Dr Elizabeth Igaga in one of the operating rooms at Smile Train partner, CORSU hospital, Uganda during a partner visit. Credit: Smile Train

By Elizabeth Igaga
KAMPALA Uganda, Jun 16 2026 (IPS)

Global health has a habit of mobilizing around the visible and the dramatic. Ebola, malaria, and Mpox have all dominated headlines related to Africa in recent years, and understandably so. But nobody is talking about one of the most consequential regional health crises waiting to happen.

When a child needs surgery, the first challenge is not the procedure itself. It is getting them safely to sleep. For decades, hospitals across sub-Saharan Africa have relied on a drug called halothane to do that. It has a faintly sweet smell, which means children breathe it in calmly, without distress or resistance. It’s affordable, stable in warm climates, and it works. Although there are anesthetics with fewer side effects that have been used for decades in higher-income countries, in low-resource settings with limited options, it has been indispensable.

Dr. Elizabeth Igaga, Senior Director of Program Safety, Smile Train

I am an anesthesiologist and perioperative patient safety specialist based in Uganda. I work with hospitals across low and middle-income countries to ensure that children who need surgical care receive it safely. Safe anesthesia is not a luxury. It is a foundation of surgical care. What I see on the ground makes the halothane shortage one of the most pressing and underacknowledged patient safety problems in global health today.

The obvious alternative is a drug called sevoflurane. As a more modern anesthetic, it’s safer and more effective than halothane. But in Uganda, sevoflurane costs approximately ten times more than halothane. In settings where health budgets are already stretched, this is not a simple swap.

This matters on an enormous scale. Research published in The Lancet shows that outcomes for children undergoing surgery in Africa are already significantly worse than those in high-income countries, including African mortality rates that are approximately 11 times higher. Remove access to the one anesthetic drug that most African pediatric facilities currently rely on, and those numbers will get worse.

The demographic stakes make this more urgent still. Africa is projected to be home to roughly 40 percent of the world’s children by 2050. The continent already carries an enormous burden of conditions that can only be treated with surgery, much of it in pediatric populations, not to mention a child hit by a car, diagnosed with cancer, or rushed to the hospital with a ruptured appendix. All of these children face the same anesthesia infrastructure as everyone else, and when that infrastructure fails, what would have been a survivable crisis becomes something far worse.

What is often misunderstood about the transition away from halothane is that it is not simply a matter of substituting one drug for another. It is a systems problem with at least four distinct components that all need to move at the same time.

The first is government procurement. Halothane is currently embedded in national drug budgets across the continent at a price point that sevoflurane cannot match. Ministers of health and national procurement authorities must make an active decision to fund the difference and begin revising their drug budgets now, before shortages force their hand under emergency conditions. Market dynamics mean dwindling supplies will make halothane increasingly expensive, another component that could put essential surgeries out of reach.

The second is equipment. Many anesthesia machines currently in use across African hospitals are not compatible with sevoflurane without modification or outright replacement. That requires hospital-by-hospital assessment to understand what is needed before a single bottle of the new drug is ordered. Committing to a new anesthetic without first confirming that the infrastructure can deliver it safely is not a transition plan; it is a different kind of crisis.

The third is the supply chain. Sevoflurane needs to be formally incorporated into national essential medicines lists and procurement frameworks so that it reaches facilities reliably and at negotiated prices, rather than arriving sporadically through fragmented channels.

The fourth is workforce training. The majority of anesthesia care in Africa is delivered by non-physician anesthesia providers rather than doctors. Administering anesthesia to a child is one of the most technically demanding and emotionally weighty responsibilities in medicine, requiring precise judgment in real time when the margin for error is razor-thin. Nobody should be put in the position of performing that task for the first time on an unfamiliar drug in the middle of an emergency. These providers need structured, supervised training on sevoflurane before the transition happens, not after. National anesthesia societies have a direct role to play here, both in alerting their members to what is coming and in developing and delivering the training programs they will need.

The World Federation of Societies of Anaesthesiologists has already called on national and regional health authorities to rapidly budget for and implement a safe transition to sevoflurane. That call deserves a far more urgent response than it has received so far. Countries that stockpiled halothane may have a few additional months of runway. Countries that did not are already running low.

The Philippines and Indonesia have already navigated this shift successfully, and they offer a promising roadmap, including training for local biomedical engineers and anesthesia providers to ensure the transition is safe, practical, and sustainable. The lesson from those experiences is not that transition is easy, but that it is entirely achievable when governments, health systems, and the medical community move together with a shared plan.

The difference between those countries and much of sub-Saharan Africa right now is time and attention. Unlike other urgent global health situations, halothane depletion will not arrive with an outbreak curve or a dramatic headline. It will arrive quietly, one empty bottle at a time, in a hospital where a child needs surgery and the only drug the staff knows how to use is no longer on the shelf. By the time that moment becomes a crisis visible enough to mobilize a response, it will already be too late.

We know this is coming and what the solution requires. The only thing that remains uncertain is whether we will treat it with the urgency it deserves.

Elizabeth Igaga is Senior Director of Program Safety, Smile Train

IPS UN Bureau

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