Disparities in adult critical care resources across Pakistan: findings from a national survey and assessment using a novel scoring system.

Khan, Mustafa Ali; Shahbaz, Hamna; Noorali, Ali Aahil; Ehsan, Anam Noor; Zaki, Mareeha; Asghar, Fahham; Hassan, Mohammed Moizul; Arshad, Haroon Muhammad; Sohaib, Muhammad; Asghar, Muhammad Ali; Khan, Muhammad Faisal; Sabeen, Amber; Aqeel, Masooma; Khan, Muhammad Haroon; Munir, Tahir; Amin, Syed Kashif; Atiq, Huba; Haider, Adil Hussain; Samad, Zainab; Latif, Asad

<bold>Background: </bold>In response to the COVID-19 pandemic, concerted efforts were made by provincial and federal governments to invest in critical care infrastructure and medical equipment to bridge the gap of resource-limitation in intensive care units (ICUs) across Pakistan. An initial step in creating a plan toward strengthening Pakistan's baseline critical care capacity was to carry out a needs-assessment within the country to assess gaps and devise strategies for improving the quality of critical care facilities.<bold>Methods: </bold>To assess the baseline critical care capacity of Pakistan, we conducted a series of cross-sectional surveys of hospitals providing COVID-19 care across the country. These hospitals were pre-identified by the Health Services Academy (HSA), Pakistan. Surveys were administered via telephonic and on-site interviews and based on a unique checklist for assessing critical care units which was created from the Partners in Health 4S Framework, which is: Space, Staff, Stuff, and Systems. These components were scored, weighted equally, and then ranked into quartiles.<bold>Results: </bold>A total of 106 hospitals were surveyed, with the majority being in the public sector (71.7%) and in the metropolitan setting (56.6%). We found infrastructure, staffing, and systems lacking as only 19.8% of hospitals had negative pressure rooms and 44.4% had quarantine facilities for staff. Merely 36.8% of hospitals employed accredited intensivists and 54.8% of hospitals maintained an ideal nurse-to-patient ratio. 31.1% of hospitals did not have a staffing model, while 37.7% of hospitals did not have surge policies. On Chi-square analysis, statistically significant differences (p < 0.05) were noted between public and private sectors along with metropolitan versus rural settings in various elements. Almost all ranks showed significant disparity between public-private and metropolitan-rural settings, with private and metropolitan hospitals having a greater proportion in the 1st rank, while public and rural hospitals had a greater proportion in the lower ranks.<bold>Conclusion: </bold>Pakistan has an underdeveloped critical care network with significant inequity between public-private and metropolitan-rural strata. We hope for future resource allocation and capacity development projects for critical care in order to reduce these disparities.

Critical Care, 2022, Vol 26, Issue 1, p1

1364-8535

Academic Journal

10.1186/s13054-022-04046-5