Evaluating capacity at three government referral hospital emergency units in the kingdom of Eswatini using the WHO Hospital Emergency Unit Assessment Tool
J L Pigoga, A P Joiner, P Chowa, J Luong, M Mhlanga, T A Reynolds, L A Wallis, J L Pigoga, A P Joiner, P Chowa, J Luong, M Mhlanga, T A Reynolds, L A Wallis
Abstract
Background: The Kingdom of Eswatini, a lower-middle income nation of 1.45 million in southern Africa, has recently identified emergency care as a key strategy to respond to the national disease burden. We aimed to evaluate the current capacity of hospital emergency care areas using the WHO Hospital Emergency Unit Assessment Tool (HEAT) at government referral hospitals in Eswatini.
Methods: We conducted a cross-sectional study of three government referral hospital emergency care areas using HEAT in May 2018. This standardised tool assists healthcare facilities to assess the emergency care delivery capacity in facilities and support in identifying gaps and targeting interventions to strengthen care delivery within emergency care areas. Senior-level emergency care area employees, including senior medical officers and nurse matrons, were interviewed using the HEAT.
Results: All sites provided some level of emergency care 24 h a day, 7 days a week, though most had multiple entry points for emergency care. Only one facility had a dedicated area for receiving emergencies and a dedicated resuscitation area; two had triage areas. Facilities had limited capacity to perform signal functions (life-saving procedures that require both skills and resources). Commonly reported barriers included training deficits and lack of access to supplies, medications, and equipment. Sites also lacked formal clinical management and process protocols (such as triage and clinical protocols).
Conclusions: The HEAT highlighted strengths and weaknesses of emergency care delivery within hospitals in Eswatini and identified specific causes of these system and service gaps. In order to improve emergency care outcomes, multiple interventions are needed, including training opportunities, improvement in supply chains, and implementation of clinical and process protocols for emergency care areas. We hope that these findings will allow hospital administrators and planners to develop effective change management plans.
Keywords: Emergency care; Emergency medicine; Global health; Health systems development.
Conflict of interest statement
None declared.
References
- Razzak J, Usmani MF, Bhutta ZA. Global, regional and national burden of emergency medical diseases using specific emergency disease indicators: analysis of the 2015 Global Burden of Disease Study. BMJ Glob Health 2019;4(2):e000733. doi: 10.1136/bmjgh-2018-000733 [published Online First: 2019/04/19].
- Mock CN, Donkor P, Gawande A, et al. Essential Surgery: Key Messages of This Volume. In: Debas HT, Donkor P, Gawande A, et al., eds. Essential Surgery: Disease Control Priorities, Third Edition (Volume 1). Washington: The International Bank for Reconstruction and Development / The World Bank; 2015.
- Obermeyer Z, Abujaber S, Makar M, et al. Emergency care in 59 low- and middle-income countries: a systematic review. Bull World Health Organ. 2015;93(8):577–86G. doi: 10.2471/BLT.14.148338.
- Burke TF, Hines R, Ahn R, et al. Emergency and urgent care capacity in a resource-limited setting: an assessment of health facilities in western Kenya. BMJ Open. 2014;4(9):e006132. doi: 10.1136/bmjopen-2014-006132.
- Eswatini Country Profile: The World Bank 2019 [Available from: accessed May 10 2019.
- Country Profile: Eswatini Geneva World Health Organization; 2017 [Available from: accessed May 10 2019.
- Swaziland U. Health budget Swaziland 2017/2018. Swaziland, 2017.
- Health KoSMo. The second National Health Sector Strategic Plan Towards attainment of universal health coverage Mbabane, Eswatini 2014.
- Tool for situational analysis to assess emergency and essential surgical care. Geneva: World Health Organization; Available at .
- Chowa EP, Espinola JA, Sullivan AF, et al. Emergency care capabilities in the Kingdom of Swaziland, Africa. Afr J Emerg Med. 2017;7:15–18. doi: 10.1016/j.afjem.2017.01.004.
- Reynolds TA, Calvello EJ, Broccoli MC, et al. AFEM consensus conference 2013 summary: emergency care in Africa – where are we now? Afr J Emerg Med 2014;4:158–163.
- Bae C, Pigoga JL, Cox M, et al. Evaluating emergency care capacity in Africa: an iterative, multicountry refinement of the emergency care assessment tool. BMJ Glob Health 2018;3(5):e001138. doi: 10.1136/bmjgh-2018-001138 [published Online First: 2018/10/27].
- Hensher M, Price M, Adomakoh S. Disease control priorities in Developing countries. Second. Washington, D.C., USA: The International Bank for Reconstruction and Development / The World Bank; 2006.
- Aufderheide TP, Nolan JP, Jacobs IG, et al. Global health and emergency care: a resuscitation research agenda--part 1. Acad Emerg Med 2013;20(12):1289–1296. doi: 10.1111/acem.12270 [published Online First: 2013/12/18].
- Coyle RM, Harrison HL. Emergency care capacity in Freetown, Sierra Leone: a service evaluation. BMC Emerg Med 2015;15:2. doi: 10.1186/s12873-015-0027-4 [published Online First: 2015/02/04].
- Robison JA, Ahmad ZP, Nosek CA, et al. Decreased pediatric hospital mortality after an intervention to improve emergency care in Lilongwe, Malawi. Pediatrics. 2012;130(3):e676–e682. doi: 10.1542/peds.2012-0026.
- Barriers to treatment of obstetric emergencies in rural communities of West Africa. The Prevention of Maternal Mortality Network: Stud Fam Plann. New York: The Prevention of Maternal Mortality; 1992. p. 279–91.
- Seitio-Kgokgwe O, Gauld RD, Hill PC, et al. Assessing performance of Botswana's public hospital system: the use of the world health organization health system performance assessment framework. Int J Health Policy Manag. 2014;3(4):179–89. 10.15171/ijhpm.2014.85.
- Chavula C, Pigoga JL, Kafwamfwa M, et al. Cross-sectional evaluation of emergency care capacity at public hospitals in Zambia. Emerg Med J 2019 doi: 10.1136/emermed-2018-207465 [published Online First: 2019/07/12].
Source: PubMed