Article Text

Download PDFPDF

Training non-physician anaesthetists in sub-Saharan Africa: a qualitative investigation of providers’ perspectives
  1. Hilary Edgcombe1,2,
  2. Linden S Baxter3,
  3. Soren Kudsk-Iversen2,
  4. Victoria Thwaites4,
  5. Fred Bulamba5
  1. 1 Nuffield Department of Clinical Neurosciences (NDA), University of Oxford, Oxford, UK
  2. 2 Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
  3. 3 Department of Anaesthetics, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
  4. 4 Department of Anaesthetics, Inverclyde Royal Hospital, Greenock, Inverclyde, UK
  5. 5 Department of Anaesthesia, Faculty of Health Sciences, Busitema University, Mbale, Uganda
  1. Correspondence to Dr Hilary Edgcombe; hilary.edgcombe{at}


Objectives To explore the views of non-physician anaesthesia providers (NPAPs) and their colleagues regarding the effectiveness of NPAP training programmes in three contrasting sub-Saharan African countries.

Design This was a qualitative exploratory descriptive study. Semistructured interviews were conducted online, recorded, transcribed and analysed thematically using NVivo.

Setting Participants’ homes or workplaces in Sierra Leone, Somaliland and Uganda.

Participants 15 NPAPs, physician anaesthetists and surgeons working in the countries concerned.

Results Three major themes were identified: (1) discrepancy between urban training and rural practice, (2) prominent development of attitudes outside the curricular set during training, including approaches to learning and clinical responsibility and (3) the importance of interprofessional relationships developed during training for later practice.

Conclusions Anaesthesia providers in different cadres and very different country contexts in sub-Saharan Africa describe common themes in training which appear to be significant for their later practice. Not all these issues are explicitly planned for in current training programmes, although they are important in the view of providers. Subsequent programme development should consider these themes with a view to enhancing the safety and quality of anaesthesia practice in this context.

  • anaesthetics
  • qualitative research
  • surgery

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors HE conceived and designed the study, completed data collection and analysis and drafted the paper for submission. FB also contributed to the conception of the study, undertook data analysis and interpretation and critically revised the paper prior to submission. LSB, SK-I and VT undertook data analysis and interpretation and critically revised the paper prior to submission.

  • Funding This work was supported in part by a grant from the International Relations Committee, representing the Association of Anaesthetists of Great Britain and Ireland and the Royal College of Anaesthetists (no grant number available).

  • Competing interests None declared.

  • Ethics approval Ethical approval was sought and obtained for this study from the King’s College London Research Ethics Committee (ref. LRU-16/17-3981), the Uganda National Council for Science and Technology (ref. HS30ES) and the Office of the Sierra Leone Ethics and Scientific Review Committee (no reference provided).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Due to the commitment to preserve participants’ anonymity and the small number and potential identifiability of participants, original interview recordings and transcripts cannot be made openly available.

  • Patient consent for publication Not required.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles