Here in the United States, we take emergency medicine and emergency services for granted. Having an emergency? Help is just a 911 call away.
Explore This IssueACEP Now: Vol 38 – No 12 – December 2019
The same isn’t true around the world. But now, with the help of the World Health Organization (WHO), things are starting to change.
Imagine what would happen if you needed immediate emergency medical care while traveling in a low- or middle-income country? Is there a system analogous to our 911 system? Even if so, would trained providers in well-equipped ambulances be dispatched? Would you be taken to an emergency department and evaluated by an emergency medicine–trained clinician?
Naturally, people have medical and surgical emergencies in every part of the world. And yet the quality and manner of emergency care delivery vary greatly among countries, even among nations with similar economic resources.
How can we raise standards everywhere so we might ensure timely, high-quality emergency care in nations of all levels of income?
The first step is awareness. From there, implementation can occur.
Fortunately, there is good news to report. Theory is starting to become reality, thanks to efforts by the governments in the nations of Ethiopia and Eswatini (a small landlocked nation in southeast Africa) and their work within the WHO structure.
Most physicians in America and around the world do not know how WHO works. I hope an inside look on how emergency medicine is making waves of change there will shed some light on it.
The World Health Assembly (WHA) is composed of health ministers from 194 member states (countries). The assembly meets annually in Geneva, Switzerland, and makes recommendations, driving policy and funding priorities for WHO. This past May, the 72nd WHA convened under the theme “Universal Health Coverage: Leaving No-one Behind.”
Emergency care is often overlooked internationally, which leaves a significant gap in care for patients who need it the most. The governments of Ethiopia and Eswatini saw this year’s theme as an opportunity to change that.
They argued that emergency care is an essential component of universal health coverage (UHC) and a crucial gateway toward the attainment of several United Nations Sustainable Development Goal targets. Capitalizing on the moment, delegates from Ethiopia and Eswatini proposed a new resolution at the 72nd WHA titled “Emergency Care Systems for Universal Health Coverage: Ensuring Timely Care for the Acutely Ill and Injured.”
During the executive board deliberations in the five months leading up to the assembly, delegates from Ethiopia and Eswatini proposed that emergency care be added as a provisional agenda item. The WHO secretariat prepared a report outlining the state of access to emergency care worldwide and the key actions needed to strengthen emergency care systems.
Simultaneously, technical experts from the aforementioned countries developed a draft resolution and distributed it to all WHO/WHA member states. Country representatives then deliberated over the language of the draft, word by word, line by line. The Ethiopian Ministry of Health chaired these sessions, which continued until all countries agreed on the text. The result became known as Resolution 72.16.
In what many of us feel was a historic moment, Resolution 72.16 went to the floor of the assembly on May 25, 2019. During the discussions, member states and representatives of professional societies spoke from the floor in support of the resolution, frequently commending the sponsoring countries for bringing attention to this area. In the end, the resolution was officially co-sponsored by more than 30 member states, and it was passed unanimously, a triumphant moment for emergency medicine.
What Does This Mean for International Emergency Medicine?
A WHA resolution is a compelling directive to WHO and its member states. It functions as a mandate to prioritize the resolution’s subject. It is a powerful guide for advocacy for a neglected area such as frontline emergency care.
Resolution 72.16 has the potential to be incredibly transformative in strengthening health systems globally. If member states and other partners heed the call, it provides an opportunity for coordinated action in a high-impact area, and to raise awareness of the enormous potential contribution of emergency care to a range of related agendas.
Resolution 72.16 specifically urges member states to promote emergency care as a pillar of UHC. It asks the member states to incorporate dedicated, equipped prehospital and hospital emergency unit care into their health strategies and to integrate facility-based and prehospital care systems. It also urges member states to establish a toll-free universal access number similar to the 911 system in the United States. It also encourages each member state to provide training programs for all levels of clinicians and to incorporate emergency care into national disaster and outbreak response plans.
You can find the full text of the adopted resolution here.
How Can You Advocate for Emergency Medicine?
The unanimous adoption of Resolution 72.16 comes at a crucial time. Currently, all world leaders are being encouraged to work toward UHC as part of the United Nations’ Sustainable Developmental Goals. We, as emergency care providers, have the opportunity to advocate for emergency care as an essential component of UHC. Ensuring timely and high-quality care forms the core of this advocacy.
The next step is to engage the public and gain their support. In this age in which social media is an advocacy tool and means of vital communication, it was exciting to see the director-general of WHO tweet about the importance of emergency care:
“Emergency care is the first point of contact with the health system for many people and the delivery of definitive care for many others,” tweeted WHO Director-General Tedros Adhanom Ghebreyesus, MSc, PhD. “WHO is ready to support countries with the evidence and tools to provide high-quality emergency care, as part of its journey towards #healthforall.”
As individuals, we, too, should use social media to disseminate our efforts in emergency care and implementation of the resolution by tagging @WHO and @drtedros, as well as local, regional, and national leaders and ministers of health.
Member states can utilize resources from WHO to determine where gaps in care exist in order to aid implementation. These resources can also be used to spread awareness for international and domestic resource mobilization.
Whenever you are using your voice as an advocate for emergency care, reinforce your efforts by reminding your officials about Resolution 72.16 or by citing the resolution text in funding applications. In addition, this resolution also enhances your capacity to persuade your audience in the importance and relevance of your particular areas of expertise and interest on a global scale. For example:
- As an educator, you can use WHO resources such as the Basic Emergency Care (BEC) course to teach frontline providers in emergency care. This five-day course covers basic approaches to life-threatening conditions and is available open-access on the WHO website. A standardized facilitator training process developed by the International Federation for Emergency Medicine consists of a Training of Trainers course as well as participation in a BEC course. ACEP facilitated those efforts by sponsoring a WHO BEC Training of Trainers course at ACPE19.
- As a researcher, you can support local researchers by working with them to develop implementation and process outcomes utilizing WHO’s data collection tools.
- As part of a nongovernmental organization, you can support countries by coordinating and mobilizing resources to implement the actions outlined in the resolution using tools described in the WHO Essential Resources for Emergency Care.
- As an administrator, you can use WHO quality improvement tools and the Emergency Unit Management Course to help train local staff in best practices in emergency unit administration.
Our success in 2019 is not the capstone but rather the cornerstone of the rise of emergency care around the world. With your help, we will see growth in 2020 and beyond.
Dr. Firew is special advisor to the Minister on Emergency Care and Strategic Partnerships for the Federal Ministry of Health in Ethiopia and assistant professor in the department of emergency medicine at Columbia University Medical Center in New York City.
WHO EM Resources
For more WHO resources for countries and organizations, visit www.who.int/emergencycare/en.