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The Bulletin of the World Health Organization is a fully open-access monthly journal of public health with a special focus on low and middle-income countries.

The United Nations 2015 Millennium Development Goals targeted a 75% reduction in maternal mortality. However, in spite of this goal, the number of maternal deaths per 100,000 live births remains unacceptably high across Sub-Saharan Africa. Because many of these deaths could likely be averted with access to safe surgery, including cesarean delivery, Epiu et al. set out to assess the capacity to provide safe anaesthetic care for mothers in the main referral hospitals in East Africa. The authors identified significant shortages of both the personnel and equipment needed to provide safe anaesthetic care for obstetric surgical cases across East Africa. There is a need to increase the number of physician anaesthetists, to improve the training of non-physician anaesthesia providers, and to develop management protocols for obstetric patients requiring anaesthesia. This will strengthen health systems and improve surgical outcomes in developing countries. More funding is required for training physician anaesthetists if developing countries are to reach the targeted specialist workforce density of the Lancet Commission on Global Surgery of 20 surgical, anaesthetic, and obstetric physicians per 100,000 population by 2030.

The International Standards for a Safe Practice of Anesthesia (ISSPA) were developed on behalf of the World Federation of Societies of Anaesthesiologists and the World Health Organization. It has been recommend as an assessment tool that allows anaesthetic providers in developing countries to assess their compliance and needs. This study from Tao et al. was performed to describe the anaesthesia service in one main public hospital during an 8-month medical mission in Cambodia and evaluate its anaesthetic safety issues according to the ISSPA.

The “WHO handbook for national quality policy and strategy” outlines an approach for the development of national policies and strategies to improve the quality of care. Such policy and strategy can help clarify the structures, roles and responsibilities within national quality efforts, support the institutionalisation of a culture of quality, and secure buy-in from health system leaders and stakeholders. The handbook is not a prescriptive process guide but is designed to support teams developing policies and strategies in this area, and very much recognizes the varied expertise, experience and resources available to countries. It outlines eight essential elements to be considered by teams developing national quality policy and strategy: national health goals and priorities; local definition of quality; stakeholder mapping and engagement; situational analysis; governance and organizational structure; improvement methods and interventions; health management information systems and data systems; quality indicators and core measures. The NQPS handbook was co-developed with countries each finding themselves at different stages of the development and execution of national quality policies and strategies and was informed by the review of a sample of more than 20 existing quality strategies across low-, middle- and high-income countries globally.

The safety of anesthesia characteristic of high-income countries today is not matched in low-resource settings with poor infrastructure, shortages of anesthesia providers, essential drugs, equipment, and supplies. Health care is delivered through complex systems. Achieving sustainable widespread improvement globally will require an understanding of how to influence such systems. Health outcomes depend not only on a country's income, but also on how resources are allocated, and both vary substantially, between and within countries. Safety is particularly important in anesthesia because anesthesia is intrinsically hazardous and not intrinsically therapeutic. Nevertheless, other elements of the quality of health care, notably access, must also be considered. Surgical and anesthesia services must not only be provided, they must be safe. The global anesthesia workforce crisis is a major barrier to achieving this. Many anesthetics today are administered by nonphysicians with limited training and little access to supervision or support, often working in very challenging circumstances. Many organisations, notably the World Health Organization and the World Federation of Societies of Anaesthesiologists, are working to improve access to and safety of anesthesia and surgery around the world. Challenges include collaboration with local stakeholders, coordination of effort between agencies, and the need to influence national health policy makers to achieve sustainable improvement. It is conceivable that safe anesthesia and perioperative care could be provided for essential surgical services today by clinicians with moderate levels of training using relatively simple (but appropriately designed and maintained) equipment and a limited number of inexpensive generic medications. However, there is a minimum standard for these resources, below which reasonable safety cannot be assured. This minimum (at least) should be available to all. Not only more resources, but also more equitable distribution of existing resources is required. Thus, the starting point for global access to safe anesthesia is acceptance that access to health care in general should be a basic human right everywhere.