Barriers and facilitators to implementing a regional anesthesia service in a low-income country: a qualitative study

  • Matthew Ho Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia
  • Patricia Livingston Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada
  • M Dylan Bould Department of Anesthesiology, University of Ottawa, Ontario, Canada
  • Jean Damascène Nyandwi Department of Anesthesiology and Intensive Care Medicine, University of Rwanda, Kigali, Rwanda
  • Françoise Nizeyimana Department of Anesthesiology and Intensive Care Medicine, University of Rwanda, Kigali, Rwanda
  • Jean Bonaventure Uwineza Department of Anesthesiology and Intensive Care Medicine, University of Rwanda, Kigali, Rwanda
  • Robin Urquart Department of Surgery Dalhousie University, Halifax, Canada
Keywords: Regional anesthesia; global health; knowledge translation; consolidated framework for implementation research (CFIR)


Introduction: regional anesthesia is a safe alternative to general anesthesia. Despite benefits for perioperative morbidity and mortality, this technique is underutilized in low-resource settings. In response to an identified need, a regional anesthesia service was established at the University Teaching Hospital of Kigali (CHUK), Rwanda. This qualitative study investigates the factors influencing implementation of this service in a low-resource tertiary-level teaching hospital.

Methods: following service establishment, we recruited 18 local staff at CHUK for in-depth interviews informed by the “Consolidated Framework for Implementation Research” (CFIR). Data were coded using an inductive approach to discover emergent themes.

Results: four themes emerged during data analysis. Patient experience and outcomes: where equipment failure is frequent and medications unavailable, regional anesthesia offered clear advantages including avoidance of airway intervention, improved analgesia and recovery and cost-effective care. Professional satisfaction: morale among healthcare providers suffers when outcomes are poor. Participants were motivated to learn techniques that they believe improve patient care. Human and material shortages: clinical services are challenged by high workload and human resource shortages. Advocacy is required to solve procurement issues for regional anesthesia equipment. Local engagement for sustainability: participants emphasized the need for a locally run, sustainable service. This requires broad engagement through education of staff and long-term strategic planning to expand regional anesthesia in Rwanda.

Conclusion: while the establishment of regional anesthesia in Rwanda is challenged by human and resource shortages, collaboration with local stakeholders in an academic institution is pivotal to sustainability.


Journal Identifiers

eISSN: 1937-8688