Health System Barriers To Delivering Safe Anesthesia In Low‑Resource Settings

https://doi.org/10.5281/zenodo.18839010

Abstract

Background: Safe anesthesia is a crucial aspect of modern surgical, obstetric and emergency practice. It is an indispensable step for the reduction of perioperative morbidity and mortality among patients worldwide. Millions of people in low-resource settings are impacted by the absence of safe anesthesia because of structural hindrances including staffing shortages, insufficient infrastructure, and intermittent drug supply, insufficient financial means, and the absence of regulation. These complications also cause preventable deaths and poor surgical outcomes in the low- and middle-income countries (LMICs).

Objective: To identify and determine key health system obstacles that influences the provision of safe anesthesia in low-resource countries and suggests ways of reinforcing anesthesia systems.

Methods: The literature review conducted in this research was a narrative review that accessed PubMed, Google scholar and policy documentaries of the World Health Organization (WHO), World Federation of Societies of Anesthesiologists (WFSA) , Scopus and Web of Science and Lancet Commission on Global Surgery. Research articles that published after 2000 up to 2025 were taken into consideration in the current study. The information was also collected and analyzed in accordance to WHO six health system building blocks as follows; service delivery, health workforce, health information systems, access to essential medicines, financing, and governance. The descriptive analysis of quantitative data, including provider densities and perioperative mortality rates, was carried out, whereas the qualitative analysis of policy, governance, and supply chain issues were analyzed thematically.

Results: The current study has identified five major barriers to the delivery of safe anesthesia in the low-and-middle-income nations (LMICs). (1) Existence of acute workforce shortage, most notably of physician anesthesiologists, in rural and district hospitals; (2) Immediate ineffective infrastructure, manifested by intermittent power supply, outdated anesthesia equipment, and a lack of monitoring devices; (3) Supply-chain malpractice that limits the supply of essential anesthetic medicines and equipment; (4) Financing constraints that restrain workforce growth, modernization of the infrastructure, and acquisition of monitoring and anesthetic drugs; and (5) Weak governance and policy gaps, including absence of national anesthesia guidelines and poor integration into National Surgical, Obstetric, and Anesthesia Plans (NSOAPs).

Conclusion: It is largely due to systemic failure, rather than the lack of individual practitioners, that the issue of unsafe anesthesia is prevalent in resource-constrained settings. In order to alleviate these problems, stakeholders should focus on labor supply and retention, investing in infrastructure, the sound development of the supply-chain, sustainability programs, and the redevelopment of policies and systems of governance to improve perioperative safety and equal access to anesthetic services.