Academic journal article Bulletin of the World Health Organization

Applying the Lessons of Maternal Mortality Reduction to Global Emergency Health

Academic journal article Bulletin of the World Health Organization

Applying the Lessons of Maternal Mortality Reduction to Global Emergency Health

Article excerpt

Appliquer les enseignements tires de la reduction de la mortalite maternelle a la situation liee au traitement des cas d'urgence sanitaire au niveau mondial

Aplicacion de las lecciones de reduccion de la mortalidad materna a la sanidad de emergencia mundial

Introduction

Global health initiatives are fuelled by the extent of the associated public health need, the severity of the problem involved and the availability of feasible solutions to that problem. In general, the success of such initiatives depends on the organized, concerted and relentless advocacy of international stakeholders--to inspire continued dedication during an often long campaign. The global effort to reduce maternal mortality has benefited from such advocacy, as demonstrated by the progress made towards the achievement of Millennium Development Goal 5--i.e. towards a 75% reduction of maternal mortality, from its 1990 level, by 2015. (1,2) The global community's approach to improvement in maternal mortality may be applied to other high-impact public health issues, including the delivery of all emergency services.

Compared with maternal illness, medical and surgical emergencies account for far more morbidity and mortality. However, efforts to improve comprehensive emergency systems globally have not achieved as much attention as the improvement of maternal health. Traditionally, attempts to improve the management of emergencies in low- and middle-income countries have been focused on the vertical delivery of health services such as trauma care or responses to obstetric emergencies. (3) Questions have been raised about the adaptability and flexibility of emergency systems designed around vertical delivery models. For example, it is unclear whether such systems facilitate an adequate response to the new and evolving needs of the communities to be served. (4) More recently, efforts to develop and improve emergency systems in low- and middle-income countries have included limited horizontal approaches. (5-7) Many of these efforts have focused on improving the care provided by ambulance services or other out-of-hospital care, formalizing training for care providers, improved transportation infrastructures and vehicles or the strengthening of public policy. (5,8) Despite these inroads into the construction of horizontal emergency systems, there has been scant investigation of effective integrated packages of emergency services or of community engagement to strengthen emergency care. There has been insufficient dialogue on the design of an effective framework to identify, understand and improve areas of weakness in the general emergency systems of low- and middle-income countries.

The right to health has been endorsed by multiple international treaties and national constitutions. (9-11) In most low- and middle-income countries, access to good emergency services during a patient's greatest time of need remains a frequently overlooked but essential element of that right. The far-reaching effects of insufficient emergency systems and health care are particularly apparent in the context of the Ebola virus outbreak in west Africa. (12) Despite the relative paucity of relevant literature on the building of good emergency systems, it has been estimated that integrated prehospital and in-hospital emergency systems could address 35-46% of morbidity and mortality in low- and middle-income countries. (3) The burden of emergencies--like the burden of maternal illness--falls largely on low- and middle-income countries. (13) Many of the lessons learnt from efforts to reach Millennium Development Goal 5 in low- and middle-income countries are transferrable to the critical barriers in the development of effective emergency systems. These lessons include the unified conceptual framework required to achieve a holistic understanding of the large morbidity and mortality burdens caused by emergencies of all types--infectious disease, noncommunicable disease and trauma. …

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