General medicine/conceptPlacing Emergency Care on the Global Agenda
Introduction
Establishing a health research agenda in developing countries has increasingly been recognized as crucial in determining health and budgeting priorities in resource-limited settings. Yet the concept of emergency care has largely been overlooked or, at times, disregarded as beyond the reach of health systems in resource-limited settings. Traditionally, research in these settings has generally existed within, as stated by the Commission on Health Research for Development, “vertical programs which are not fully integrated in the national health research picture and therefore do not contribute optimally to the development of a strong and self-reliant national health research system.”1 Certain devastating diseases, such as HIV,2, 3 malaria,4, 5 and tuberculosis,6, 7 have received widespread funding attention, leading to important basic science research, clinical trials, cost-effectiveness analyses, and implementation strategies. However, although these vertical programs help to broaden the frontiers of knowledge concerning specific diseases, there is a paucity of information about how to best deliver care in resource-limited settings.
One area of investigation that has been long neglected on the global health research agenda is that of emergency care in lower- and middle-income countries.8, 9 Significant efforts have been made by those within the emergency medicine community to highlight the need for emergency care research, but outside of this field emergency care has attracted little attention. Acute medical and surgical needs grow increasingly important as populations undergo the epidemiologic transition from communicable diseases to noncommunicable diseases.10 Thus, policymakers should be increasingly aware of the abilities or inabilities of their health systems to respond to these needs.
Emergency care encompasses more than emergency medicine as practiced in developed countries. It can be conceptualized as the ability of a health system to provide access to acute health care, such as injury stabilization and initial treatment of acute illnesses, many of which are not preventable. However, emergency care can also serve as an access point for other health care services, such as preventive care and more definitive medical care. There is a critical need for documenting the role of emergency care within specific health systems and its effects on overall morbidity and mortality. Emergency care should be thought of more broadly as a means of meeting important health care needs for a population, rather than as just a location of care delivery. We argue that emergency care should be on the list of essential priorities to be studied in lower- and middle-income countries. Research on the importance of emergency care and its cost-effectiveness can enhance a meaningful appreciation of the need for and role of emergency care services in resource-limited settings. Emergency physicians interested in global health should understand these issues to initiate discussions with those outside of the specialty concerning the importance of emergency care in lower- and middle-income countries.
Section snippets
Paucity of Data on Emergency Care in Health Systems
Traditionally, emergency care has often been conceptualized as peripheral and costly health care services that only well-developed and well-funded health systems are able to offer, in comparison to primary care services, which are frequently touted as low cost.11, 12 This emphasis on primary care resulted from the International Conference on Primary Health Care, held in Alma-Ata in 1978. The 1978 Declaration of Alma-Ata emphasized primary health care as a method of achieving “health for all.”
Measuring the Importance of Emergency Care
WHO has suggested a systematic approach to resource allocation for strategic health research that includes calculating the burden of disease, judging the adequacy of the current knowledge base, and assessing the current level of effort.8 More recently, the Child Health and Nutrition Research Initiative has proposed a systematic methodology for setting health research investment priorities that has been used successfully in a variety of contexts.30, 31, 32, 33, 34, 35, 36 However, this
Developing a Research Agenda for Emergency Care in Global Health
Research in emergency care falls within, as Jamison et al64 point out, “core functions” of international health organizations because they can be viewed as public goods. There has been significant effort by some to place the broad concept of emergency care on the global health agenda through such venues as the WHO Guidelines for Essential Trauma Care,65, 66 the Pre-hospital Trauma Care Guidelines,67 and the essential obstetric care guidelines.68 Similarly, the WHO Office of Essential Health
Conclusion
This article delineates the need for increased research activities and better measurement of the role of emergency care in developing countries. A critical component of this need is for health practitioners, researchers, and policymakers globally to be aware of the large and growing societal demand for emergency care. Many communities often judge the success or failure of their government by the government's ability to provide critical infrastructure, such as security and access to critical
References (74)
- et al.
Cost-effectiveness of malaria control in sub-Saharan Africa
Lancet
(1999) - et al.
From Alma-Ata to Almaty: a new start for primary health care
Lancet
(2008) - et al.
Secondary crisis in African health care
Lancet
(2004) - et al.
The burden of injuries in the Philippines: implications for national research policy
Accid Anal Prev.
(2004) - et al.
The burden of road traffic injuries in developing countries: the 1st national injury survey of Pakistan
Public Health
(2004) - et al.
Measuring the burden of premature mortality in Pakistan: use of sentinel surveillance systems
Public Health
(2005) - et al.
Childhood pneumonia and diarrhoea: setting our priorities right
Lancet Infect Dis.
(2007) - et al.
Advancement of global health: key messages from the Disease Control Priorities Project
Lancet
(2006) - et al.
Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data
Lancet
(2006) - et al.
Too far to walk: maternal mortality in context
Soc Sci Med.
(1994)
The United Nations Process Indicators for emergency obstetric care: reflections based on a decade of experience
Int J Gynaecol Obstet.
Essential trauma care: strengthening trauma systems round the world
Injury
Cost-effectiveness analysis and capital costs
Soc Sci Med.
Estimating hospital costsA multiple-output analysis
J Health Econ.
Trauma care systems in South Africa
Injury
Risk adjustment and hospital cost-based resource allocation, with an application to El Salvador
Soc Sci Med.
International collective action in health: objectives, functions, and rationale
Lancet
Benchmarking of performance of Mexican states with effective coverage
Lancet
Health research: essential link to equity in development
Commission on Health Research for Development
Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of the evidence
Lancet
Cost effectiveness analysis of strategies to combat HIV/AIDS in developing countries
BMJ
Cost effectiveness analysis of strategies to combat malaria in developing countries
BMJ
Cost effectiveness analysis of strategies for tuberculosis control in developing countries
BMJ
Interventions to reduce tuberculosis mortality and transmission in low- and middle-income countries
Bull World Health Organ
Investing in Health Research and Development: Report of the Ad Hoc Committee on Health Research Relating to Future Intervention Options
Minimum Package of Health Services: Criteria, Method and Data
Disease control priorities in developing countries: health policy responses to epidemiological change
Am J Public Health
Emergency medical care in developing countries: is it worthwhile?
Bull World Health Organ
A decade after Alma AtaCan primary care lead to health for all?
N Engl J Med.
Emergency medical systems in low- and middle-income countries: recommendations for action
Bull World Health Organ
Burden of disease—implications for future research
JAMA
Relation between burden of disease and randomised evidence in sub-Saharan Africa: survey of research
BMJ
Relation between randomized controlled trials published in leading general medical journals and the global burden of disease
CMAJ
Incidence, patterns and severity of reported unintentional injuries in Pakistan for persons five years and older: results of the National Health Survey of Pakistan 1990-94
BMC Public Health
Childhood drowning in low- and middle-income countries: urgent need for intervention trials
J Paediatr Child Health
The impact of traumatic brain injuries: a global perspective
Neurorehabilitation
Cited by (73)
Essential human and material resources for emergency care in the district hospitals of Burundi
2023, African Journal of Emergency MedicineThe morbidity burden from emergency conditions in Jimma city, Southwest Ethiopia
2021, International Emergency NursingCitation Excerpt :Despite this, little is known about the burden of emergency conditions and the frequency at which patients seek medical care in these countries [2,4,5]. The paucity of information regarding the burden of emergency conditions hinders attempts to develop appropriate systems and to improve the effectiveness of existing emergency care in sub-Saharan Africa [3,6,7]. Furthermore, in sub-Saharan Africa, data on the local burden of emergency disease, particularly at a local level, are scarce due to a lack of standardized reporting methods [4,5,8].
Novel educational adjuncts for the World Health Organization Basic Emergency Care Course: A prospective cohort study
2020, African Journal of Emergency MedicinePublic Health Rationale for Investments in Emergency Medicine in Developing Countries – Ghana as a Case Study
2018, Journal of Emergency MedicineRisks of Early Mortality and Associated Factors at Adult Emergency Department of Jimma University Medical Center
2023, Open Access Emergency Medicine
Supervising editor: William R. Mower, MD, PhD
Dr. Callaham recused himself from the decisionmaking about this article.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.
Publication date: Available online February 6, 2010.
Reprints not available from the authors.