Emergency care capacity in Sierra Leone: A multicentre analysis

Area of Science:

• Global Health
• Public Health Policy
• Emergency Medicine

Background:

• Over 50% of annual mortality in low- and middle-income countries is attributable to conditions treatable with improved emergency care.
• Sierra Leone's Ministry of Health and Sanitation has identified emergency care as a national priority.
• This study presents the first multicentre analysis of emergency care capacity in Sierra Leone.

Purpose of the Study:

• To assess the current emergency care capacity across 14 government hospitals in Sierra Leone.
• To identify specific areas of strength and weakness within the national emergency care system.
• To provide data to inform national strategies for strengthening emergency care.

Main Methods:

• Utilized the Hospital Emergency Unit Assessment Tool (HEAT), a standardized World Health Organization-recommended assessment.
• Employed purposeful sampling to select 14 government facilities nationwide.
• Conducted 2-day in-person visits with multidisciplinary teams at each facility, creating a HEAT-adjusted Emergency Care Capacity Score.

Main Results:

• Human Resources was the strongest parameter (49%), with all hospitals providing 24/7 emergency cover.
• Emergency Diagnostic Services was the most limited (29%), with 3 hospitals lacking basic radiography.
• Infrastructure scored 47%, with significant deficits in electricity (2/14 adequate), water (5/14 adequate), and oxygen supply (none adequate).
• Clinical services (39%) and signal functions (38%) were also weak, with limited triage, no designated emergency units in most hospitals, and unreliable access to essential emergency drugs.

Conclusions:

• The overall HEAT-adjusted Emergency Care Capacity Score for the assessed hospitals was 40%.
• Identified gaps have already prompted local interventions, such as focusing resources on resuscitation areas and enhancing team training.
• Facility-level data can inform broader assessments and strategic prioritization for sustainable strengthening of Sierra Leone's national emergency care system.