Abstract
Injury is a leading cause of the global disease burden, accounting for 10 percent of all deaths worldwide. Despite 90 percent of these deaths occurring in low and middle-income countries (LMICs), the majority of trauma research and infrastructure development has taken place in high-income settings. Furthermore, although accessible services are of central importance to a mature trauma system, there remains a paucity of literature describing the spatial accessibility of emergency services in LMICs. Using data from the Service Provision Assessment component of the Demographic and Health Surveys of Namibia and Haiti we defined the capabilities of healthcare facilities in each country in terms of their preparedness to provide emergency services. A Geographic Information System-based network analysis method was used to define 5- 10- and 50-kilometer catchment areas for all facilities capable of providing 24-hour care, higher-level resuscitative services or tertiary care. The proportion of a country’s population with access to each level of service was obtained by amalgamating the catchment areas with a population layer. A significant proportion of the population of both countries had poor spatial access to lower level services with 25% of the population of Haiti and 51% of the population of Namibia living further than 50 kilometers from a facility capable of providing 24-hour care. Spatial access to tertiary care was considerably lower with 51% of Haitians and 72% of Namibians having no access to these higher-level services within 50 kilometers. These results demonstrate a significant disparity in potential spatial access to emergency services in two LMICs compared to analogous estimates from high-income settings, and suggest that strengthening the capabilities of existing facilities may improve the equity of emergency services in these countries. Routine collection of georeferenced patient and facility data in LMICs will be important to understanding how spatial access to services influences outcomes.
Highlights
Injury is recognized as being a major contributor to the global disease burden, accounting for approximately 1 out of every 10 deaths in the most recent World Health Organization (WHO) estimates [1]
Spatial access to tertiary care was considerably lower with 51% of Haitians and 72% of Namibians having no access to these higherlevel services within 50 kilometers. These results demonstrate a significant disparity in potential spatial access to emergency services in two low and middle-income countries (LMICs) compared to analogous estimates from high-income settings, and suggest that strengthening the capabilities of existing facilities may improve the equity of emergency services in these countries
Of the 410 facilities found to be operational in Namibia at the time of the SPA, 12.4%, 7.3%, and 1.2% were found to be capable of providing level A, B, and C care, respectively. 88% of facilities were found to be unsuitable for providing emergency care and were designated as level X
Summary
Injury is recognized as being a major contributor to the global disease burden, accounting for approximately 1 out of every 10 deaths in the most recent World Health Organization (WHO) estimates [1]. Decades of research have led to the development of effective emergency services designed to reduce the morbidity and mortality associated with trauma, the progress has been largely limited to developed countries where only 10% of injury-related deaths occur [2,3,4,5] This disparity in emergency services access, availability and quality prompted the World Health Assembly (WHA) to pass Resolution 60.22 in 2007 [6]. This document supported the effectiveness of improving trauma and emergency care services, and urged WHO member states to develop 10 specific areas deemed essential to improving these services [6,7] Identified in this resolution was the need to “assess comprehensively the prehospital and emergency care context including, where necessary, identifying unmet need”[6]. Several studies have evaluated aspects of trauma care services in a subset of mostly African countries, but these studies have focused almost exclusively on infrastructure and personnel, leaving issues concerning spatial access to services largely unstudied [8,9]
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