ABSTRACT
Background Anaesthesia delivery in Pakistan remains limited to conventional intraoperative procedures, with research showing ongoing challenges in quality and resourcing. We aimed to identify systemic challenges in the delivery of quality anaesthesia services for surgical support in Pakistan’s Punjab province.
Methods This qualitative study included 22 semi-structured interviews with purposively selected anaesthesia system experts in Punjab province, including heads of teaching hospital anaesthesia departments, healthcare commission representatives, and health department officials. We analysed data thematically, using deductive and inductive coding.
Results We identified three themes of anaesthetist recruitment and retention, quality-of-care and in-service training, and discrepancies between specialities, describing major challenges experienced within the speciality. Findings indicated that workforce shortages and maldistribution, insufficient in-service training and standards, inadequate equipment maintenance, and lack of anaesthesia representation in decision-making compromised anaesthesia provision quality and safety.
Conclusions Improving anaesthesia provision in Punjab would require increasing physician and non-physician anaesthetist numbers and rotation to peripheral postings, strengthening training quality, and ensuring availability of minimum essential equipment and supplies. To achieve essential anaesthesia provision standards, policy interventions are needed to, for example, balance anaesthesiologist and surgeon numbers, require that anaesthesiology graduates work a few years in-country (e.g. scholarship bonds), ensure in-service training attendance for skills updates, and implement quality assurance standards for equipment and supplies.
What is already known on this topic?Existing research on anaesthesia in lower-income economies focuses on provision discrepancies and capacity measurement of HIC-partnered interventions. However, managerial and frontline challenges that weaken quality anaesthesia provision in countries such as Pakistan, and thus affect global surgery indicators, are largely unexamined.
What this study adds This study is the first to highlight ongoing challenges within the anaesthesia delivery system in Punjab province as experienced by senior practitioners and health officials, thus contributing to the knowledge base on anaesthesia provision challenges in lower-income economies.
How this study might affect research, practice, or policy Findings show the urgent need to increase recruitment, retention, and peripheral distribution of physician and non-physician anaesthetists along with developing clear national legislation and practice guidelines for standardised quality of anaesthesia care and raising the public profile of anaesthesia in Pakistan.
Competing Interest Statement
The authors have declared no competing interest.
Clinical Trial
NA
Funding Statement
No funding was provided.
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
The University of the Punjab Department of Public Health Doctoral Program Committee provided study approval (D/154/ISCS March 18, 2021).
I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Yes
I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.
Yes
Data Availability
An anonymised and de-identified dataset can be accessed through the University of the Punjab repository via the lead author.