title: Anesthetic Care in Mozambique.
abstract: BACKGROUND
  The World Bank and Lancet Commission in 2015 have prioritized surgery in Low-Income Countries (LIC) and Lower-Middle Income Countries (LMICs). This is consistent with the shift in the global burden of disease from communicable to noncommunicable diseases over the past 20 years. Essential surgery must be performed safely, with adequate anesthesia monitoring and intervention. Unfortunately, a huge barrier to providing safe surgery includes the paucity of an anesthesia workforce. In this study, we qualitatively evaluated the anesthesia capacity of Mozambique, a LIC in Africa with limited access to anesthesia and safe surgical care. Country-based solutions are suggested that can expand to other LIC and LMICs.
  
  
  METHODS
  A comprehensive review of the Mozambique anesthesia system was conducted through interviews with personnel in the Ministry of Health (MOH), a school of medicine, a public central referral hospital, a general first referral hospital, a private care hospital, and leaders in the physician anesthesia community. Personnel databases were acquired from the MOH and Maputo Central Hospital.
  
  
  RESULTS
  Quantitative results reveal minimal anesthesia capacity (290 anesthesia providers for a population of >25 million or 0.01:10,000). The majority of physician anesthesiologists practice in urban settings, and many work in the private sector. There is minimal capacity for growth given only 1 Mozambique anesthesia residency with inadequate resources. The most commonly perceived barriers to safe anesthesia in this critical shortage are lack of teachers, lack of medical student interest in and exposure to anesthesia, need for more schools, low allocation to anesthesia from the list of available specialist prospects by MOH, and low public payments to anesthesiologists. Qualitative results show assets of a good health system design, a supportive environment for learning in the residency, improvement in anesthetic care in past decades, and a desire for more educational opportunities and teachers.
  
  
  CONCLUSIONS
  Mozambique has a strong health system design but few resources for surgery and safe anesthesia. At present, similar to other LICs, human resources, access to essential medicines, and safety monitoring limit safe anesthesia in Mozambique.
authors.affiliation: From the *Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee; †Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University, Nashville, Tennessee; ‡Universidade Eduardo Mondlane, Maputo, Mozambique; §Department of Anesthesiology, Maputo Central Hospital, Maputo, Mozambique; and ‖Department of Anesthesiology, Maputo Central Hospital and Ministry of Health, Maputo, Mozambique.
authors.forename: Camila B
authors.initials: CB
authors.lastname: Lyon
authors.forename: Amina I
authors.initials: AI
authors.lastname: Merchant
authors.forename: Teresa
authors.initials: T
authors.lastname: Schwalbach
authors.forename: Emilia F V
authors.initials: EF
authors.lastname: Pinto
authors.forename: Emilia C
authors.initials: EC
authors.lastname: Jeque
authors.forename: K A Kelly
authors.initials: KA
authors.lastname: McQueen
mesh_terms: D000758:Anesthesia / Q000009:adverse effects / Q000592:standards; D000761:Anesthesia Department, Hospital; D000776:Anesthesiology / Q000193:education / Q000458:organization & administration / Q000592:standards; D016208:Databases, Factual; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D003906:Developing Countries; D004501:Education, Medical; D019538:Health Care Surveys; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006280:Health Workforce / Q000458:organization & administration / Q000592:standards; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D007407:Interviews as Topic; D017146:Models, Organizational; D009073:Mozambique; D020380:Needs Assessment; D017064:Process Assessment, Health Care / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards