Library guides: Global development: Committee resources

Guide index

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Spotlight

The WAME Board of Directors has approved the following addendum to the WAME Statement on Promoting Global Health:

WAME on abstract translations Jan 17, 2020
WAME encourages all medical journal editors to encourage authors to provide abstracts in the language of the location where the research took place and that journals should make those abstracts available to readers when provided. See statement

World Association of Medical Editors (WAME).
WAME on abstract translations [Internet]. January 17, 2020.https://www.wame.org/news-details.php?nid=28. Accessed 29 January 2020.

Article from the reference list of the original statement:Koplan JP, Bond TC, Merson MH, et al. Towards a common definition of global health. Lancet (London, England). 2009;373(9679):1993-1995. Read the original statement here.

The 2015 Lancet Commission - Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development

The Global Surgery 2030 report (including the great introductory video - shown centre tab on this page) has developed 5 key messages stressing the importance of access to safe affordable surgical and anaesthesia care when needed.

5 billion people do not have access to safe, affordable surgical and anaesthesia care when needed.
143 million additional surgical procedures are needed in LMICs each year to save lives and prevent disability (an increase from an estimated 313 million procedures per year).
33 million individuals face catastrophic health expenditure due to payment for surgery and anaesthesia care each year (plus another 48 million cases of catastrophic expenditure attributable to non-medical costs).
Investing in surgical services in LMIC is affordable, saves lives and promotes economic growth.
Surgery is an “indivisible, indispensable part of health care”.

More information is available from the Lancet Commission on Global Surgery website.

ANZCA supports the vision established through the Lancet Commission on global surgery. Universal access to safe, affordable surgical and anaesthesia care when needed.

Books & e-Books

Anesthesia in Low-Resourced Settings: Near Misses and Lessons Learned by John G. Brock-Utne This book outlines the many anesthesia-related obstacles, concerns, and challenges that may be encountered by western trained anaesthesiologists in low-resourced settings. Each chapter presents a challenging scenario with solutions. It is therefore an essential handbook that will prepare those performing anesthesia in this milieu.
ISBN: 9783030776534
Publication Date: 2021-10-31
Australasian Anaesthesia 2023 by Matthew Doane [ed]
Call Number: 617.96 AUS
>> REQUEST 2021 PRINT LOAN <<
Also available: podcasts for the 2021 edition.
ISBN: 9780645147216
Publication Date: 2023-09-07
Invited papers and selected continuing education lectures.
>> SEARCH & ACCESS content using the library discovery service (full-text access via AIRR)
Developing anaesthesia: guidelines for anaesthesia in developing countries V.1.6 2010 by David Pescod The Developing Anaesthesia Textbook has been created to promote the advancement of anaesthetic practice and to empower anaesthetists in countries with limited resources. The text has chapters on the following topics: preoperative management, general anaesthesia, paediatric anaesthesia, obstetrics, regional anaesthesia, recovery, critical incident management, and quality assurance.
Call Number: 617.96091724 PES
>> REQUEST PRINT <<
ISBN: 0958645256
Publication Date: 2010 (Print copy: College members; eBook from author website - free access, see E-books page)
Essential Surgery Volume of Disease Control Priorities, 3e [Open Access] “The Essential Surgery volume of DCP3 helps definitively dispel many of the myths about surgery’s role in global health, in part by showing the very large health burden from conditions that are primarily or extensively treated by surgery. It dispels the myth that surgery is too expensive by showing that many essential surgical services rank amongst the most cost-effective of all heath interventions.”
Publication Date: 2015
Global Anaesthesia (Oxford Specialist Handbooks) by Rachael Craven; Hilary Edgcombe; Ben Gupta [eds] The Oxford Specialist Handbook of Global Anaesthesia is a key reference for anaesthetists working in environments with scarce resources. Whether due to rural locations, poverty, natural disasters, the outbreak of epidemics, or war and conflict, this handbook supports anaesthetists to practice to a high standard in challenging situations and to problem solve when faced with unusual circumstances.
ISBN: 9780198809821
Publication Date: 2020-10-20
Global Cardiac Surgery Capacity Development in Low and Middle Income Countries by Jacques Kpodonu [ed] This book provides a focused resource on how cardiac surgery capacity can be developed and how it assists in the sustainable development and strengthening of associated health systems. Background is provided on the extent of the problems that are experienced in many nations with suggestions for how suitable frameworks can be developed to improve cardiac healthcare provision.
ISBN: 9783030838638
Publication Date: 2021-11-23
Global Surgery and Anesthesia Manual by John G. Meara; Craig D. McClain; Selwyn O. Rogers; David P. Mooney [eds] This guide provides in-depth instruction on epidemiology and ethics surrounding surgical services, and on anesthesia, perioperative care, trauma surgery, and non-trauma surgery. With contributions from a group of culturally and academically diverse clinicians, each chapter is enriched by at least one commentary from a surgeon or anesthesia provider in a low- or middle-income country (LMIC) who shares first-hand perspectives on the realities and complexities of providing surgical care in these settings with limited resources.
ISBN: 9780429156212
Publication Date: 2014-12-12
Guide to Pain Management in Low-Resource Settings by Andreas Kopf; Nilesh B. Patel [eds] The Guide to Pain Management in Low-Resource Settings is intended to support health care providers in low-resource settings. Chapters were written by a multidisciplinary and multinational team of authors. Practitioners in settings with limited resources will benefit from easy-to-read information about simple and cost-effective approaches that can provide maximum effects in managing pain in their patients.
Publication Date: 2010
How to Practice Academic Medicine and Publish from Developing Countries?: A Practical Guide by Samiran Nundy; Atul Kakar; Zulfiqar A Bhutta The book provides an overview of the state of research in developing countries - Africa, Latin America, and Asia (especially India) and why research and publications are important in these regions. It addresses budding but struggling academics in low and middle-income countries. It is written mainly by senior colleagues who have experienced and recognized the challenges with design, documentation, and publication of health research in the developing world.
ISBN: 9789811652479
Publication Date: 2021-10-24
Infectious Diseases and Rural Livelihood in Developing Countries by Fingani Annie Mphande This book focuses on the effects of rural livelihood and the impact of infectious diseases on health and poverty. It explores cultures and traditions in developing countries and their role in infectious-disease management and prevention. It highlights the associated healthcare systems and how these have contributed to some of the challenges faced, and goes on to elaborate on the significance of community involvement in infectious-disease prevention, management and control. It also emphasizes the importance of surveillance and setting up strategies on infectious-disease management that are favourable for poor communities and developing countries
ISBN: 9789811004285
Publication Date: 2016-02-11
Obstetric anaesthesia for developing countries (OAL) by Paul Clyburn; Rachel Collis; Sarah Harries [eds] Anaesthesia services for obstetric procedures pose a particular problem in developing countries, where high rates of anaesthesia-related complications and foetal/maternal mortality are seen in connection with otherwise common procedures such as caesarean section. This concise and practical pocketbook covers the basic principles of obstetric anaesthesia with a special emphasis on the unique challenges of service delivery in the developing world. The book will be useful for a range of practitioners in developing countries including anaesthetists, trainees, nurse anaesthetists, and district hospital doctors.
Call Number: 617.9682 OBS
>> REQUEST PRINT LOAN <<
ISBN: 9780199572144
Publication Date: 2010-06-11
Setting up Community Health and Development Programmes in Low and Middle Income Settings, 4e by Ted Lankester; Nathan J. Grills [eds] Setting up Community Health Programmes in Low and Middle Income Settings, 4e provides a practical introductory guide to the initiation, management, and sustaining of health care programmes in developing countries. The book has been fully revised to take into account the Millennium Development Goals, Sustainable Development Goals, and Universal Health Coverage.
ISBN: 9780198806653
Publication Date: 2019-05-28

For a comprehensive list of titles, see: Global health

Find out more

The Global Development committee is "committed to improving education and training capacity in anaesthesia and pain medicine in response to the needs expressed by low and middle income countries (LMIC)".

Fellows of the college develop and contribute to variety of anaesthesia and pain medicine programs across the Pacific, Asia and Africa. In response to a number of frequently asked questions the Global Development Committee has prepared information for fellows and trainees interested in working and teaching overseas.

For further information please visit the Global Health page on the ANZCA website, which includes resources and initiatives like:

Global Development Committee's 2018-2022 Strategic Priorities Plan
Scholarships and courses, and more...

Latest articles in global development

Last updated: 6 September 2023

Open access articles

Qin RX, Zhang G, Lim MX, et al. Assessment of essential surgical and anaesthesia care capacity: a cross-sectional study in five Pacific Island Countries. Lancet Reg Health West Pac. 2023;39:100830. Keywords: Global surgery; Health system strengthening; National surgical planning; Pacific Island Countries.
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Abstract
Background: Pacific Island Countries (PICs) face unique challenges in providing surgical care. We assessed the surgical care capacity of five PICs to inform the development of National Surgical, Obstetric and Anaesthesia Plans (NSOAP).

Methods: We conducted a cross-sectional survey of 26 facilities in Fiji, Tonga, Vanuatu, Cook Islands, and Palau using the World Health Organization - Program in Global Surgery and Social Change Surgical Assessment Tool.

Findings: Eight referral and 18 first-level hospitals containing 39 functioning operating theatres, 41 post-anaesthesia care beds, and 44 intensive care unit beds served a population of 1,321,000 across the five countries. Most facilities had uninterrupted access to electricity, water, internet, and oxygen. However, CT was only available in 2/8 referral hospitals, MRI in 1/8, and timely blood transfusions in 4/8. The surgical, obstetric, and anaesthetist specialist density per 100,000 people was the highest in Palau (49.7), followed by Cook Islands (22.9), Tonga (9.9), Fiji (7.1), and Vanuatu (5.0). There were four radiologists and 3.5 pathologists across the five countries. Surgical volume per 100,000 people was the lowest in Vanuatu (860), followed by Fiji (2,247), Tonga (2,864), Cook Islands (6,747), and Palau (8,606). The in-hospital peri-operative mortality rate (POMR) was prospectively monitored in Tonga and Cook Islands but retrospectively measured in other countries. POMR was below 1% in all five countries.

Interpretation: Whilst PICs share common challenges in providing specialised tertiary services, there is substantial diversity between the countries. Strategies to strengthen surgical systems should incorporate both local contextualisation within each PIC and regional collaboration between PICs.
Qin RX, Yoon S, Fowler ZG, et al. Financing surgical, obstetric, anaesthesia, and trauma care in the Asia-Pacific region: proceedings. BMC Proc. 2023;17(Suppl 5):10. Keywords: Asia–Pacific; Global surgery; National surgical planning; Partnership; Surgical system strengthening.
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Surgical, obstetric, and anaesthesia care saves lives, prevents disability, promotes economic prosperity, and is a fundamental human right. Session two of the three-part virtual meeting series on Strategic Planning to Improve Surgical, Obstetric, Anaesthesia, and Trauma Care in the Asia-Pacific Region discussed financing strategies for surgical care. During this session, participants made a robust case for investing in surgical care given its cost-effectiveness, macroeconomic benefits, and contribution to health security and pandemic preparedness. Funding for surgical system strengthening could arise from both domestic and international sources. Numerous strategies are available for mobilising funding for surgical care, including conducive macroeconomic growth, reprioritisation of health within government budgets, sector-specific domestic revenue, international financing, improving the effectiveness and efficiency of health budgets, and innovative financing. A wide range of funders recognised the importance of investing in surgical care and shared their currently funded projects in surgical, obstetric, anaesthesia, and trauma care as well as their funding priorities. Advocacy efforts to mobilise funding for surgical care to align with the existing funder priorities, such as primary health care, maternal and child health, health security, and the COVID-19 pandemic. Although the COVID-19 pandemic has constricted the fiscal space for surgical care, it has also brought unprecedented attention to health. Short-term investment in critical care, medical oxygen, and infection prevention and control as a part of the COVID-19 response must be leveraged to generate sustained strengthening of surgical systems beyond the pandemic.
Schnaubelt S, Garg R, Atiq H, et al. Cardiopulmonary resuscitation in low-resource settings: a statement by the International Liaison Committee on Resuscitation, supported by the AFEM, EUSEM, IFEM, and IFRC. Lancet Glob Health. 2023;11(9):e1444-e1453.
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Abstract
Most recommendations on cardiopulmonary resuscitation were developed from the perspective of high-resource settings with the aim of applying them in these settings. These so-called international guidelines are often not applicable in low-resource settings. Organisations including the International Liaison Committee on Resuscitation (ILCOR) have not sufficiently addressed this problem. We formed a collaborative group of experts from various settings including low-income, middle-income, and high-income countries, and conducted a prospective, multiphase consensus process to formulate this ILCOR Task Force statement. We highlight the discrepancy between current cardiopulmonary resuscitation guidelines and their applicability in low-resource settings. Successful existing initiatives such as the Helping Babies Breathe programme and the WHO Emergency Care Systems Framework are acknowledged. The concept of the chainmail of survival as an adaptive approach towards a framework of resuscitation, the potential enablers of and barriers to this framework, and gaps in the knowledge are discussed, focusing on low-resource settings. Action points are proposed, which might be expanded into future recommendations and suggestions, addressing a large diversity of addressees from caregivers to stakeholders. This statement serves as a stepping-stone to developing a truly global approach to guide resuscitation care and science, including in health-care systems worldwide.
He Y, Peng S, Chen M, Yang Z, Chen Y. A Transformer-based Prediction Method for Depth of Anesthesia During Target-controlled Infusion of Propofol and Remifentanil [epub ahead of print, 2023 Aug 15]. IEEE Trans Neural Syst Rehabil Eng.
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Abstract
Accurately predicting anesthetic effects is essential for target-controlled infusion systems. The traditional (PK-PD) models for Bispectral index (BIS) prediction require manual selection of model parameters, which can be challenging in clinical settings. Recently proposed deep learning methods can only capture general trends and may not predict abrupt changes in BIS. To address these issues, we propose a transformer-based method for predicting the depth of anesthesia (DOA) using drug infusions of propofol and remifentanil. Our method employs long short-term memory (LSTM) and gate residual network (GRN) networks to improve the efficiency of feature fusion and applies an attention mechanism to discover the interactions between the drugs. We also use label distribution smoothing and reweighting losses to address data imbalance. Experimental results show that our proposed method outperforms traditional PK-PD models and previous deep learning methods, effectively predicting anesthetic depth under sudden and deep anesthesia conditions.
Malik M, Khan FA. Anesthetic drug shortages in Pakistan: a multicentre nationwide survey [epub ahead of print, 2022 Dec 28]. Can J Anaesth. 2022;1-8. Keywords: anesthetic drugs; developing countries; patient safety.
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Abstract
Purpose: There is a paucity of literature on anesthetic drug shortages and their impact on patient safety in lower-middle-income countries. We sought to determine the magnitude of the problem, the effect on patient care and safety, and the adverse patient outcomes witnessed by anesthesiologists in Pakistan METHODS: We conducted a nationwide, multicentre, cross-sectional survey of a representative sample of anesthesiologists in Pakistan (January 2021 to June 2021). The survey questionnaire was adapted from the American Society of Anesthesiologists (ASA) survey on drug shortages and was modified based on the national essential medication list 2018 of Pakistan. It was distributed through Google Forms to anesthesiologists practicing in both the private and government sector. The names of hospitals or the identity of anesthesiologists was not required. The questionnaire consisted of 20 items and focused on the anesthesiologists' experience of drug shortages, the availability of drugs, and the impact of drug shortages on their individual practice.

Results: Two hundred and forty-six responses were received. Approximately 50% (122/246) of anesthesia practitioners in Pakistan reported anesthetic drug shortages. Fifty-seven percent of respondents mentioned using an inferior drug that may have significantly affected the delivery of anesthetic care. Four participants mentioned severe morbidity and another four mentioned observing a mortality associated with drug shortage.

Conclusion: Anesthetic drug shortages are common in anesthetic practice in Pakistan and they appear to affect patient care and outcomes.
Evans FM, Krotinger AA, Lilaonitkul M, et al. Evaluation of Open Access Websites for Anesthesia Education. Anesth Analg. 2022;135(6):1233-1244.
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Abstract
Background: While the prevalence of free, open access medical education resources for health professionals has expanded over the past 10 years, many educational resources for health care professionals are not publicly available or require fees for access. This lack of open access creates global inequities in the availability and sharing of information and may have the most significant impact on health care providers with the greatest need. The extent of open access online educational websites aimed for clinicians and trainees in anesthesiology worldwide is unknown. In this study, we aimed to identify and evaluate the quality of websites designed to provide open access educational resources for anesthesia trainees and clinicians.

Methods: A PubMed search of articles published between 2009 and 2020, and a Startpage search engine web search was conducted in May 2021 to identify websites using the following inclusion criteria: (1) contain educational content relevant for anesthesia providers or trainees, (2) offer content free of charge, and (3) are written in the English language. Websites were each scored by 2 independent reviewers using a website quality evaluation tool with previous validity evidence that was modified for anesthesia (the Anesthesia Medical Education Website Quality Evaluation Tool).

Results: Seventy-five articles and 175 websites were identified; 37 websites met inclusion criteria. The most common types of educational content contained in the websites included videos (66%, 25/37), text-based resources (51%, 19/37), podcasts (35%, 13/37), and interactive learning resources (32%, 12/37). Few websites described an editorial review process (24%, 9/37) or included opportunities for active engagement or interaction by learners (30%,11/37). Scores by tertile differed significantly across multiple domains, including disclosure of author/webmaster/website institution; description of an editorial review process; relevancy to residents, fellows, and faculty; comprehensiveness; accuracy; disclosure of content creation or revision; ease of access to information; interactivity; clear and professional presentation of information; and links to external information.

Conclusions: We found 37 open access websites for anesthesia education available on the Internet. Many of these websites may serve as a valuable resource for anesthesia clinicians looking for self-directed learning resources and for educators seeking to curate resources into thoughtfully integrated learning experiences. Ongoing efforts are needed to expand the number and improve the existing open access websites, especially with interactivity, to support the education and training of anesthesia providers in even the most resource-limited areas of the world. Our findings may provide recommendations for those educators and organizations seeking to fill this needed gap to create new high-quality educational websites.
The Lancet Global Health. Global health 2021: who tells the story? Lancet Glob Health. 2021;9(2):e99. Keywords: Global health; Health equity; Academia
Epiu I, Tindimwebwa JV, Mijumbi C, et al. Challenges of Anesthesia in Low- and Middle-Income Countries: A Cross-Sectional Survey of Access to Safe Obstetric Anesthesia in East Africa. Anesth Analg. 2017;124(1):290-299.
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Background: The United Nations 2015 Millennium Development Goals targeted a 75% reduction in maternal mortality. However, in spite of this goal, the number of maternal deaths per 100,000 live births remains unacceptably high across Sub-Saharan Africa. Because many of these deaths could likely be averted with access to safe surgery, including cesarean delivery, we set out to assess the capacity to provide safe anesthetic care for mothers in the main referral hospitals in East Africa.

Methods: A cross-sectional survey was conducted at 5 main referral hospitals in East Africa: Uganda, Kenya, Tanzania, Rwanda, and Burundi. Using a questionnaire based on the World Federation of the Societies of Anesthesiologists (WFSA) international guidelines for safe anesthesia, we interviewed anesthetists in these hospitals, key informants from the Ministry of Health and National Anesthesia Society of each country (Supplemental Digital Content, http://links.lww.com/AA/B561).

Results: Using the WFSA checklist as a guide, none of respondents had all the necessary requirements available to provide safe obstetric anesthesia, and only 7% reported adequate anesthesia staffing. Availability of monitors was limited, and those that were available were often nonfunctional. The paucity of local protocols, and lack of intensive care unit services, also contributed significantly to poor maternal outcomes. For a population of 142.9 million in the East African community, there were only 237 anesthesiologists, with a workforce density of 0.08 in Uganda, 0.39 in Kenya, 0.05 in Tanzania, 0.13 in Rwanda, and 0.02 anesthesiologists in Burundi per 100,000 population in each country.

Conclusions: We identified significant shortages of both the personnel and equipment needed to provide safe anesthetic care for obstetric surgical cases across East Africa. There is a need to increase the number of physician anesthetists, to improve the training of nonphysician anesthesia providers, and to develop management protocols for obstetric patients requiring anesthesia. This will strengthen health systems and improve surgical outcomes in developing countries. More funding is required for training physician anesthetists if developing countries are to reach the targeted specialist workforce density of the Lancet Commission on Global Surgery of 20 surgical, anesthetic, and obstetric physicians per 100,000 population by 2030.

Bartovic J,Datta SS, Severonic S, D'Annaa V.Ensuring equitable access to vaccines for refugees and migrants during the COVID-19 pandemic. Bulletin of the World Health Organisation. 2021; 99:3-3a. doi:10.2471/BLT.20.267690

Pouramin P, Li CS, Busse JW, et al. Delays in hospital admissions in patients with fractures across 18 low-income and middle-income countries (INORMUS): a prospective observational study.Lancet Global Health. 2020;8(5):e711-e720. doi:10.1016/S2214-109X(20)30067-X

Kayambankadzanja RK, Likaka A, Mndolo SK, Chatsika GM, Umar E, Baker T. Emergency and critical care services in Malawi: findings from a nationwide survey of health facilities. Malawi Medical Journal. 2020;32(1):19-23. doi:10.4314/mmj.v32i1.5

Dobson GP. Trauma of major surgery: a global problem that is not going away. International Journal of Surgery. 2020;81:47-54. doi:10.1016/j.ijsu.2020.07.017

Marun GN, Morriss WW, Lim JS, Morriss JL, Goucke CR.Addressing the challenge of pain education in low-resource countries: essential pain management in Papua New Guinea. Anesthesia and Analgesia. 2020;2020 Mar 12.

Pakenham-Walsh N, Godlee F. Healthcare information for all [published correction appears in BMJ. 2020 Feb 28;368:m818]. BMJ. 2020;368:m759. Published 2020 Feb 28. doi:10.1136/bmj.m759

Articles accessible with an ANZCA ID and password

Evans FM, Wake PB, Gathuya ZN, McDougall RJ. Access to Safe Pediatric Anesthesia in LMICs-The Problem Is Clear; It Is Time to Solve It!. Anesth Analg. 2022;134(4):724-727. Editorial
Holmaas G, Abate A, Woldetsadik A, Hevrøy O. Establishing a sustainable training programme in anaesthesia in Ethiopia [epub ahead of print, 2022 Jun 24]. Acta Anaesthesiol Scand. 2022;10.1111/aas.14106. Keywords: Ethiopia; Low-income countries; Postgraduate anaesthesia education; sustainability.
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Abstract
Background: Lack of qualified staff is a major hindrance for quality and safety improvements in anaesthesia and critical care in many low-income-countries. Support in specialist training may enhance perioperative treatment and have a positive downstream impact on other hospital services, which may improve the overall standard of care.

Methods: Between 2011 and 2019, consultant anaesthetists from Haukeland University Hospital in Norway supported a postgraduate anaesthesia-training programme at Addis Ababa University / Tikur Anbessa Specialized Hospital in Ethiopia. The aim of the programme was to build a self-sustainable work force of anaesthetists across the country who could perform high quality anaesthesia within the confinement of limited local resources. Over the course of 10 years, an almost continuous rotation of experienced anaesthetists and intensivists assisted training of Ethiopian residents in anaesthesia and critical care. Local specialists organised the programme; however, external support was necessary during this period to establish a sustainable training programme.

Results: Since the programme's commencement at Addis Ababa University in 2011, 159 residents have entered the programme and 71 have graduated. As the number of qualified anaesthetists increased, Ethiopian specialists gradually obtained responsibility for the programme. Candidates are recruited from various regions and from neighbouring countries. Five other Ethiopian training sites have been established. To date (May 2022), 112 residents have completed their training in Ethiopia, and 195 residents expect to graduate within three years.

Conclusion: Nearly 11 years after establishment of the programme, locally trained highly qualified anaesthetists work in Ethiopia's major hospitals throughout the country.
Hirsch LA. Is it possible to decolonise global health institutions? Lancet. 2021;397(10270):189-190. Keywords: Global health; Anti-racism
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In the past year, decolonising global health has gained prominence. Much of this movement has come from students of global health in high-income countries and preceded the recurrence of Black Lives Matter movements after the violent murder of George Floyd. Black Lives Matter and Decolonising Global Health movements have managed to shake schools of global health if not to their core then at least awake. As a reaction schools of global health have made statements about racial equality and have avowed to address racism, increase staff and student diversity, and to train their staff in the art of decolonisation. I have been involved in these processes of decolonisation at my own institution. Yet I also view such efforts critically.
Khan FA, Merry AF. Improving Anesthesia Safety in Low-Resource Settings. Anesth Analg. 2018;126(4):1312-1320.
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Abstract
The safety of anesthesia characteristic of high-income countries today is not matched in low-resource settings with poor infrastructure, shortages of anesthesia providers, essential drugs, equipment, and supplies. Health care is delivered through complex systems. Achieving sustainable widespread improvement globally will require an understanding of how to influence such systems. Health outcomes depend not only on a country's income, but also on how resources are allocated, and both vary substantially, between and within countries. Safety is particularly important in anesthesia because anesthesia is intrinsically hazardous and not intrinsically therapeutic. Nevertheless, other elements of the quality of health care, notably access, must also be considered. More generally, there are certain prerequisites within society for health, captured in the Jakarta declaration. It is necessary to have adequate infrastructure (notably for transport and primary health care) and hospitals capable of safely carrying out the "Bellwether Procedures" (cesarean delivery, laparotomy, and the treatment of compound fractures). Surgery, supported by safe anesthesia, is critical to the health of populations, but avoidable harm from health care (including very high mortality rates from anesthesia in many parts of the world) is a major global problem. Thus, surgical and anesthesia services must not only be provided, they must be safe. The global anesthesia workforce crisis is a major barrier to achieving this. Many anesthetics today are administered by nonphysicians with limited training and little access to supervision or support, often working in very challenging circumstances. Many organizations, notably the World Health Organization and the World Federation of Societies of Anaesthesiologists, are working to improve access to and safety of anesthesia and surgery around the world. Challenges include collaboration with local stakeholders, coordination of effort between agencies, and the need to influence national health policy makers to achieve sustainable improvement. It is conceivable that safe anesthesia and perioperative care could be provided for essential surgical services today by clinicians with moderate levels of training using relatively simple (but appropriately designed and maintained) equipment and a limited number of inexpensive generic medications. However, there is a minimum standard for these resources, below which reasonable safety cannot be assured. This minimum (at least) should be available to all. Not only more resources, but also more equitable distribution of existing resources is required. Thus, the starting point for global access to safe anesthesia is acceptance that access to health care in general should be a basic human right everywhere.

Lal A, Erondu NA, Heymann DL, Gitahi G, Yates R. Fragmented health systems in COVID-19: rectifying the misalignment between global health security and universal health coverage. Lancet. 2021 Jan 2;397(10268):61-67. doi: 10.1016/S0140-6736(20)32228-5.

Prasad A. Loyce Pace: equity, solidarity, and humility in global health. Lancet. 2021 Jan 2;397(10268):16. doi: 10.1016/S0140-6736(20)32670-2.

Loh PS, Chaw SH, Shariffuddin II, Ng CC, Yim CC, Hashim NHM. A developing nation's experience in using simulation-based training as a preparation tool for the Coronavirus disease 2019 outbreak. Anesthesia and Analgesia. 2021 Jan;132(1):15-24. doi: 10.1213/ANE.0000000000005264. Lonergan D. I am a Mzungu. Anesthesiology. 2020 Sep 1;133(3):667-669. doi: 10.1097/ALN.0000000000003264.

Henry JA, Volk AS, Kariuki SK, et al. Ending neglected surgical diseases (NSDs): definitions, strategies, and goals for the next decade [published online ahead of print, 2020 Aug 11]. International Journal of Health Policy and Management. 2020;10.34172/ijhpm.2020.140. doi:10.34172/ijhpm.2020.140

Ma X, Marinos J, De Jesus J, Lin N, Sung CY, Vervoort D. Human rights-based approach to global surgery: a scoping review [published online ahead of print, 2020 Aug 21]. International Journal of Surgery. 2020;82:16-23. doi:10.1016/j.ijsu.2020.08.004

Goucke, RC, Chaudakshetrin, P. Pain: a neglected problem in the low-resource setting. Anesth Analg. 2018;126(4):1283–1286.