Capacity of Anesthesiology Residency Programs in Four East African Countries: Can Supply Meet the Demand?

Abstract

BACKGROUND: By 2015, 4 East African countries (Kenya, Uganda, Rwanda, and Burundi) had identified a deficit in the number of anesthesiologists, with a mean density of 0.30 physician anesthesia providers (PAP) per 100,000 population, which was significantly lower than the World Federation of Societies of Anaesthesiologists (WFSA) recommended minimum of 5.0/100,000 population. This workforce shortfall has been recognized as 1 factor that may negatively affect surgical outcomes. This survey sought to assess the capacity of anesthesia residency programs to meet recommended human resource standards in these countries. METHODS: This retrospective cross-sectional study surveyed heads of anesthesia departments, principals of medical colleges that host residency programs and registrars of national medical councils in 4 East African countries. A descriptive analysis of the infrastructural characteristics, human resources, cost of training, enrollment, and output from the programs over 5 years (2015–2020) was conducted. The growth in the number of registered PAP and trends in workforce density were determined. The 2020 needs deficit was calculated based on the WFSA benchmark, and the projected workforce needs in 2030 were estimated based on the population growth trajectory. RESULTS: There were 7 accredited university-based anesthesia residency programs in 2020, with median (range) enrollment and graduation rates of 10.5 (2–18) and 5.5 (0–13) residents/country/year, respectively. Enrollment was unstable with some countries having years with no enrollment at all. Only 1 country had new programs planned. There was a median resident to supervisor ratio of 1.44 (0.89–7):1 and 50.3 (21.4–100)% of residency training supervisors had no academic faculty appointment. The median university tuition was $1677 (600–6165)/year. The number of PAP increased in all 4 countries median 5-year growth of 79.3 (22.7–150)%, with minimal impact on the low workforce density, median of 0.23 (0.04–0.35)/100,000 in 2020. The median deficit in PAP in 2020 was an estimated 1410 (589–2499) PAP, with a median need for 1763 (763–2911) new specialists per country by 2030. CONCLUSIONS: The PAP workforce deficits significantly outstripped the annual output of all residency programs. Anesthesia societies need to raise awareness about this deficit and engage policymakers to increase investment in anesthesia training, including providing scholarships and employment of PAP in training institutions. Integrating nonuniversity-based residency programs may support an increased output. The attainability of the 2030 workforce goals will need review. National strategies are needed to increase the total anesthesia workforce, which includes nonphysician anesthesia providers (NPAPs) as part of the task-sharing framework.