The State of Anesthesia Practice in Sub-Saharan Africa: Statistics, Case Studies, and Ways Forward

BACKGROUND: There is substantial need for additional anesthesia resources in Sub-Saharan Africa. In this region of the world, maternal and surgical mortality are high. Non-coincidentally, the number of anesthesiologists and anesthesia providers is low and provision of medications and other basic supplies is lacking. This thesis aims to describe anesthesia practice in Sub-Saharan Africa using statistics and case studies, present current initiatives already in place to improve access to care, and suggest other strategies that may improve anesthesia capacity in the future. OBJECTIVE: Non-adherence to minimum guidelines from the World Federation of Societies of Anaesthesiologists (WFSA) for anesthesia practice in the areas of staffing and physical resources is associated with poor anesthesia and surgical outcomes, which could be improved by improving training programs and increasing available physical resources. METHODS: A Pubmed literature search was performed using key words. Relevant articles from these searches were retrieved and references from these articles were also examined. Websites for organizations mentioned in the articles were queried. Websites containing factual information about individual Sub-Saharan African countries were consulted. The information found was grouped by themes and presented. RESULTS: The numbers of anesthesiology providers in Sub-Saharan Africa are insufficient to provide safe anesthesia care. A lack of medications and supplies and inadequate technology, including monitoring equipment, contribute to the problem. The situation in Ghana, Mozambique, Liberia, and Rwanda helps to illustrate this problem. Initiatives such as the founding of the World Federation of Societies of Anaesthesiologists and Lifebox, as well as formalizing task-sharing, have attempted to improve the situation. Continuing to ensure that equipment adapted to the reality of the practice environment in the region and careful planning and coordinating of future humanitarian projects can help improve anesthesia care provided in the region. CONCLUSION: The current state of anesthesia in Sub-Saharan Africa is insufficient to meet population needs. The causes are multi-factorial and include issues providing adequate human and material resources. Establishing strong, coordinated humanitarian efforts on the ground is critical to addressing the problem. Reorganizing manpower to best utilize precious human resources is another way forward. Providing appropriate resources in the form of equipment and medications, as well as encouraging local research, can help provide innovative solutions for the region.