An Assessment of Anesthesia Capacity in Liberia: Opportunities for Rebuilding Post-Ebola

listen audio

Study Justification:
– The health system in Liberia has been severely impacted by a civil war and the Ebola epidemic, leading to a decline in health indicators, including maternal mortality rates.
– Access to safe surgery is crucial for improving these metrics, but data on surgical and anesthesia capacity in Liberia post-Ebola are limited.
– This study aims to assess anesthesia capacity in Liberia post-Ebola as part of the development of a National Surgical, Obstetric, and Anesthesia Plan (NSOAP).
Highlights:
– The study used the World Federation of Societies of Anaesthesiologists (WFSA) Anaesthesia Facility Assessment Tool (AFAT) to survey 26 out of 32 Ministry of Health recognized hospitals in Liberia.
– Anesthesiologist and nurse anesthetist workforce densities were found to be low compared to surgeons and obstetricians/gynecologists.
– On average, each hospital had 2 functioning operating rooms, but only half had a postanesthesia care unit (PACU) and intensive care unit (ICU).
– Availability of essential medications and equipment varied across hospitals, with some not meeting the minimum World Health Organization (WHO)-WFSA standards for surgical and anesthesia care.
Recommendations:
– Further investment is needed across all domains to bridge the critical gaps in anesthesia and surgical capacity in Liberia.
– The development of an NSOAP for Liberia should consider the study results to ensure the provision of safe surgery and anesthesia.
Key Role Players:
– Ministry of Health officials
– Anesthesia department heads
– Medical directors
Cost Items for Planning Recommendations:
– Training and education programs for anesthesiologists and nurse anesthetists
– Infrastructure improvements, including the construction or renovation of operating rooms, PACUs, and ICUs
– Procurement of essential medications and equipment
– Monitoring and evaluation systems to ensure compliance with international standards

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study conducted a cross-sectional survey of 26 out of 32 Ministry of Health recognized hospitals in Liberia, which represents a significant portion of the population. The survey assessed various aspects of anesthesia capacity, including infrastructure, workforce, service delivery, medications, and equipment. The findings highlight critical gaps in anesthesia and surgical capacity in Liberia, indicating the need for further investment to meet international standards. However, the abstract does not provide specific statistical data or analysis, which could have strengthened the evidence. To improve the strength of the evidence, the study could have included a larger sample size and conducted a more comprehensive analysis of the survey data, including statistical comparisons and correlations. Additionally, providing specific recommendations for improvement based on the survey findings would enhance the actionable steps to address the identified gaps in anesthesia capacity.

BACKGROUND: The health system of Liberia, a low-income country in West Africa, was devastated by a civil war lasting from 1989 to 2003. Gains made in the post-war period were compromised by the 2014-2016 Ebola epidemic. The already fragile health system experienced worsening of health indicators, including an estimated 111% increase in the country’s maternal mortality rate post-Ebola. Access to safe surgery is necessary for improvement of these metrics, yet data on surgical and anesthesia capacity in Liberia post-Ebola are sparse. The aim of this study was to describe anesthesia capacity in Liberia post-Ebola as part of the development of a National Surgical, Obstetric, and Anesthesia Plan (NSOAP). METHODS: Using the World Federation of Societies of Anaesthesiologists (WFSA) Anaesthesia Facility Assessment Tool (AFAT), we conducted a cross-sectional survey of 26 of 32 Ministry of Health recognized hospitals that provide surgical care in Liberia. The surveyed hospitals served approximately 90% of the Liberian population. This assessment surveyed infrastructure, workforce, service delivery, information management, medications, and equipment and was performed between July and September 2019. Researchers obtained data from interviews with anesthesia department heads, medical directors and through direct site visits where possible. RESULTS: Anesthesiologist and nurse anesthetist workforce densities were 0.02 and 1.56 per 100,000 population, respectively, compared to 0.63 surgeons per 100,000 population and 0.52 obstetricians/gynecologists per 100,000 population. On average, there were 2 functioning operating rooms (ORs; OR in working condition that can be used for patient care) per hospital (standard deviation [SD] = 0.79; range, 1-3). Half of the hospitals surveyed had a postanesthesia care unit (PACU) and intensive care unit (ICU); however, only 1 hospital had mechanical ventilation capacity in the ICU. Ketamine and lidocaine were widely available. Intravenous (IV) morphine was always available in only 6 hospitals. None of the hospitals surveyed completely met the minimum World Health Organization (WHO)-WFSA standards for health care facilities where surgery and anesthesia are provided. CONCLUSIONS: Overall, we noted several critical gaps in anesthesia and surgical capacity in Liberia, in spite of the massive global response post-Ebola directed toward health system development. Further investment across all domains is necessary to attain minimum international standards and to facilitate the provision of safe surgery and anesthesia in Liberia. The study results will be considered in development of an NSOAP for Liberia.

Based on the provided information, here are some potential innovations that could be recommended to improve access to maternal health in Liberia:

1. Increase the number of trained anesthesiologists and nurse anesthetists: Address the shortage of anesthesia providers by implementing training programs and incentives to attract and retain more professionals in the field.

2. Improve infrastructure: Invest in the construction and renovation of operating rooms, postanesthesia care units (PACUs), and intensive care units (ICUs) to ensure they meet minimum international standards for surgical and anesthesia care.

3. Enhance equipment and medication availability: Ensure that hospitals have adequate supplies of essential anesthesia equipment, such as mechanical ventilation machines, and a wide range of medications, including intravenous morphine, to effectively manage maternal health emergencies.

4. Strengthen information management systems: Implement electronic medical records and data collection systems to improve the tracking and monitoring of maternal health outcomes, anesthesia utilization, and surgical procedures.

5. Develop a National Surgical, Obstetric, and Anesthesia Plan (NSOAP): Create a comprehensive plan that outlines strategies and targets for improving surgical and anesthesia capacity in Liberia, with a specific focus on maternal health. This plan should involve collaboration between the Ministry of Health, healthcare providers, and international partners.

6. Increase funding for maternal health services: Allocate more resources to maternal health programs, including anesthesia services, to ensure sustainable and equitable access to quality care for all women in Liberia.

These recommendations aim to address the critical gaps in anesthesia and surgical capacity identified in the study and contribute to the overall improvement of maternal health outcomes in Liberia.
AI Innovations Description
Based on the assessment of anesthesia capacity in Liberia post-Ebola, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Increase the workforce: Address the shortage of anesthesiologists and nurse anesthetists by implementing training programs and incentives to attract and retain skilled professionals in the field. This can be done through partnerships with medical schools and international organizations to provide specialized training and support.

2. Improve infrastructure: Invest in the development and renovation of operating rooms (ORs) in hospitals to ensure they are fully functional and equipped with necessary anesthesia and surgical equipment. Additionally, establish postanesthesia care units (PACUs) and intensive care units (ICUs) in more hospitals to provide comprehensive care for patients.

3. Enhance medication availability: Ensure a consistent and adequate supply of essential medications, such as IV morphine, to manage pain during and after childbirth. Collaborate with pharmaceutical companies and international organizations to improve the availability and affordability of these medications.

4. Strengthen information management: Implement electronic health record systems to improve data collection and management. This will enable better monitoring of maternal health indicators and facilitate evidence-based decision-making for policy development and resource allocation.

5. Collaborate with international organizations: Seek partnerships and support from international organizations, such as the World Health Organization (WHO) and the World Federation of Societies of Anaesthesiologists (WFSA), to leverage their expertise and resources in improving anesthesia and surgical capacity in Liberia. This can include technical assistance, training programs, and funding opportunities.

By implementing these recommendations, Liberia can work towards developing a National Surgical, Obstetric, and Anesthesia Plan (NSOAP) that addresses the critical gaps in anesthesia and surgical capacity. This will ultimately improve access to safe surgery and anesthesia for maternal health, leading to a reduction in maternal mortality rates.
AI Innovations Methodology
Based on the provided description, here are some potential recommendations to improve access to maternal health in Liberia:

1. Increase the number of trained anesthesiologists and nurse anesthetists: Given the low workforce densities of anesthesiologists and nurse anesthetists in Liberia, it is crucial to invest in training programs and incentives to attract and retain more professionals in these fields. This will help ensure that anesthesia services are readily available during childbirth and other maternal health procedures.

2. Improve infrastructure and equipment: The assessment revealed that many hospitals in Liberia have limited functioning operating rooms and lack essential equipment like mechanical ventilation capacity in the intensive care unit. Investing in infrastructure upgrades and providing necessary equipment will enhance the capacity to provide safe surgery and anesthesia.

3. Strengthen postanesthesia care units (PACUs) and intensive care units (ICUs): While half of the surveyed hospitals had PACUs and ICUs, it is important to ensure that these units are adequately staffed and equipped to provide appropriate postoperative care. This includes ensuring access to mechanical ventilation and essential medications.

4. Enhance medication availability: Although ketamine and lidocaine were widely available, the availability of intravenous morphine was limited. Ensuring a consistent supply of essential medications, including pain management drugs, is crucial for providing quality maternal health care.

To simulate the impact of these recommendations on improving access to maternal health, a possible methodology could include the following steps:

1. Collect baseline data: Gather data on the current status of maternal health access indicators, such as maternal mortality rates, availability of anesthesia services, and surgical capacity.

2. Define simulation parameters: Determine the specific variables and metrics that will be used to measure the impact of the recommendations. For example, this could include the number of trained anesthesiologists and nurse anesthetists, the availability of functioning operating rooms, and the presence of well-equipped PACUs and ICUs.

3. Develop a simulation model: Create a mathematical or computational model that incorporates the baseline data and simulates the impact of the recommendations. This model should consider factors such as population size, healthcare infrastructure, workforce densities, and resource availability.

4. Run simulations: Use the simulation model to project the potential impact of implementing the recommendations. This could involve running multiple scenarios with varying levels of improvement in each recommendation area.

5. Analyze results: Evaluate the simulation outputs to assess the projected changes in maternal health access indicators. This analysis can help identify the most effective recommendations and their potential impact on improving access to maternal health.

6. Refine and validate the model: Continuously refine the simulation model based on feedback, additional data, and expert input. Validate the model by comparing the simulation results with real-world data and observations.

By following this methodology, policymakers and stakeholders can gain insights into the potential impact of different recommendations on improving access to maternal health in Liberia. This information can guide decision-making and resource allocation to address the identified gaps in anesthesia and surgical capacity.

Partagez ceci :
Facebook
Twitter
LinkedIn
WhatsApp
Email