To the Editor, We read with interest the article by Hall et al. on shortages of anesthetic drugs in Canada. We work in a large referral hospital in Zimbabwe and also face drug shortages in our anesthesia and critical care practice. The problem of drug shortages is global; however, our situation has not received as much scrutiny as is the case in Canada and North America. In Sub-Saharan Africa, our anesthetic and related drug shortages are similar to those in Canada and include a range of drugs, e.g., propofol, muscle relaxants, opioid and non-opioid analgesics, inotropes, local anesthetics, and benzodiazepines. In a study of anesthesia resources in Uganda (Sub-Sahara), Hodges et al. reported severe anesthetic drug shortages. Except for ketamine, most of the drugs were not easily available; in addition, only 54% of the anesthetists had pethidine or morphine available on a continuous basis. In the same study, 30% of the anesthetists stated that they never had local anesthetic solution for a subarachnoid block in their hospitals, while 28% revealed that they only sometimes had the solution. In a recent study by Baelani et al. on the availability of critical care resources to implement the guidelines for the Surviving Sepsis Campaign in Africa, the authors showed that drugs, amongst other resources, were available less frequently in Sub-Saharan Africa than in high-income countries. In this study, 20.1% and 26.3% of the respondents from Africa revealed that they never had dopamine and noradrenaline, respectively, while 13.8% and 6.9% of the respondents reported that they never had propofol and a nondepolarizing muscle relaxant, respectively. These shortages have been shown to hinder the efficient delivery of anesthesia and critical care in the region. Van Houwe commented that provision of anesthesia in Africa is closely related to the overall framework of the health system, which in turn is also tightly linked to the economic (including per capita expenditure on health) and political priorities in the African countries. Per capita expenditure on health in Zimbabwe is US$18, and the average for Africa is US$84 (World Bank data for 2010), with over 68% of that being out of pocket. This expenditure is far below the US$2,100 for the Belgian government in 2004. There is not enough money to spend on health resources, which explains the major infrastructural shortages, such as oxygen, hospital equipment (e.g., anesthetic machines), and drugs. For us, the proximal causes of the shortages may be different from those for Canada and North America. In the majority of African countries, manufacturers are much further away from users than they are in North America and Europe. In a survey of existing profiles of the pharmaceutical industries in member states of the Common Market for Eastern and Southern Africa (COMESA), the major producers were Egypt and Kenya. Most of the locally produced or finished drugs are generics. In Zimbabwe, none of the 14 pharmaceutical G. T. Nyakatawa, MBChB (&) F. D. Madzimbamuto, MBChB Department of Anaesthesia and Critical Care Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe e-mail: gtnyakatawa@yahoo.co.uk