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,L A Wallis,J Luong,A P Joiner,M Mhlanga,P Chowa,T A Reynolds

doi:10.1186/s12873-020-00327-w

Abstract

BackgroundThe 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.MethodsWe 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.ResultsAll 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).ConclusionsThe 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.

Highlights

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
Two hospitals reported that their emergency care areas were staffed only with rotating providers assigned for periods of approximately 1 month, and did not have staff permanently assigned to emergency care areas
In order to improve emergency care and outcomes in Eswatini, additional training is likely needed relating to triage and resuscitation, as well as trauma and airway interventions, and neonatal care

Summary

Introduction

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. The African continent in particular carries a disproportionate burden of these emergencies and their related mortality, and clinical outcomes are worse in the region compared to high-income countries [2]. Challenges associated with building a robust system to manage such cases are intensified in limited-resource settings [3] In spite of these difficulties, improving emergency care systems in these settings is of paramount importance, as doing so is likely to reduce death and disability substantially [2]. The Kingdom of Eswatini Ministry of Health (MoH) has identified emergency care strengthening as a key mechanism to improve health outcomes and move the country towards universal health coverage

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