Expanding Anaesthesia Access in South Africa: Integrating Specialist Anaesthetists and Nurse-Anaesthetists
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Nurse-anaesthetists,
Patient safety,
Specialist anaesthetists,
Task-sharing
Main Article Content
Michael Mncedisi Willie
Siyabonga Jikwana
Onke Ronaldy Mnyaka
Wezile Wilson Chitha
Khona Dyantyi
Darion Barclay
Thokoe Vincent Makola
Abstract
Background: South Africa faces an acute shortage of specialist anaesthetists, limiting equitable access to safe surgical care, particularly in rural and secondary-level hospitals. Task-sharing with nurse-anaesthetists has been proposed to close these gaps, yet no such cadre exists in South African law and the South African Nursing Council does not recognise anaesthesia as a nursing specialty. Outside tertiary centres, most anaesthesia is administered by non-specialist medical officers.
Aims: This study examines the roles, training, and regulation of specialist and nurse anaesthetists to develop a framework for expanding anaesthesia access while safeguarding patient safety, and asks whether a nurse-anaesthetist cadre is the appropriate response given the medical officers and clinical associates deployed in district hospitals.
Methods: A qualitative, document-based design integrated peer-reviewed literature, national policies, regulatory guidelines, and international benchmarks. Thematic content analysis spanned ten domains, including workforce distribution, training, supervision, task-sharing, and regulatory oversight, with international comparison.
Results: Structured task-sharing with nurse-anaesthetists may extend services when underpinned by formal training, supervision, and clear regulation, but substantial gaps persist in national accreditation, competency assessment, and implementation. The proposed Integrated Anaesthesia Workforce and Task-Sharing Framework (IAWTF) guides workforce planning, competency development, and service delivery.
Conclusion: A regulated non-physician cadre could help mitigate shortages, but statutory recognition by the South African Nursing Council is a legal precondition, since the Health Professions Council of South Africa has no jurisdiction over nurses. Its merits must be weighed against strengthening the role of medical officers and clinical associates. Future research should evaluate clinical outcomes and cost-effectiveness.
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Copyright (c) 2026 Michael Mncedisi Willie, Siyabonga Jikwana, Onke Ronaldy Mnyaka, Wezile Wilson Chitha, Khona Dyantyi, Darion Barclay, Thokoe Vincent Makola
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