New Anaesthesia Workforce Map shows huge shortages impacting 5 billion people worldwide

May 24, 2017

Today the World Federation of Societies of Anaesthesiologists (WFSA) officially launched a landmark online resource tool mapping the total number of anaesthesia providers worldwide. A high number of countries reported a total anaesthesia provider number of less than 5 per 100,000 population, highlighting the current crisis in the surgical and anaesthesia workforce that has left 5 billion people without access to safe and affordable anaesthesia and surgical care [1].

The WFSA conducted a global workforce survey during 2015-2016, sending member societies a list of information required and a link to an online survey, as well as collecting information from anaesthesiologists during international conferences and contacting anaesthesia providers working in non-WFSA-member countries.

Recent seminal papers have highlighted major discrepancies in the provision of safe anaesthesia and surgery worldwide [1, 2]. The Lancet Commission on Global Surgery estimated that 5 billion of the world's 7 billion people do not have access to safe, affordable anaesthesia and surgical care when needed [1]. As the essential role of anaesthesia in the provision of surgical care is not always understood by decision makers, the development of anaesthesia has often been given a lower priority than the development of surgery per se in the global health agenda.

However, on 22nd May 2015 the World Health Assembly passed the ground-breaking Resolution 68.15 entitled "Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage"[3]; a potential game-changer for the 5 billion people without access.

The online resource tool announced today, which shows data for countries representing more than 7 billion people, highlights the huge shortage in anaesthesia workforce worldwide and also highlights the gap between the rich and poor. There is a large difference between the average anaesthesia provider workforce densities in high income countries compared with low income countries.

For example, there is a 35-fold difference between the anaesthesia provider workforce density in Germany compared with the Democratic Republic of Congo, and a 50-fold difference between the workforce density in the United States compared with Indonesia, despite comparable population sizes. While the United States has more than 100,000 anaesthesia providers, Indonesia has only 1,950 to serve the whole population of 323.9 million and 258.3 million respectively.

Of the countries reporting a total anaesthesia provider number of less than 6 per 100,000 population, none are in the North American or European regions. Instead, most are located in Sub-Saharan Africa, the West Pacific, the Caribbean, Central America and South America, South East Asia, North Africa, the Middle East and West Asia, where many countries and regions face anaesthesia and surgical workforce shortages.

"The crisis in anaesthesia is perhaps most apparent in terms of workforce. Safe anaesthesia requires a trained provider and yet across large parts of Sub-Saharan Africa, South-East Asia, and beyond, ratios of far less than 1 trained provider per 100,000 population are commonplace. In high income countries we are used to ratios of 20 per 100,000 or higher, and we experience very low mortality from anaesthesia, yet in low income countries we actually have examples of there being 1,000 times fewer trained providers and 1,000 times higher mortality rates. It's wrong." Julian Gore-Booth, WFSA Chief Executive, explained.

Dr Wayne Morriss, Director of Programmes at the WFSA, shared the significance of the findings: "We know that there is a problem, and we know that there is a solution. Anaesthesia provision is affordable with research from the World Bank highlighting a return on investment as high as ten to one [2]. The map shows that substantial investment in educating anaesthesia providers is required as soon as possible, and the WFSA is well placed to work with the WHO, its own member societies, other specialist medical organisations, governments, NGOs and country level health systems to correct the workforce gap and achieve safe anaesthesia for all by 2030."

The WFSA Global Anaesthesia Workforce Map is being presented at an open event in the Geneva Press Club at 16.00 on Wednesday 24th May 2017 and will be available online from 09.00 BST on 24th May at http://www.wfsahq.org/workforce-map.
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References

[1] Meara JG, Leather AJ, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 2015; 386:569-624.

[2] World Bank. Disease Control Priorities, Third Edition, Volume 1: Essential Surgery. Available at: http://dcp-3.org/surgery. doi:10.1596/978-1-4648-0346-8.

[3] WHA Resolution 68.15. Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage. World Health Assembly, Geneva, May 2015. Available at: http://apps.who.int/medicinedocs/documents/s21904en/s21904en.pdf. Accessed December 29, 2016.

World Federation of Societies of Anaesthesiologists

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