The State of Critical Care Provision in Low-Resource Environments

Document Type



Anaesthesiology (East Africa)


In this edition of the Journal, Kifle et al1 present the state of intensive care provision in public hospitals across Ethiopia. In this comprehensive survey of 51 of the 53 public intensive care units (ICUs), they report that there are 0.3 ICU beds per 100,000 population, with more than half of facilities only providing care consistent with a Level 1 ICU, and that the majority of these beds reside in the capital of Addis Ababa. Resources are limited. No site has piped oxygen, invasive monitoring is rarely available, the presence of a single infusion pump or suction is not universal, isolation policies exist in <25% of units, and handover policies are present in approximately three-quarters of the facilities. Furthermore, not a single ICU fulfilled the criteria for a Level 3 unit.

While these findings are striking, they are not unexpected in Africa.2 This work is important, as it is the first comprehensive analysis of ICUs at a low- and middle-income country (LMIC) level in Africa. It shines a light on the challenges we will have to overcome, to provide adequate critical care in resource-limited environments. However, the numbers presented in the report do not convey the full enormity of the challenge. There are large regional differences across Ethiopia that further aggravate the problem. Ethiopia has a population of 114 million people, of which 4 million are in the capital of Addis Ababa. Yet, Addis Ababa has 25% of the total ICU bed capacity and 51% of critical care physicians of the entire country. This means that outside of the capital, the true ICU bed number is 243 ICU beds per 100 million population or a staggering 0.0002 ICU beds per 100 000 population, with <1 ICU bed per 100 hospital beds.

Publication (Name of Journal)

Anesthesia & Analgesia