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World Pharmacist Day is an initiative by the International Pharmaceutical Federation (FIP) to promote the role that pharmacists play in improving patient safety. In this blog, Roohil Yusuf, Global Pharmacy Advisor at Save the Children, looks at the work of different partners in delivering safe pharmacy services in Afghanistan, Yemen and Sudan.

Fragile, conflict-affected and vulnerable (FCV) settings is a broad term describing a range of situations including humanitarian crises, protracted emergencies and armed conflicts. In FCV settings delivery of quality health services faces significant challenges, including disruption of routine health service organization and delivery systems, increased health needs, complex and unpredictable resourcing issues, and vulnerability to multiple public health crises. Despite the difficulty of addressing quality in FCV settings, the need is acute, given the significant health needs of the populations in such environments and the increasing numbers of people for whom FCV settings are home.   WHO is working with Member States, the Global Health Cluster, and technical and academic partners to support action to address quality in FCV settings. Building on the foundations of the WHO National quality policy and strategy initiative, WHO has developed a technical document, “Quality of care in fragile, conflict-affected and vulnerable settings: taking action”. The document outlines a practical approach to action planning and implementation of quality interventions in FCV settings and is accompanied by a curated compendium of tools.

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 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.

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.