Perioperative care capacity in East Africa: results of an Ethiopian national cross-sectional survey

Abstract

Background: Provision of safe surgery has gained focus recently. In 2015, the World Health Organization (WHO) called for the strengthening of surgical and anesthesia services as a universal health coverage component. The same year, the Ethiopian Ministry of Health (MOH) launched the “Saving Lives through Safe Surgery” initiative to prioritize and scale-up surgical services. This study provides an updated overview of perioperative facilities’ status to facilitate the identification of future focus areas. Methods: An online national cross-sectional survey was conducted in September–November 2020, incorporating elements from recognized surgical and anesthesia facility assessment tools to assess infrastructure, workforce, and availability of resources across Ethiopian government facilities. Results: Responses were received from 81/289 (28%) facilities, conducting a mean of 6.9 (range: 1–37) surgeries per day. All regions were represented. There were shortages in specialty surgical, obstetric, and anesthesiology workforce, functioning anesthesia machines, airway equipment, recommended monitoring devices, and capnography. Shortages of analgesia, anesthesia, and emergency medications were reported. Sixty-eight (84%) facilities had a postanesthetic care unit with a mean of 3.1 (range: 1–15) beds. The presence of trained nurses, oxygen, monitoring devices, equipment, medications, and postoperative care guidelines was minimal. Conclusions: This study provides an updated overview of surgical capacity in Ethiopia. Despite the expansion of surgical access, there are ongoing resource deficits. Expansion of surgical capacity should be accompanied by a similar expansion in the provision of adequately equipped and staffed postanesthetic care units and a focus on postoperative care.