1. Critical Care Development in Africa
Emirates Critical Care Conference, Dubai, April 2010
Dr Hala Abuzeid Ahmed, FRCP
Consultant in Critical Care, Sudan

2. Night
sudan

3. night
Africa

4. Facts to be considered about Africa
Poorest continent, emerging new diseases
Inhabited by 1/3 of the world’s population
Resources are limited and therefore the critical care practice is extremely challenging
Wars, injustices, corruption produced late and inadequate investments into health and act as limitations to adequate care delivery.

5. Twenty-nine of 31 countries lowest in the United Nations human development index are in Africa.
Life expectancy in these countries has been falling in recent years , the Botswana crisis!!!

6. Annual spending on health in African countries 3-8 % of the GDP
USA = 16% (WHO International spending as percent of gross domestic product 2006)

7. South Africa is unique and is considered the highest spender on health ( 8%-10%)
Sudan invests < $100/ individual/year on health issues
Sudan spends > $1000/ personnel/month on security and defense issues
Huge in-cordination between all public, military and police medical services.

8. Critical Care in SE Asia
Most rapid economic growth.
Countries vary widely in their income and spending
In some countries, critical care compete for resources with basic public health programs and primary care limiting public sector resources
Well established in private sectors, but still evolving regarding organizational structure
Few full time-time intensivists
Specialist Training in Critical Care Medicine is established in Hong Kong Taiwan and Philippines

9. Statistical figures ICU/HDU facilities
National Distribution of facilities
20% ICU in public hospitals Vs 80% ICU in private hospitals (1.7% of total bed proportion in public Vs 10% in Private)
Most ICU beds are in the urban areas rather than rural
Person : ICU bed ratio can range from 1:20 to as high as 1: 30000
2-5% of all commissioned beds were not in use

10. Transfer Practices in Hospitals with no ICU/ HDU Facilities
70% of public hospitals don't have ICU facilities , leading to the need to transfer BUT
Transport Vehicles are uncommon in the majority
Delays in transportation have been shown to increase mortality and morbidity

11. Nursing Care Resources
Deficit in ICU nurses is huge ( In Sudan 62000, Vs SA 7920)
ICU nurses lack the experience ( 40% = 0-5 years)
Non retention of experienced nurses due to migration
Lack of incentives act as a repellent
Capacity building is a rare event
Lack of motivation amongst staff

12. Open Vs Closed Units Open systems are the dominant
Around 4% of ICUs in Africa are run by an intensivist
In Sudan the deficit of intensivists is estimated to be around 500 ( 1200 Hospitals, < 320 Urban)
With the current rate of production will take at least 50 years

13. Oxygen, Water & Electricity Supply
Very expensive
Uganda has Oxygen in only 635 of its hospitals
Difficult logistics
Oxygen generators Vs Electricity supply and sustainability
Back up generators may take significant time to connect
Staff need training of the local conditions

14. Equipments
Mortality in ICUs is related to the availability of appropriate technical equipments ( Bastos PG et al Brazil APACHE III study group, Intensive care medicine 1996;22:664-9)
Appropriate Ventilators independent of compressed gases and disposable circuits are ideal
Invasive arterial blood pressure monitoring and haemodyialsis require a lot of consumables.

15. Supporting Services Laboratory Radiology
Routine investigations might be a luxury in most of the rural areas
APACHE Scoring will be affected
Blood Transfusion Services and International Standards
Microbiological Services
Imaging

16. Disease Spectrum & Outcome
Overall Mortality 25% , surgical patients
True in most of the African countries
Future planning should consider t to be close to Ors
Tetanus remains a major challenge
Malaria and MODS

17. Polio Epidemic 1952 Copenhagen, Kommune Hospital

18. Critical care services in Africa had been hampered by economic reversals
Practice is in an early stage of development

19. So don’t we need to act?
YES

20. Short Term Recommendations
Regionalization & Integration
Protocols and Guidelines
CPD & Outreach
Retention Strategies

21. Medium- term Dealing with the gross deficiency in HR
2 tiered programmes:
Programme 1:
Driven by nurses and doctors with intermediate skills and experience
Programme 2 :
Driven by intensivists and fully trained nurses
Both should have clear scope of practice, training and incentive schemes

22. Medium-term Telemedicine
Tier 1 units to have access to Tier 2 units as and when required
Maximizing use of existing beds

23. Long-term Changing open to closed units New Units
National Database to help with ongoing evaluation , to plan for proper strategies

24. Possible??