Author/Authors :
Kannan, V.C. Beth Israel Deaconess Medical Center - Harvard Medical School - Boston - MA, USA , Tenner, A University of California San Francisco - San Francisco - CA, USA , Sawe, H.R. Muhimbili University of Health and Allied Sciences - Dar es Salaam, Tanzania , Osiro, M Department of Emergency Medical Services - Ministry of Health, Uganda , Kyobe, T Association of Ambulance Professionals Uganda - Kampala, Uganda , Nahayo, E Emergency Department - Centre Hospitalier Universitaire de Kigali, Rwanda , Rasamimanana, N.G. University Hospital of Mahajanga P-ZAGA - Mahajanga, Madagascar , Kivlehan, S Brigham and Women's Hospital - Harvard Medical School - Boston, MA, USA , Moresky, R Columbia Mailman School of Public Health - New York - NY, USA
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.
Keywords :
Emergency care quality , Health systems , Emergency care systems , Quality
