What is the minimum number of specialist anaesthetists needed in low-income and middle-income countries?

Abstract

IntroductionThe number of specialist anaesthetists in most low-income and middle-income countries is below what is needed to provide a safe quality anaesthesia service. There are no estimates of the optimal number; therefore, we estimated the minimum density of specialist anaesthetists to achieve a reasonable standard of healthcare as indicated by the maternal mortality ratio (MMR).MethodsUtilising existing country-level data of the number of physician anaesthesia providers (PAPs), MMR and Human Development Index (HDI), we developed best-fit curves to describe the relationship between MMR and PAPs, controlling for HDI. The aim was to use this relationship to estimate the number of PAPs associated with achieving the median MMR.ResultsWe estimated that, in order to achieve a reasonable standard of healthcare, as indicated by the global median MMR, countries should aim to have at least four PAPs per 100 000 population. Existing data show that currently 80 countries have fewer than this number.ConclusionFour PAPs per 100 000 population is a modest target, but there is a need to increase training of doctors in many countries in order to train more specialist anaesthetists. It is important that this target is considered during the development of national workforce plans, even if a stepwise approach to workforce planning is chosen.

Surgical referrals in Northern Tanzania: a prospective assessment of rates, preventability, reasons and patterns

“…Currently, there are less than 50 physician anesthesia providers and about 180 nonphysician anesthesia providers for a population of 53 million people equaling 0.09 anesthesia providers per 100,000 population [34]. This density falls significantly below the recommended 4-5 physician anesthesia providers per 100,000 population [34,35]. Delays in surgical care provision resulting from a shortage of anesthesia care have been documented in Tanzania and other parts of sub-Saharan Africa [34,36,37].…”

‘Safe anaesthesia care for all’ in India – Challenges

“…[4] Another estimate, using a methodology similar to that followed by the LCoGS, recommended a minimum density of 4 of 100,000 physician anaesthesiologists. [5] This workforce gap must be filled up by well-trained non-physician anaesthesia providers (NPAPs), primarily to provide services in rural areas. [6]…”

Strengthening medical specialisation policy in low-income and middle-income countries

“…In light of this, models of specialist deployment used in high-income countries may need to be completely rethought for LMICs. For example, a recent paper on specialist anaesthetists proposed that a minimum standard in LMICs would be four specialist anaesthetists per 100 000 population 35. In Uttar Pradesh however, where there is a total of 297 specialist anaesthetists in the public sector (private sector numbers are unknown) for a population of 232 million (or 0.13 per 100 000 population) this seems like an unrealistic target.…”