India has only one anaesthetist for every 100,000 individuals, according to a new survey which found that five billion people worldwide do not have access to safe and affordable anaesthesia and surgical care. The World Federation of Societies of Anaesthesiologists (WFSA), a global alliance of anaesthesiologists, has launched an online resource tool mapping the total number of anaesthesia providers worldwide. A high number of countries reported a total anaesthesia provider number of less than five per 100,000 population, highlighting the current crisis in the surgical and anaesthesia workforce.
According to their findings presented in Geneva, Switzerland last week, India, with a population of 1.3 billion, has 883,812 physicians, while the number of physician anaesthesia providers is only 16,500. This means the density of physician anaesthesia providers per 100,000 population in India is just 1.27. While the number of surgeons in India is 31,560, the number of physician providers that have an anaesthetic qualification is 12,000, the report said.
The WFSA conducted a global workforce survey during 2015 -2016, sending member societies a list of information required and a link to an online survey, as well as collecting information from anaesthesiologists during international conferences and contacting anaesthesia providers working in non-WFSA-member countries. The online resource tool, which shows data for countries representing nearly seven billion people, highlights the huge shortage in anaesthesia workforce worldwide and also the gap between the rich and poor.
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There is a large difference between the average anaesthesia provider workforce densities in high income countries compared with low income countries. For example, there is a 35-fold difference between the anaesthesia provider workforce density in Germany compared with the Democratic Republic of Congo, and a 50-fold difference between the workforce density in the US compared with Indonesia, despite comparable population sizes. While the US has more than 100,000 anaesthesia providers, Indonesia has only 1,950 to serve the whole population of 323.9 million and 258.3 million respectively.
Of the countries reporting a total anaesthesia provider number of less than 6 per 100,000 population, none are in the North American or European regions. Instead, most are located in Sub-Saharan Africa, the West Pacific, the Caribbean, Central America and South America, South East Asia, North Africa, the Middle East and West Asia, where many countries and regions face anaesthesia and surgical workforce shortages. “The crisis in anaesthesia is perhaps most apparent in terms of workforce. Safe anaesthesia requires a trained provider and yet across large parts of Sub-Saharan Africa, South-East Asia, and beyond, ratios of far less than 1 trained provider per 100,000 population are commonplace,” said Julian Gore-Booth, WFSA Chief Executive.
“In high income countries we are used to ratios of 20 per 100,000 or higher, and we experience very low mortality from anaesthesia, yet in low income countries we actually have examples of there being 1,000 times fewer trained providers and 1,000 times higher mortality rates. It is wrong,” said Gore-Booth. “We know that there is a problem, and we know that there is a solution. Anaesthesia provision is affordable with research from the World Bank highlighting a return on investment as high as ten to one,” said Wayne Morriss, Director of Programmes at the WFSA.