Social resource as a critical and overlooked factor for patient safety in low-resource settings

Hilary Edgcombe^1*Gatwiri Murithi²Mary Mungai³Stephen Okelo⁴Sassy Molyneux¹Helen Higham⁵Mike English^1*

• ¹Health Systems Collaborative, Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
• ²Center for Public Health and Development, Nairobi, Kenya
• ³Anaesthetics Department, Kijabe Hospital, Kijabe, Kenya
• ⁴Department of Surgery and Anaesthesiology, Maseno University, Maseno, Kenya
• ⁵Nuffield Department of Anaesthetics, University of Oxford, Oxford, United Kingdom

Clinicians, NGOs, funders and academics (among others) in global health are accustomed to discussion of the "low-resource setting". Commonly, the resources implicit in this term are physical (equipment, drugs) and infrastructural (electricity, water and sanitation) in nature. Human resources are well recognised as scarce in this context too, and the focus in most "workforce" research is on the number, distribution and/or training of healthcare workers. In this article, we make the case for closer examination of "social resource" as necessary to patient safety and distinct from simple enumeration of available/trained personnel. We use the clinical specialty of anaesthesia as a case study, identifying the different ways in which social resource is necessary to enable safe practice for anaesthesia providers, and the potential challenges to accessing social resource relevant in the lowand middle-income context. Finally, we suggest ways in which social resource for anaesthesia professionals in LMICs might be meaningfully investigated, with a view to improving its priority and access for safe anaesthesia care worldwide.