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Understanding Barriers to Emergency Care in Low-Income Countries: View from the Front Line

Published online by Cambridge University Press:  28 June 2012

Adam C. Levine ,
David Z. Presser ,
Stephanie Rosborough ,
Tedros A. Ghebreyesus  and
Mark A. Davis
Adam C. Levine*
Affiliation:
Institute for International Emergency Medicine and Health, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
David Z. Presser
Affiliation:
Institute for International Emergency Medicine and Health, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
Stephanie Rosborough
Affiliation:
Institute for International Emergency Medicine and Health, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
Tedros A. Ghebreyesus
Affiliation:
Tigray Regional Ministry of Health, Mekelle, Tigray, Ethiopia
Mark A. Davis
Affiliation:
Institute for International Emergency Medicine and Health, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
*
Adam C. Levine, MD, MPH Department of Emergency Medicine Brigham and Women's Hospital, 75 Francis Street Boston, MA USA 02115 E-mail: alevine2@partners.org
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Abstract

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Introduction:

Morbidity and mortality due to acute but treatable conditions remain high in the developing world, as many significant barriers exist to providing emergency medical care.This study investigates these barriers in a rural region of Ethiopia.

Hypothesis:

The limited capacity of frontline healthcare workers to diagnose and treat acute medical and surgical conditions represents a major barrier to the provision of emergency care in rural Ethiopia.

Methods:

Health providers at a convenience sample of 16 rural health centers in the state of Tigray, Ethiopia completed a questionnaire designed to assess the availability of diagnostic and treatment modalities, the proximity and methods of transportation to referral facilities, and health providers' level of comfort in diagnosing and treating a variety of representative emergency medical conditions.

Results:

Thirteen (81%) providers had only a very basic level of medical training, and seven (44%) lacked access to any diagnostic equipment.While most providers could offer oral rehydration solution (ORS), anti-pyretic medications, and antibiotics, none of the providers could offer blood transfusions or any form of surgery. Ten (63%) respondents stated that their patients had to travel >10 km from the health center to a referral hospital, with only a minority of patients having access to motorized transport. For the seven emergency conditions assessed, a majority of providers felt comfortable diagnosing these conditions, though fewer felt comfortable treating them.

Conclusion:

There is a significant need for both health worker training and improvements in transportation infrastructure in order to increase access to emergency medical care in rural areas of the developing world.Low-cost interventions that improve human capacity in a context-appropriate manner are warranted as transportation and hospital network capacity expansions are considered.

Keywords

barriers to careemergency medicineemergency medical servicesglobalhealth educationinternationalprehospital medicinetransportation
Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 22 , Issue 5 , October 2007 , pp. 467 - 470
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2007

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