. Results We identified three themes of anaesthetist recruitment and retention, quality-of-care and in-service training, and discrepancies between specialities, describing major challenges experienced within the speciality. Findings indicated that workforce shortages and maldistribution, insufficient in-service training and standards, inadequate equipment maintenance, and lack of anaesthesia representation in decision-making compromised anaesthesia provision quality and safety. Conclusions Improving anaesthesia provision in Punjab would require increasing physician and non-physician anaesthetist numbers and rotation to peripheral postings, strengthening training quality, and ensuring availability of minimum essential equipment and supplies. To achieve essential anaesthesia provision standards, policy interventions are needed to, for example, balance anaesthesiologist and surgeon numbers, require that anaesthesiology graduates work a few years in-country (e.g. scholarship bonds), ensure in-service training attendance for skills updates, and implement quality assurance standards for equipment and supplies.

show abstract

Anaesthesia delivery systems in low and lower-middle-income Asian countries: a scoping review of capacity and effectiveness

Shahbaz

Howard

2023

Preprint

View full text Add to dashboard Cite

Background Literature on anaesthesia systems in low and lower middle-income countries is limited, focused on the Africa region, and provides minimal data on anaesthesia or associated disciplines within intensive care, pain management and emergency medicine. We thus conducted a review of primary and secondary research literature on low and lower middle-income countries in the Asia region from 2000-2021, to clarify existing knowledge, important gaps, and possible subsequent steps. Methods We applied Arksey and O’Malley’s scoping literature review method to search, screen, extract, and synthesise data under three themes: (i) availability and type of anaesthesia workforce; (ii) anaesthesia system infrastructure, equipment, and supplies; and (iii) effectiveness of anaesthesia provision. Results We included 25 eligible sources of 603 identified. Only ten (40%) were published in the last 5 years and Asian lower-income countries were primarily represented in 15 multi-country sources. Fifteen (60%) sources used quantitative methods and provided limited information on data collection, e.g. sampling criteria or geographic areas included. No sources included countrywide data, despite anaesthesia delivery and resources differing significantly sub-nationally (e.g., central versus rural/remote, or insecure areas). Data on anaesthesiology delivery were limited, with findings including insufficiencies in workforce, supplies, training and skills-building of anaesthesia personnel, along with the lack of consistent strategies for overcoming maldistribution of resources and improving anaesthesia delivery systems in the region. Conclusions This review, a first attempt to synthesise existing data on anaesthesia delivery systems in low and lower-middle-income Asian countries, shows the anaesthesia literature is still limited. Findings highlight the urgent need for additional research and collaboration nationally and regionally to strengthen anaesthesia delivery and surgical facilities in resource-constrained settings.

show abstract

Anesthesia Health System Capacities in Public Hospitals of Punjab, Pakistan

Cited by 5 publications

References 32 publications

Anaesthesia delivery systems in low and lower-middle-income Asian countries: A scoping review of capacity and effectiveness

Anaesthesia delivery systems in low and lower-middle-income Asian countries: A scoping review of capacity and effectiveness

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

Anaesthesia delivery systems in low and lower-middle-income Asian countries: a scoping review of capacity and effectiveness

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