Anesthesia Provider Training and Practice Models: A Survey of Africa
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
Anesthesia & Analgesia
Abstract
In Africa, most countries have fewer than 1 physician anesthesiologist (PA)
per 100,000 population. Nonphysician anesthesia providers (NPAPs) play a large role in the
workforce of many low- and middle-income countries (LMICs), but little information has been
systematically collected to describe existing human resources for anesthesia care models. An
understanding of existing PA and NPAP training pathways and roles is needed to inform anesthesia
workforce planning, especially for critically underresourced countries.
METHODS: Between 2016 and 2018, we conducted electronic, phone, and in-person surveys
of anesthesia providers in Africa. The surveys focused on the presence of anesthesia training
programs, training program characteristics, and clinical scope of practice after graduation.
RESULTS: One hundred thirty-one respondents completed surveys representing data for 51 of
55 countries in Africa. Most countries had both PA and NPAP training programs (57%; mean, 1.6
pathways per country). Thirty distinct training pathways to become an anesthesia provider could
be discriminated on the basis of entry qualification, duration, and qualification gained. Of these
30 distinct pathways, 22 (73%) were for NPAPs. Physician and NPAP program durations were a
median of 48 and 24 months (ranges: 36–72, 9–48), respectively. Sixty percent of NPAP pathways
required a nursing background for entry, and 60% conferred a technical (eg, diploma/license)
qualification after training. Physicians and NPAPs were trained to perform most anesthesia tasks
independently, though few had subspecialty training (such as regional or cardiac anesthesia).
CONCLUSIONS: Despite profound anesthesia provider shortages throughout Africa, most countries
have both NPAP and PA training programs. NPAP training pathways, in particular, show
significant heterogeneity despite relatively similar scopes of clinical practice for NPAPs after
graduation. Such heterogeneity may reflect the varied needs and resources for different settings,
though may also suggest lack of consensus on how to train the anesthesia workforce.
Lack of consistent terminology to describe the anesthesia workforce is a significant challenge
that must be addressed to accelerate workforce research and planning efforts.
Description
Keywords
Anesthesia Provider Training, Practice Models, Africa
Citation
Law, Tyler J., et al. "Anesthesia provider training and practice models: a survey of Africa." Anesthesia & Analgesia 129.3 (2019): 839-846. DOI: 10.1213/ANE.0000000000004302