Perioperative Provider Safety in Low- and Middle-income Countries During the COVID-19 Pandemic



A new publication in the Annals of Surgery highlights the importance of investing in resources and training during a global public health emergency.

The study – conducted by Lifebox in collaboration with Smile Train and Jhpiego through a survey of 230 facilities and 507 healthcare providers representing 52 low- and middle-income countries (LMICs) – calls for the protection of the healthcare workforce during COVID-19.

“The COVID-19 pandemic is far from over, particularly in low-income settings where vaccines are scarce. Protecting the surgical workforce with PPE and training in LMICs is essential to ensure basic health services continue throughout this time of crisis.” Dr. Nichole Starr, general surgery resident, University of California San Francisco, Lifebox Fellowship Advisor, and study co-author. 

Healthcare providers in low-income and lower-middle-income countries (LIC/L-MICs) did not have routine access to essential protective equipment the study found: N95s (37.1%), surgical masks (29.1%), gloves (21.6%), or eye protection (30.9%). Clinicians also reported having to purchase their own PPE where available and reusing it – sometimes without decontamination (7.7% in LIC/L-MICs).

The continued unavailability of vaccines in many contexts was also highlighted in the paper, emphasizing the importance of continued investment in protection for medical providers. To date, only 8.5% of people in low-income countries have received at least one dose of the COVID-19 vaccine.

The study also calls for training to ensure best practices for PPE are followed to protect the healthcare workforce. Lifebox has offered training on the use and safe reuse of PPE during COVID-19, especially in low-resource contexts.

“The protection of the surgical and anesthesia workforce in low- and middle-income countries with PPE, training, and safety protocols in low-income countries is essential while vaccine inequities persist around the globe.” Dr. Tihitena Negussie, pediatric surgeon, Lifebox Global Clinical Director, and study author.

Throughout the COVID-19 pandemic, Lifebox and partners have distributed tools and resources, including PPE and pulse oximeters, to medical providers in 49  countries. Pulse oximeters are a critical tool in the management of COVID-19 patients, used for patient triage, clinical decision-making, and ongoing patient monitoring.

“With solidarity, creativity, and persistence, we can improve workplace safety as we fight to emerge from the COVID-19 pandemic, and improve our global preparedness for the future without leaving providers in the lowest-income environments behind,” the study concludes.

A visual abstract was developed in 2021 along with a briefing report on the data. Find out more here.