Improving Anesthesia Safety in Low-Income Regions of the World

Abstract

Safe anesthesia is dependent on a skilled clinician, a functioning anesthesia machine, monitoring equipment, drugs and a healthcare facility with support services and staff. In high-income regions we expect a quality service with excellent levels of safety. In low-income countries, competition for healthcare resources is significant, and surgery has been neglected as a component of public health services. Anesthesia is relatively expensive because of the high cost of imported equipment and drugs, and underinvestment is common. Small numbers of inadequately resourced providers struggle to deliver a service sometimes associated with alarmingly high mortality rates (as much as 1,000 times higher than in the best centers). These factors impact on development of the specialty and recruitment and training, creating a dangerous situation for patients. We review published data on anesthesia services in low-income regions, describe the difficulties, analyze where improvements should be prioritized and make recommendations to improve anesthesia safety in poorer regions of the world.