The Task-Sharing Path to Safe and Accessible Anaesthesia Care in India: The Role of Professional Associations in Health Policy Reform.

The worldwide anaesthesia workforce shortage is a concern and 'shared responsibility' for all the national or state anaesthetic societies and Ministries of Health. The Lancet Commission on Global Surgery estimated the need for 143 million additional surgeries each year globally. These would be included in the World Health Organization's (WHO) 44 essential surgeries to be performed at district hospitals. However, insufficient availability of safe anaesthesia is a key barrier. The World Federation of Societies of Anaesthesiologists (WFSA) recommends at least five specialist physician-anaesthesia providers per 100,000 population. India requires at least 60,000 additional physician-anaesthesiologists over the next 10 years. This paper discusses the two-decade journey of a policy initiative by the Ministry of Health and Family Welfare (MoHFW) in India to create a new category of a physician with Life Saving Anaesthetic Skills (LSAS). This addressed the shortage of anaesthetists specifically for the dire emergency obstetric situations at the First Referral hospitals. The annual training capacity for physicians for LSAS training was 40-100 in 5 of the poorest states of India, with the maximum shortages of anaesthetists. On following up a sample of 838 LSAS physicians, only about two-thirds were able to practice their life-saving skills. The MoHFW innovated further by pairing a physician trained in Emergency Obstetric Care with an LSAS-physician (buddy-pairing) as a functioning team. For comparison, we discuss the midwife model supported by the professional association of obstetricians in India. The flexible, 'team-based' task-sharing approach optimizes anaesthesia care within available resources. Leadership and vision from the professional societies of anaesthesiology are key to policy reform in India. National engagement can be facilitated through support for district-level non-specialist physician provider with life-saving anaesthesia skills training, engagement in research and formulation of the national surgical and anaesthesia plans to achieve universal healthcare in India.