Implementing the WHO's Emergency Care Systems toolkit: a qualitative study for facilitators and barriers

Area of Science:

• Global Health
• Health Systems Strengthening
• Emergency Medicine

Background:

• Low-income countries face a disproportionately high burden of emergency medical disease.
• Fragmented emergency care systems in these nations contribute to preventable deaths.
• The World Health Organization's Emergency Care Systems (WHO-ECS) toolkit offers a structured approach to improve emergency care.

Purpose of the Study:

• To identify facilitators and barriers to implementing the WHO-ECS toolkit in Ethiopian primary hospitals.
• To analyze factors influencing the successful integration of structured emergency care within a national initiative.

Main Methods:

• Qualitative research conducted over 14 months in 10 primary hospitals in Ethiopia's Oromia region.
• Data collection through focus group discussions with healthcare workers and key-informant questionnaires.
• Thematic data analysis to identify implementation facilitators and barriers.

Main Results:

• Key facilitators included a supportive implementation model, enthusiastic staff, and the toolkit itself.
• Barriers comprised a lack of medications and equipment, certain toolkit components, and insufficient permanent emergency department staff.
• Supportive hospital administrators were crucial facilitators, while their absence posed a significant hurdle.

Conclusions:

• Successful WHO-ECS toolkit implementation in low-income settings depends on project implementer and administrator support.
• Stakeholder involvement is vital for facilitating emergency care system improvements.
• Misalignment of toolkits with local context and resource limitations can impede progress; lessons learned are applicable to similar healthcare settings.