Anaesthesia provision challenges in public hospitals of Pakistan’s Punjab province: a qualitative study of expert perspectives

Background Anaesthesia delivery in Pakistan remains limited to conventional intraoperative procedures, with research showing ongoing challenges in quality and resourcing. We aimed to identify systemic challenges in the delivery of quality anaesthesia services for surgical support in Pakistan’s Punjab province. Methods This qualitative study included 22 semi-structured interviews with purposively selected anaesthesia system experts in Punjab province, including heads of teaching hospital anaesthesia departments, healthcare commission representatives, and health department officials. We analysed data thematically, using deductive and inductive coding. Results We identified three themes of anaesthetist recruitment and retention, quality-of-care and in-service training, and discrepancies between specialities, describing major challenges experienced within the speciality. Findings indicated that workforce shortages and maldistribution, insufficient in-service training and standards, inadequate equipment maintenance, and lack of anaesthesia representation in decision-making compromised anaesthesia provision quality and safety. Conclusions Improving anaesthesia provision in Punjab would require increasing physician and non-physician anaesthetist numbers and rotation to peripheral postings, strengthening training quality, and ensuring availability of minimum essential equipment and supplies. To achieve essential anaesthesia provision standards, policy interventions are needed to, for example, balance anaesthesiologist and surgeon numbers, require that anaesthesiology graduates work a few years in-country (e.g. scholarship bonds), ensure in-service training attendance for skills updates, and implement quality assurance standards for equipment and supplies. HIGHLIGHTS What is already known on this topic? Existing research on anaesthesia in lower-income economies focuses on provision discrepancies and capacity measurement of HIC-partnered interventions. However, managerial and frontline challenges that weaken quality anaesthesia provision in countries such as Pakistan, and thus affect global surgery indicators, are largely unexamined. What this study adds This study is the first to highlight ongoing challenges within the anaesthesia delivery system in Punjab province as experienced by senior practitioners and health officials, thus contributing to the knowledge base on anaesthesia provision challenges in lower-income economies. How this study might affect research, practice, or policy Findings show the urgent need to increase recruitment, retention, and peripheral distribution of physician and non-physician anaesthetists along with developing clear national legislation and practice guidelines for standardised quality of anaesthesia care and raising the public profile of anaesthesia in Pakistan.