Regents of the University of Michigan

Reducing Mortality and Improving Health in Africa through Emergency Care Highly Ranked

Health care access

Improving access to emergency care in Africa through sustainable, effective, financially inclusive systems that deliver low cost, quality care by a specialty-trained health care workforce.

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To learn more about – or provide significant funding to – this project, please contact Lever for Change.

Project Summary

28 million people die annually from medical emergencies, representing half of the world’s mortality. In Africa, emergencies annually contribute to 262 years of life lost per 1,000 persons, compared to 129 years globally. Few patients have access to the life-saving treatments for time-sensitive medical conditions that emergency departments (EDs) and emergency medical systems (EMS) effectively provide in developed countries.Utilizing existing ED infrastructure, our project initially builds EDs and EMS across three countries in Sub-Saharan Africa. We partner with hospital and governmental leaders to replicate proven training programs that we launched in Ghana in 2009. We integrate these programs with remedial business best practices, digital information systems, pre-hospital transport and community-based primary care.Emergency-related deaths and disabilities will fall. The number of people who receive care will rise while per patient costs plummet. We will enhance preparedness for large-scale emergencies. We will make emergency care more accessible and financially inclusive.

Problem Statement

Throughout many African countries, there are no emergency phone numbers, ambulances, effective response strategies for large-scale emergencies, or functional hospital EDs. Emergency medical situations from car accidents to public health outbreaks can strike any person or community at any time. Health threats caused by emergencies are on the rise. By using infrastructure already in place, EDs in Africa have great and imminent potential to serve as a nexus for high-functioning health systems. EDs provide a “front door” to hospitals’ inpatient and outpatient franchises. They can operate as training sites for skilled workforces, integrate with primary care, extend scarce community resources, provide a social safety net and stand ready as first responders to epidemics and disasters.This potential is stymied because few ED clinicians are specialty trained. When a patient comes in having hit their head, the injury may be treated while the underlying cause – perhaps dizziness, fainting or domestic violence – goes undiagnosed. Emergency clinicians ask why this event happened.Africa’s health systems can leverage new technologies that are increasingly commonplace in developed countries. Africa’s hospitals and EDs still lack: failsafe digital identification; digital payments and other financial services (e.g., remittances); rudimentary digital information systems; and standardized business best practices. Revolutionary breakthroughs in low-cost diagnostics (e.g., ultrasound) and therapies stall out — even though EDs may have the equipment — for lack of training, funding and functioning infrastructure. In many cases, useful equipment goes unused because there is no budget to maintain it. That means patients aren’t properly diagnosed.

Solution Overview

Our solution positions large teaching hospitals in each of several African countries as a nexus of regionally integrated, patient-centered systems of emergency care. We have proven this model in Ghana and Tanzania. Since 2009 in Ghana, we have trained a world-class emergency care workforce with an unyielding culture of putting patients first. After ten years, graduates of the Ghana program lead EDs that annually provide care for nearly 100,000 patient encounters. We train medical professionals in their own settings and transform care processes through empowering collaborations at local levels, working closely with frontline workforces and patients who directly experience the impact. Once trained, we retain our graduates within and throughout Ghana. We do this by aligning professional incentives and providing career development opportunities at both teaching and non-teaching hospitals.Over time, and as we scale this work, the number of annual patient encounters will increase dramatically. As part of this scaling, our graduates will become key leaders in establishing training programs and delivering great emergency care in other countries across Africa. We will extend to many non-teaching hospitals all of our step-wise measures to build emergency medicine function. Scaling will proceed in three phases starting at large teaching hospitals and extending thereafter to smaller facilities. Clinical training will be joined with administrative and vocational training to shore up operations, finances and basic digital information systems. Conventional metrics will capture clinical, operational and financial progress. Developing the health workforce and creating financially sustainable ED’s are the foundation of our solution.

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