Assessing emergency medical care in low income countries: A pilot study from Pakistan

Junaid A Razzak¹ , Adnan A Hyder² , Tasleem Akhtar³ , Mubashir Khan⁴ and Uzma R Khan¹

¹Department of Medicine, Aga Khan University, Karachi, Pakistan

²Department of International Health and Center for Injury Research & Policy, Johns Hopkins Bloomberg School of Public Health Baltimore, USA

³Fatima Memorial System, Lahore, Pakistan

⁴Pakistan Medical Research Council Islamabad, Pakistan

author email corresponding author email

BMC Emergency Medicine 2008, 8:8doi:10.1186/1471-227X-8-8


Published:	3 July 2008

Abstract

Background

Emergency Medical Care is an important component of health care system. Unfortunately it is however, ignored in many low income countries. We assessed the availability and quality of facility-based emergency medical care in the government health care system at district level in a low income country – Pakistan.

Methods

We did a quantitative pilot study of a convenience sample of 22 rural and 20 urban health facilities in 2 districts – Faisalabad and Peshawar – in Pakistan. The study consisted of three separate cross-sectional assessments of selected community leaders, health care providers, and health care facilities. Three data collection instruments were created with input from existing models for facility assessment such as those used by the Joint Commission of Accreditation of Hospitals and the National Center for Health Statistics in USA and the Medical Research Council in Pakistan.

Results

The majority of respondents 43/44(98%), in community survey were not satisfied with the emergency care provided. Most participants 36/44(82%) mentioned that they will not call an ambulance in health related emergency because it does not function properly in the government system. The expenses on emergency care for the last experience were reported to be less than 5,000 Pakistani Rupees (equivalent to US$ 83) for 19/29(66%) respondents. Most health care providers 43/44(98%) were of the opinion that their facilities were inadequately equipped to treat emergencies. The majority of facilities 31/42(74%) had no budget allocated for emergency care. A review of medications and equipment available showed that many critical supplies needed in an emergency were not found in these facilities.

Conclusion

Assessment of emergency care should be part of health systems analysis in Pakistan. Multiple deficiencies in emergency care at the district level in Pakistan were noted in our study. Priority should be given to make emergency care responsive to needs in Pakistan. Specific efforts should be directed to equip emergency care at district facilities and to organize an ambulance network.