The Head of the Department of Anaesthesia at Kabale University, Dr. Isabella Epiu, has been awarded the Africa Society of Regional Anaesthesia (AFSRA) Diamond Prize for her outstanding contribution to advancing regional anesthesia across the continent. The award was presented at the 13th AFSRA Conference in Constantine, Algeria.
According to Dr. Epiu’s November 2025 research on How Africa is Revolutionizing Obstetric Anesthesia for Safer Birth, obstetric anesthesia remains a critical determinant of maternal outcomes across Africa.
Disparities in access and quality persist both between countries and between urban and rural regions. While some nations have achieved notable improvements through innovative programs and policy reforms, many healthcare systems continue to face fundamental challenges, with maternal mortality rates varying widely across and within countries.
Her study highlights the current state of obstetric anesthesia in Africa, examining regional variations, successful interventions, persistent barriers, and evidence-based recommendations.
Drawing on recent data and insights from obstetric anesthesiologists across the continent, it provides a comprehensive perspective on how anesthesia care affects maternal safety in diverse African contexts.
Regional Disparities in Practice and Resources
The landscape of obstetric anesthesia varies considerably across Africa. In East Africa, countries like Uganda and Kenya demonstrate progress alongside ongoing challenges. A recent audit at Aga Khan University Hospital in Nairobi shows spinal anesthesia as the predominant method for cesarean sections, with general anesthesia reserved for specific cases.
Epidural analgesia for labor remains limited at just 1.5% due to resource constraints and cultural factors, despite being the gold standard in high-resource settings. Postoperative pain management is improving, with ultrasound-guided transversus abdominis plane (TAP) blocks used in 80% of cases to reduce opioid requirements.
North Africa presents a different picture. Morocco’s universal health insurance program has improved access to anesthesia services in medium-sized cities, though rural areas still face workforce shortages. Libya experiences similar disparities, with urban centers benefiting from private-sector investment while rural areas rely on short-term locum providers.
Central Africa faces significant workforce challenges. In Cameroon, nurse anesthetists perform most procedures due to a shortage of physician anesthetists, with a ratio of just 0.75 anesthesia providers per 100,000 population. Spinal anesthesia predominates, but essential medications and monitoring equipment are often unavailable in rural facilities.
South Africa demonstrates leadership in improving obstetric anesthesia through specialist societies and guidelines, yet rural facilities still contend with equipment shortages and reliance on junior practitioners. Across the continent, physician anesthetists are concentrated in urban areas, leaving non-physician providers to operate largely unsupervised in rural regions.
Workforce Challenges and Training Innovations
A shortage of skilled anesthesia providers remains a major barrier to safe obstetric care. Rural areas are particularly affected, with many countries falling below the recommended minimum of four to five physician anesthetists per 100,000 population.
Contributing factors include limited training capacity, low retention in rural areas, and international migration of skilled professionals.
Innovative training models are emerging. Rwanda partners with international organizations to strengthen residency programs through simulation training, while the College of Anaesthesiologists of East, Central, and Southern Africa (CANECSA) has implemented a standardized four-year curriculum across eight countries.
Task-sharing programs, such as Uganda’s Safer Anaesthesia From Education (SAFE-OBS) course, have trained non-physician anesthetists to safely provide obstetric anesthesia, expanding access across Africa.
Infrastructure and Technological Advancements
Many rural facilities lack basic monitoring equipment and reliable power, but portable monitoring devices and handheld ultrasound machines are improving safety in low-resource settings. Point-of-care ultrasound initiatives, supported by the African Society of Regional Anaesthesia and Pain Medicine, have equipped hundreds of anesthetists with essential diagnostic and procedural skills.
Policy Frameworks and Health System Strengthening
National Surgical, Obstetric, and Anesthesia Plans (NSOAPs) in countries including Senegal, Ethiopia, Nigeria, Madagascar, Zambia, Rwanda, Kenya, and Tanzania provide roadmaps for improving infrastructure, workforce development, and service delivery.
These plans prioritize anesthesia care as part of broader maternal health strategies. Programs such as Tanzania’s expansion of anesthesia providers and Cameroon’s prepayment “Cheque Santé” initiative demonstrate the impact of policy-driven solutions in improving access to care.
Conclusion
Africa’s obstetric anesthesia landscape presents both challenges and opportunities. While disparities persist, success stories from Uganda, Kenya, Tanzania, Rwanda, South Africa, and other nations demonstrate the potential for improvement through committed leadership, innovation, and context-specific solutions.
By investing in workforce development, infrastructure, and policy frameworks, Africa can achieve equitable access to safe obstetric anesthesia and significantly reduce preventable maternal mortality.
Dr. Epiu’s recognition with the AFSRA Diamond Prize underscores the vital role of leaders in driving this transformation and improving maternal health across the continent.
