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

Abstract

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.

Keywords

• regional anesthesia
• global health
• knowledge translation
• consolidated framework for implementation research (cfir)