Emergency care systems in Africa: A focus on quality

Abstract

Emergency care systems (ECS) are undergoing a period of rapid development on the African continent. What were formerly large intake zones are now being shaped into dedicated emergency units. Emergency care providers are being trained via certificate and even residency programs. However, significant challenges still exist. Resource limitations, staffing, and other system inputs are often the easiest issues to identify, but they only account for part of the problem. There are other prominent barriers to the delivery of high quality emergency care including lack of governmental leadership, poor system and facility organization, lack of provider training, and community misunderstanding of ECS functions. Released in May 2019, World Health Assembly (WHA) 72 resolution 12.9 “Emergency care systems for universal health coverage: ensuring timely care for the acutely ill and injured” has squarely placed ECS strengthening as a priority item to member state governments. Moving forward, it will be important to ensure that these systems are set up for success, as high-quality emergency care systems have the potential to avert half of all deaths in low- and middle-income countries (LMIC). With momentum building from the recent WHA amendment and the health systems community more focused than ever on the consideration of quality in health systems design, it is of the utmost importance that ECS planners dovetail these interests such that these nascent systems are designed while 1) applying a systems thinking lens and 2) maintaining a focus on quality. This article helps to accomplish this by breaking down ECS into five major categories for evaluation as defined by the WHO Emergency Care Systems Assessment tool, providing an understanding of the functions of each, and identifying which indicators might be used to gauge performance. We also reinforce the notion that these indicators must dive deeper than system inputs and health outcomes, they must be patient centered in order to truly be reflective of success.

Non-hospital healthcare center’s preparedness assessment toolbar for providing basic emergency care: a sequential exploratory mixed-method study

“…Globally, emergency care delivered in NHHCs has been neglected, with particular emphasis on low- and middle-income countries [ 62 ]. Strengthening the emergency care system at the level of non-hospital centers is an urgent issue in many healthcare systems in the world, and there is a need to develop strategic plans in order to reduce mortality and disability [ 63 , 64 ]. There are multiple complexities in the emergency care chain at the NHHCs level, including poorly resourced emergency areas, inadequate emergency transport, critical personnel shortages, unclear referral pathways, and barriers along the way to escalate emergency patients to appropriate facilities [ 5 ].…”

Perception of an Introductory Point-of-Care Ultrasound Course for Thai Medical Students on Emergency Medicine Rotation

“…Similar to other countries, interns or general practitioners instead of trained EM physicians are often responsible for the delivery of emergency medical care. [18][19][20] The survey data indicated that during their internship almost all of the respondents were frontline ED providers. This shortage of trained EM specialists is faced by many other low and middle-resource environments and even rural hospitals in the United States.…”

“…This shortage of trained EM specialists is faced by many other low and middle-resource environments and even rural hospitals in the United States. [20][21][22] It is imperative that we must be training medical students to meet the needs of emergency patients. POCUS is a tool that improves the timely diagnosis and management of critically ill patients in low-resource or low-income countries.…”

An Integrated Emergency Response Tool for Developing Countries: Case of Uganda

“…On the other hand, in the developed world, customized apps and devices provide a range of services from health management to cost effective health care services at the patients' convenience [6] . Emergency care systems have the potential to avert half of all deaths in low-and middle-income countries (LMIC) [7] .…”

“…EHS range from on-scene care to a global demand to improve efficiency of health systems. In this work we consider emergency condition to include road traffic, trauma, infections, non-communicable diseases and complications of pregnancy which accounted for 90% of the leading death in low and middle income countries in 2017 [7] . The emergency panic/deficit brought by the COVID-19 outbreak has shown the ill preparedness of health systems and highlighted the need to priorities emergency services in Uganda [9] .…”