Barriers and facilitators to providing facility-based emergency care in Addis Ababa, Ethiopia: A mixed methods study

Illness and injury that may be impacted by emergency care account for over half of all deaths in low- and middle-income countries. However, studies show that Emergency Units in these countries face numerous barriers to facility-based emergency care. Yet, data on the barriers to facility-based emergency care in Ethiopia and some reasons for these barriers have not been established, and this study aimed to bridge this gap.

The study followed an explanatory, sequential mixed-methods design. In phase one, a cross-sectional evaluation of five hospitals was done using WHO's Hospital Emergency Unit Assessment Tool (HEAT). A purposive sampling technique was used to select the hospitals, and a convenience sampling technique was used to determine the participants. Quantitative data were analysed descriptively. In phase two, in-depth key informant interviews were done. Qualitative data were analysed using content analysis. Finally, the integration of the results from the two phases was done.

We surveyed 38 participants in phase one and interviewed 15 in phase two. The most apparent findings to emerge from the quantitative phase of the study were the participants from across the hospitals reported the absence of equipment (n = 119) and stock out of supplies (n = 47) as the two most common barriers. Similarly, the most common reasons reported for not performing diagnostic services across all facilities were absent equipment (n = 128) and stock out of supplies (n = 99). The most important barriers identified from the qualitative phase of the study included a shortage or lack of resources, and inadequate management of resources. The facilitators identified for the procedures they could perform were the availability of essential resources, including trained human resources, good management practices, and coordination among the staff.

Overall, the tertiary hospitals in Addis Ababa reported they could perform the majority of the diagnostic and therapeutic procedures in the emergency units despite the interruption of some of the services. Some of the services' complete absence or interruptions were due to several barriers. Both existing literature and the findings of this study indicate the EUs of Ethiopian hospitals need further investment to improve resource availability and proper management of available resources.