State of global health

The challenges facing anaesthetists and surgeons in many low-income countries include a critical shortage of trained providers (both physician and non-physician), poor facilities and a lack of essential drugs, equipment and supplies. The result is severely restricted access to essential services. There has been very little progress towards the Millennium Development Goal 4 (MDG4) to reduce child mortality and MDG 5 to reduce maternal mortality: safe anaesthesia and basic intensive care of the acutely ill mother have an essential role.

  • In terms of disability-adjusted life years, surgical conditions account for 11% of the global burden of disease. Approximately two billion people worldwide do not have proper access to functional surgical facilities – this is a global public health crisis.
  • The deficit in operating theatre provision in many countries is huge. In high income countries there are >14 operating theatres per 100 000 population; in sub Saharan Africa <2 operating theatres per 100 000 population. More than 77,000 operating theatres do not have access to a pulse oximeter, equivalent to over 30 million operations performed worldwide annually without basic safe monitoring.
  • Anaesthetists have an important role in treating all the major causes of maternal death (haemorrhage, sepsis, obstructed labour, uterine rupture, hypertensive disease in pregnancy) - all are preventable.
  • The world average maternal mortality rate is 400 maternal deaths per 100,000 live births. The vast majority of maternal deaths occur in middle- and low-income countries and the MMR is as high as 1000 per 100 000 live births in some countries. The lifetime risk of death during pregnancy is 1 in 6 in Sierra Leone, 1 in 16 across sub-Saharan Africa and 1 in 9,000 in the UK.
  • There is a desperate shortage of anaesthetists across the world; there are some countries with no medically qualified anaesthetists, and in many, there is an inequitable distribution, with few anaesthetists working at district level where the essential public health is provided. Sub-specialty anaesthesia programmes, even in urban centres, are few.
  • Nurse anaesthetic programmes have been developed to make up some of the deficit - some are extensive and sustained, others sporadic and poorly supported. Sustained access to adequate equipment and regular professional education is essential to maintain safe provision of anaesthesia by these essential health-workers.
  • District hospitals are the cornerstone of secondary healthcare and have been broadly neglected in funding priorities: anaesthesia is a cross cutting specialty and supporting anaesthetists at district hospital level supports essential health workers who provide direct care for obstetrics, safe surgery, mothers, children and any emergency patient.

The AAGBI, through the International Relations Committee, has been working to support these hard pressed, isolated anaesthetists across the world in their efforts to provide safe anaesthesia.