Baxter Linden S, Ravelojaona Vaonandianina A, Rakotoarison Hasiniaina N, Herbert Alison, Bruno Emily, Close Kristin L, Andean Vanessa, Andriamanjato Hery H, Shrime Mark G, White Michelle C
From the *Mercy Ships, Port of Toamasina, Madagascar; †College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; ‡Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; §Department of Anesthesia, The Austin Hospital, Melbourne, Australia; ‖Ministère de la Santé Publique, Madagascar; ¶Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts; and #Office of Global Surgery and Health, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
Anesth Analg. 2017 Jun;124(6):2001-2007. doi: 10.1213/ANE.0000000000002049.
The global lack of anesthesia capacity is well described, but country-specific data are needed to provide country-specific solutions. We aimed to assess anesthesia capacity in Madagascar as part of the development of a Ministry of Health national surgical plan.
As part of a nationwide surgical safety quality improvement project, we surveyed 19 of 22 regional hospitals, representing surgical facilities caring for 75% of the total population. The assessment was divided into 3 areas: anesthesia workforce density, infrastructure and equipment, and medications. Data were obtained by semistructured interviews with Ministry of Health officials, hospital directors, technical directors, statisticians, pharmacists, and anesthesia providers and through on-site observations. Interview questions were adapted from the World Health Organization Situational Analysis Tool and the World Federation of Societies of Anaesthesiologists International Standards for Safe Practice of Anaesthesia. Additional data on workforce density were collected from the 3 remaining regions so that workforce density data are representative of all 22 regions.
Anesthesia physician workforce density is 0.26 per 100,000 population and 0.19 per 100,000 outside of the capital region. Less than 50% of hospitals surveyed reported having a reliable electricity and oxygen supply. The majority of anesthesia providers work without pulse oximetry (52%) or a functioning vaporizer (52%). All the hospitals surveyed had very basic pediatric supplies, and none had a pediatric pulse oximetry probe. Ketamine is universally available but more than 50% of hospitals lack access to opioids. None of the 19 regional hospitals surveyed was able to completely meet the World Federation of Societies of Anaesthesiologists' standards for monitoring.
Improving anesthesia care is complex. Capacity assessment is a first step that would enable progress to be tracked against specific targets. In Madagascar, scale-up of the anesthesia workforce, investment in infrastructure and equipment, and improvement in medication supply-chain management are needed to attain minimal international standards. Data from this study were presented to the Ministry of Health for inclusion in the development of a national surgical plan, together with recommendations for the needed improvements in the delivery of anesthesia.
全球麻醉能力不足的情况已广为人知，但需要国别数据来提供针对具体国家的解决方案。作为卫生部国家外科手术计划制定工作的一部分，我们旨在评估马达加斯加的麻醉能力。
作为一项全国性手术安全质量改进项目的一部分，我们对22家地区医院中的19家进行了调查，这些医院代表了为75%的总人口提供护理的手术设施。评估分为三个领域：麻醉工作人员密度、基础设施和设备以及药物。数据通过与卫生部官员、医院院长、技术主任、统计人员、药剂师和麻醉提供者进行半结构化访谈以及现场观察获得。访谈问题改编自世界卫生组织情况分析工具和世界麻醉医师协会联合会《麻醉安全实践国际标准》。从其余3个地区收集了关于工作人员密度的更多数据，以便工作人员密度数据能代表所有22个地区。
麻醉医师工作人员密度为每10万人口0.26人，首都地区以外为每10万人口0.19人。接受调查的医院中，不到50%报告有可靠的电力和氧气供应。大多数麻醉提供者在没有脉搏血氧饱和度仪（52%）或正常工作的蒸发器（52%）的情况下工作。所有接受调查的医院儿科用品都非常基础，且没有一家有儿科脉搏血氧饱和度探头。氯胺酮普遍可得，但超过50%的医院无法获得阿片类药物。接受调查的19家地区医院中没有一家能够完全达到世界麻醉医师协会联合会的监测标准。
改善麻醉护理工作很复杂。能力评估是第一步，它能使人们根据具体目标跟踪进展情况。在马达加斯加，需要扩大麻醉工作人员队伍、投资基础设施和设备以及改善药品供应链管理，以达到最低国际标准。本研究的数据已提交给卫生部，以便纳入国家外科手术计划的制定工作，并附上关于麻醉服务所需改进措施的建议。
