Development of the anaesthesia workforce and organisation of the speciality in Uganda: a mixed-methods case study

Abstract

Background: The development of modern anaesthesia practice in many low-income countries has lagged behind that of high-income countries despite early reports. Detailed descriptions of ‘surgery under anaesthesia’ in Uganda are available through Robert W. Felkin’s elaborate accounts of caesarean sections done in the Bunyoro-Kitara Kingdom. However, the earliest documented ‘modern’ surgical and anaesthesia procedures were performed by Sir Albert Cook and his brother Dr Jack Cook in 1897 at Mengo Hospital. Since then, anaesthesia has developed into an independent speciality with workforce development, professional bodies and a recognised practice. This study aimed to describe the development of the anaesthesia workforce and speciality since independence while sharing our experiences to benefit those countries on a similar journey. 
Methods: We employed a mixed-methods approach, including surveys among anaesthesia providers, as well as key informant interviews and a workforce database review. Whenever possible, information was corroborated with written literature. 
Results: There are three levels of training of anaesthesia providers in Uganda, including a Master of Medicine in anaesthesia for specialist physician providers, a Bachelor of Science in anaesthesia and a Higher Diploma in anaesthesia for non-physician providers. There are two Master of Medicine programmes, two Bachelor of Science in anaesthesia programmes and seven Higher Diploma programmes. The existing workforce consists of 68 specialists and more than 600 non-physician providers. The anaesthesia providers are organised under professional associations, namely the Association of Anesthesiologists of Uganda and the Uganda Anaesthetic Officers Association. International and regional collaborations have been critical in the development of anaesthesia in Uganda. 
Conclusion: Uganda still has a low density of anaesthesia providers both in number and distribution but has established critical steps to substantially increase the workforce. These steps include three levels of training with numerous training programmes, professional bodies and partnerships. We present our experiences with different strategies, highlighting those that have failed, and suggest further recommendations on developing anaesthesia in Uganda.