SAFE – Impact & Sustainability | Association of Anaesthetists
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SAFE – Impact & Sustainability


SAFE Course Impact & Sustainability

SAFE courses include a monitoring and evaluation component as standard. Further studies have evaluated the impact of SAFE courses in several countries and report improved knowledge and skills following SAFE course training, which are maintained longer term, as well as positive behavioural changes, workplace and system improvements and improved confidence and motivation.

Publications related to SAFE include:

  • Livingston P, Evans F, Nsereko E, et al. Safer obstetric anesthesia through education and mentorship: a model for knowledge translation in Rwanda. Can J Anaesth 2014; 61:1–12
  • Enright A, Grady K, Evans F. A New Approach to Teaching Obstetric Anaesthesia in Low-Resource Areas. J Obstet Gynaecol Can 2015;37(10):880–884 
  • Sharkey E, Boyd N, Burton Z, et al. Safe paediatric anaesthesia project: scaling-up paediatric anaesthesia training in east and central Africa. Arch Dis Child 2017;102:A1-A2
  • Boyd N, Sharkey E, Nabukenya M, Tumukunde J, Sipuka N, Walker I, Byrne-Davis L. The Safer Anaesthesia from Education (SAFE) paediatric anaesthesia course: educational impact in five countries in East and Central Africa. Anaesthesia 2019; doi: 10.1111/anae.14778
  • White MC, Rakotoarisoa T, Cox NH, Close KL, Kotze J, Watrous A. A Mixed-Method Design Evaluation of the SAFE Anaesthesia Course at 4 and 12-18 months After Training in the Republic of Congo and Madagascar. Anesth Analg 2019 doi: 10.1213/ANE.0000000000004329
  • Lilaonitkul M, Mishra S, Pritchard N, Andhoga J, Olang’ P, Kibet EB, Walker IA, Hart J, Byrne-Davis L. Mixed methods analysis of factors influencing change in clinical behaviours of non-physician anaesthetists in Kenya following obstetric anaesthesia training. Anaesthesia 2020; doi:10.1111/anae.15091 
  • Moore J, Morriss W, Asfaw G, Tesfaye G, Ahmed A, Walker I. The impact of the Safer Anaesthesia from Education (SAFE) obstetric anaesthesia training course in Ethiopia: A mixed methods longitudinal cohort study. Anaesthesia and Intensive Care 2020; doi:10.1177/0310057X20940330

Although SAFE courses can be run as standalone training, courses are often run in collaboration with local societies, educational institutions, health authorities, existing partnerships or as components of larger projects. This approach, along with the incorporation of SAFE Train the Trainers courses, reduces the reliance on international faculty presence for course delivery.

Several courses have been locally driven and delivered independently and external support from international administration and faculty is offered to support local faculty in doing this.

As the SAFE initiative expands, further models of training are being developed and piloted to strengthen the impact and sustainability of SAFE. These include:

  • Post-SAFE course 1or 2-day refresher training and mentoring programs
  • Incorporation into national anaesthesia curricula or other training programmes
  • Combining SAFE modules or courses with other short courses
  • Digital SAFE materials and modules
  • Adaptations to create context specific courses for delivery in specific regions or countries

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