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What is the minimum number of specialist anaesthetists needed in low-income and middle-income countries?
  1. Justine I Davies1,2,
  2. Eric Vreede3,
  3. Bisola Onajin-Obembe4,
  4. Wayne W Morriss5,6
  1. 1 Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the Witwatersrand School of Public Health, Johannesburg, South Africa
  2. 2 Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  3. 3 Department of Anaesthesia, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
  4. 4 Department of Anaesthesiology, University of Port Harcourt, Port Harcourt, Nigeria
  5. 5 Department of Anaesthesia, University of Otago, Christchurch Hospital, Christchurch, New Zealand
  6. 6 World Federation of Societies of Anaesthesiologists, London, UK
  1. Correspondence to Professor Justine I Davies; j.davies.6{at}


Introduction The number of specialist anaesthetists in most low-income and middle-income countries is below what is needed to provide a safe quality anaesthesia service. There are no estimates of the optimal number; therefore, we estimated the minimum density of specialist anaesthetists to achieve a reasonable standard of healthcare as indicated by the maternal mortality ratio (MMR).

Methods Utilising existing country-level data of the number of physician anaesthesia providers (PAPs), MMR and Human Development Index (HDI), we developed best-fit curves to describe the relationship between MMR and PAPs, controlling for HDI. The aim was to use this relationship to estimate the number of PAPs associated with achieving the median MMR.

Results We estimated that, in order to achieve a reasonable standard of healthcare, as indicated by the global median MMR, countries should aim to have at least four PAPs per 100 000 population. Existing data show that currently 80 countries have fewer than this number.

Conclusion Four PAPs per 100 000 population is a modest target, but there is a need to increase training of doctors in many countries in order to train more specialist anaesthetists. It is important that this target is considered during the development of national workforce plans, even if a stepwise approach to workforce planning is chosen.

  • Anaesthesia
  • Global Health
  • Global Surgery

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  • Handling editor Seye Abimbola

  • Correction notice This article has been corrected since it published Online First. The second affiliation is corrected to Institute of Applied Health Research (it currently reads Allied Health Research and email address for the corresponding author is updated to

  • Contributors EV conceived the idea. JD did the analysis. All authors equally contributed to writing the drafts. Bisola Onajin-Obembe compiled the reference list.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not Required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data used in this analysis are freely available from the references cited in the text.

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