From the Department of Anesthesiology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
Anesth Analg. 2018 Apr;126(4):1291-1297. doi: 10.1213/ANE.0000000000002722.
The majority of the world's population lacks access to safe, timely, and affordable surgical care. Although there is a health workforce crisis across the board in the poorest countries in the world, anesthesia is disproportionally affected. This article explores some of the key issues that must be tackled to strengthen the anesthesia workforce in low- and lower-middle-income countries. First, we need to increase the overall number of safe anesthesia providers to match a huge burden of disease, particularly in the poorest countries in the world and in remote and rural areas. Through using a task-sharing model, an increase is required in both nonphysician anesthesia providers and anesthesia specialists. Second, there is a need to improve and support the competency of anesthesia providers overall. It is important to include a broad base of knowledge, skills, and attitudes required to manage complex and high-risk patients and to lead improvements in the quality of care. Third, there needs to be a concerted effort to encourage interprofessional skills and the aspects of working and learning together with colleagues in a complex surgical ecosystem. Finally, there has to be a focus on developing a workforce that is resilient to burnout and the challenges of an overwhelming clinical burden and very restricted resources. This is essential for anesthesia providers to stay healthy and effective and necessary to reduce the inevitable loss of human resources through migration and cessation of professional practice. It is vital to realize that all of these issues need to be tackled simultaneously, and none neglected, if a sustainable and scalable solution is to be achieved.
世界上大多数人无法获得安全、及时和负担得起的外科护理。尽管在世界上最贫穷的国家普遍存在卫生人力危机，但麻醉受到的影响不成比例。本文探讨了一些必须解决的关键问题，以加强中低收入国家的麻醉人力。首先，我们需要增加安全麻醉提供者的总数，以应对巨大的疾病负担，特别是在世界上最贫穷的国家以及偏远和农村地区。通过使用任务分担模式，需要增加非医师麻醉提供者和麻醉专家的数量。其次，需要提高和支持麻醉提供者的整体能力。必须包括管理复杂和高风险患者以及领导护理质量改进所需的广泛的知识、技能和态度。第三，需要共同努力，鼓励跨专业技能以及在复杂的外科生态系统中与同事一起工作和学习的方面。最后，必须注重培养一支能够应对倦怠以及压倒性临床负担和非常有限资源挑战的有弹性的劳动力。这对于麻醉提供者保持健康和高效是必要的，也是减少因移民和停止专业实践而不可避免的人力资源流失所必需的。至关重要的是要认识到，如果要实现可持续和可扩展的解决方案，所有这些问题都需要同时解决，而不能忽视任何一个问题。
