Barriers and facilitators to implementing a regional anesthesia service in a low-income country: a qualitative study

Abstract

Introduction Regional anesthesia is a safe alternative to general anesthesia. Despite benefits for perioperative morbidity and mortality, this technique is underutilized in low-resource settings. In response to an identified need, a regional anesthesia service was established at the University Teaching Hospital of Kigali (CHUK), Rwanda. This qualitative study investigates the factors influencing implementation of this service in a low-resource tertiary-level teaching hospital. Methods Following service establishment, we recruited 18 local staff at CHUK for in-depth interviews informed by the “Consolidated Framework for Implementation Research” (CFIR). Data were coded using an inductive approach to discover emergent themes. Results Four themes emerged during data analysis. Patient experience and outcomes: where equipment failure is frequent and medications unavailable, regional anesthesia offered clear advantages including avoidance of airway intervention, improved analgesia and recovery and cost-effective care. Professional satisfaction: morale among healthcare providers suffers when outcomes are poor. Participants were motivated to learn techniques that they believe improve patient care. Human and material shortages: clinical services are challenged by high workload and human resource shortages. Advocacy is required to solve procurement issues for regional anesthesia equipment. Local engagement for sustainability: participants emphasized the need for a locally run, sustainable service. This requires broad engagement through education of staff and long-term strategic planning to expand regional anesthesia in Rwanda. Conclusion While the establishment of regional anesthesia in Rwanda is challenged by human and resource shortages, collaboration with local stakeholders in an academic institution is pivotal to sustainability.

Point-of-Care Ultrasound: Applications in Low- and Middle-Income Countries

“…A survey of anesthesiologists in Colombia showed that only 62.7% of respondents had access to an ultrasound machine for central venous catheter placement [ 6 ]. An in-depth narrative was published about the barriers of establishing a regional anesthesia service in Rwanda [ 7 ]. In addition to a shortage of regional nerve block needles and supplies, there was a lack of adequately trained providers and local stakeholders.…”

“…Amongst others, the guide discusses considerations such as the conduction of a needs assessment, development of a local curriculum, machine management, and quality assurance. Furthermore, supply constraints, such as ultrasound gel and probe covers, limit ultrasound use in LMICs [ 7 ]. Low-cost locally funded supplies could present a more sustainable solution than infrequent and expensive external donations.…”

Regional anesthesia educational material utilization varies by World Bank income category: A mobile health application data study

“…Nearly half of the Disease Control Priorities-3 core procedures can be performed under neuraxial or regional anesthesia [ 7 ]. However, a lack of physician instructors, essential drugs, and required equipment have limited the teaching and implementation of regional anesthesia techniques in low and middle-income countries (LMIC) [ 8 ]. Limited data are available to gauge the interest in, or adoption of, peripheral nerve block (PNB) techniques in these environments.…”

Systematic review and bibliometric analysis of African anesthesia and critical care medicine research part I: hierarchy of evidence and scholarly productivity

“…Research has been used, for example, to map the workforce deficit and to identify obstacles to the development of A.C.C.M. services in Africa [5,6]. Also, research can help design, monitor, and evaluate context-specific solutions to previously identified problems [4].…”