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

Justine Davies, Eric Vreede, Bisola Onajin-Obembe, Wayne W Morriss

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14 Citations (Scopus)
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Introduction The 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
Methods Utilising 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.
Results We 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.
Conclusion Four 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.
Original languageEnglish
Article numbere001005
JournalBMJ Global Health
Issue number6
Publication statusPublished - 1 Dec 2018


  • Anaesthesia
  • Global Health
  • Global Surgery


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