Provision of anaesthesia services for emergency obstetric care through task shifting in South Asia.

Anaesthesia is required for certain procedures in emergency obstetric care, such as caesarean section and the repair of ruptured uterus. Task shifting for provision of anaesthesia has been implemented in public sector rural hospitals of South Asia in recent years because of significant shortages of anaesthetists, but there has been limited research on this issue. This paper reviews the literature on this topic and documents existing programmes for task shifting anaesthesia services to mid-level providers in South Asia to increase access to emergency obstetric care and reduce maternal mortality. We found that task shifting of anaesthesia services has been effective in expanding coverage and access to care in South Asia, but most programmes have not been implemented systematically as part of an overall human resources strategy. A comprehensive approach, to maximise the benefits of these programmes, calls for countries to appoint a director at national or state level who is responsible for the availability of anaesthesia services in rural areas; legal protections, licensing by a competent authority and registration to perform anaesthesia services, including prescription of anaesthesia drugs; supportive managerial arrangements, competency-based training, monitoring and evaluation; performance rewards, career structure and job clarity; adequate equipment and supplies; support from specialist anaesthetists and quality assurance for safety.