Inclusion Decisions Research Articles

How bountiful is the ocean? Participatory valuation of human\u2013nature relationships in Yaeyama Islands, Okinawa, Japan

Valuations of nature are vital for effective conservation planning, and discussions are underway globally on improving the valuation process. Plural valuations of human–nature relationships are the key for better, more inclusive decision-making, which is demonstrated in this research using a case study on human–ocean relationships on Ishigaki Island, a part of the Yaeyama archipelago, Japan. We applied a network analysis to text data obtained from answers on questionnaires with open-ended questions to quantify the importance of values with respect to the pluralities among local people. Therefore, five core elements encompassing the values of the human–ocean relationships on Ishigaki Island were proposed as follows: “Livelihood,” “Attachment and inspiration,” “Local marine culture,” “Respect and fear for nature,” and “Anthropocene environmental problems.” The “Anthropocene environmental problems” element included social and environmental problems caused by various human activities including excessive tourism development, and the data collected through tourism market value analysis implied that past ecosystem service assessments may have over-valued or even triggered this issue. The “Respect and fear for nature” element was found to be important as a potentially unique value in these regions, but this is currently understudied within the literature related to ecosystem services and nature’s contributions to people. This study is among the first works to extract and visualize place-based human–ocean relations in an Asian country. We hope that our methods and findings will be applied to other areas, especially to the local communities of understudied countries and regions, to drive the transformative change of coral reef governance in the Anthropocene.

Transparency in fisheries governance: Achievements to date and challenges ahead

Globally, fisheries continue to face a range of pressures that can be addressed by more effective national, regional, and international fisheries governance. Increasing the transparency of decision-making and implementation of adopted measures is widely recognised as forming part of the solution to this challenge. While transparency has emerged as a good governance principle in general, it is embedded in specific international law obligations when it comes to fisheries. For fisheries management, it is crucial that relevant data be available to inform decisions and that the process be inclusive. Ensuring inclusive decision-making relies not only on the participation of outsiders but also on the equality of States in the negotiations leading to a decision. Furthermore, transparency serves important functions in relation to compliance and accountability: putting information on vessels, States, international organisations or even private actors in the public domain enables scrutiny, might encourage compliance, and builds trust in the regime. Several lessons for fisheries management arise from the contributions to this special issue of Marine Policy. First, the positive impact of transparency ought not to be accepted without a thorough examination of its implementation in practice. Second, transparency in a substantive sense does not mean simply the availability of data; it must also focus on information of high quality and usability for specific stakeholders. Finally, keeping in mind the ultimate purpose of sustainability, transparency is but one stone in the larger process of building legitimate and effective regimes for managing shared resources.

The tree of participation: a new model for inclusive decision-making

Abstract Community development often involves organizing participatory decision-making processes. The challenge is for this to be meaningful. Participatory decision-making has the potential to increase the transparency, accountability, equity and efficiency with which public administration serves the least privileged in society. However, in practice, it often fails to bring about these outcomes. A number of academics and practitioners have, therefore, theorized how participatory decision-making processes can better empower marginalized groups. By critically reviewing this body of work and empirically grounding the debate in recent practice, we aimed to develop a theoretically rigorous, easily applicable and holistic model of an inclusive participatory decision-making process that can work across a range of contexts. The empirical strand included surveying public engagement practitioners and participants about the participatory events they had organized or attended. These empirical findings were combined with insights from the theoretical literature to devise a new conceptual model of emancipatory, inclusive and empowering participatory decision-making – the ‘Tree of Participation’. The model can be useful to both organizers of participatory processes, as a check for empowering and inclusive practice, and to disadvantaged groups, as a set of expectations and demands when engaging in public decision-making.

Super-bureaucracy in climate adaptation governance in Bangladesh

ABSTRACT State bureaucratic settings and associated governance patterns have an enormous impact on the planning and implementation of a country's climate development policy. Contextually, a typical superior bureaucratic framework with its decision-making power centred on climate adaptation projects funding prevails in Bangladesh. This paper deploys the concepts of Weberian bureaucracy and super-bureaucracy and its governance pattern to explore the power attributes of climate bureaus and associated bureaucratic practices and decision-making behaviour regarding adaptation funding in climate adaptation governance. The study employs all climate adaptation development projects (n = 573) financing in Bangladesh. The analysis finds that the general administration cadre employees rather than technical professionals are involved in multiple decision-making processes, including appraisal and approval and monitoring and evaluating projects holding powerful pivotal positions both centrally and locally. These super bureaus also expand their power resources in climate adaptation policy by governing big adaptation projects, keeping the project director position, and approving the said position. The power capabilities and interests of the super-bureaus accrue by creating new climate institutions too. The decision-making behaviour and governance pattern underpin a state of super-bureaucracy, which are not supportive enough of innovative policy-making through inclusive participation and collective decision-making for governing dynamic climate adaptation policy.

MO400HISTOPATHOLOGICAL SPECTRUM OF SNAKE- BITE INDUCED KIDNEY INJURY IN INDIA: A SYSTEMATIC REVIEW

Abstract Background and Aims Snakebite is a public health problem leading to about 55,000 deaths every year in India. Kidney injury subsequent to snakebite envenomation is common ( reported prevalence up to 32%). It is estimated that 3% of total acute kidney injury (AKI) is attributable to snakebites. The current study aims to elucidate the spectrum of renal histopathology in AKI cases followed by snake bite. Method We searched seven electronic database studies to identify studies describing the histopathological findings in the kidney associated with snakebite envenomation from India. Two reviewers independently conducted titles and abstract screening as well as full-text evaluation for final inclusion decision. Data were extracted as per a standardized form and conducted narrative synthesis. Results We retrieved 1364 studies and finally included 21 studies involving 961 patients who met the eligibility criteria. Provisional results are presented. Patient ages ranged from 2.5 years to 80 years. Viper bite was the commonest cause related to AKI. 92 % of the AKI were oliguric and required dialysis. kidney biopsy was usually done after 3 weeks of AKI onset. Acute tubular necrosis (ATN) was the most common finding followed by acute interstitial nephritis, acute cortical necrosis, and thrombotic microangiopathy (TMA).Vasculitic changes in vessels were rarely reported. Conclusion Oligo-anuric presentation and prolonged kidney dysfunction were frequent in post snake bite AKI. ATN was the common histological finding

The illusion of participation: Are participatory indicators truly effective in neigborhood sustainability assessment tools

Neighborhood Sustainability Assessment Tools (NSATs) are well-established pathways to attain urban sustainability; however, this comes with its own set of scrutiny particularly with regards to the environmental bias of NSATs towards sustainability. However, more socially driven gaps that exist are generally mentioned but never fully investigated. For instance, gaps have been identified that question the effectiveness of NSATs in considering the opinion of the general public in the urban development project; and such participatory indicators that promote inclusive decision making is a key element of sustainability. Thus, this study investigates 15 NSATs to determine the competency of participatory indicators and criteria in effectively allowing relevant stakeholders to make accurate and impactful decisions in design, planning, and construction of urban spaces. The key method used was Arnstein's hierarchical ladder approach, which determines how genuine participatory exercises are through ranking. The second approach, Rowe and Frewer acceptance and process criteria, was used to determine the quality of the decision-making exercise. The results showed the misconceptions that exist within participatory indicators and criteria by drawing out ambiguities that circumvent these inclusivity claims. Some of the gaps detected were the elective nature of most participatory indicators, the low points allocated to these indicators and vagueness and open-ended nature of the instructions and execution of inclusive decision-making. Furthermore, results showed varying quality in how decisions are made. The study proceeded to provide recommendations to improve participatory indicators and mitigate the loopholes observed. These recommendations include, mandating specific participatory indicators, increasing the weights of participatory indicators, providing specific procedures on how to effectively participate within the NSAT manual and utilizing third party participatory tools such as the IAP2 framework to ensure high-level quality participatory procedures are executed.

Pathways to Mitigate Challenges of Learner Academic Performance in a Grade 10 Economics Class in South Africa

This paper aims to explore the pathways to mitigate challenges of learner academic (LAP) performance in a Grade 10 economics class in South Africa. The challenge of poor LAP has ushered a myriad of predicaments in schools globally. These predicaments include lack of teacher inclusion in decision making, inability to work cooperatively together, and lack of professional development opportunities geared towards LAP. The study was qualitative, with 15 participants chosen through purposeful sampling from one rural school in the Thabo-Mofutsanyane education district. This paper is couched in critical emancipatory research with emphasis on the emancipation of the teachers regarding pathways they can self-develop to mitigate the challenges of LAP. The focus group discussions were used to gather information regarding pathways to mitigate the challenges of LAP in schools. The study revealed that teachers possess a very equivocal and varying experience regarding the pathways to use to mitigate the challenges of LAP. The findings suggest that for successful implementation of pathways to mitigate the challenges of LAP, schools need to invest in training teachers for team-teaching and avail the necessary resources (both human and physical) to ensure effective quality teaching and learning exist in the school. The article recommends that schools should develop policy frameworks, together with relevant stakeholders, to guide novice teachers on the strategies they can use to mitigate the challenges of LAP in their classes.

Anticoagulation versus placebo for heart failure in sinus rhythm.

People with chronic heart failure (HF) are at risk of thromboembolic events, including stroke, pulmonary embolism, and peripheral arterial embolism; coronary ischaemic events also contribute to the progression of HF. The use of long-term oral anticoagulation is established in certain populations, including people with HF and atrial fibrillation (AF), but there is wide variation in the indications and use of oral anticoagulation in the broader HF population. To determine whether long-term oral anticoagulation reduces total deaths and stroke in people with heart failure in sinus rhythm. We updated the searches in CENTRAL, MEDLINE, and Embase in March 2020.We screened reference lists of papers and abstracts from national and international cardiovascular meetings to identify unpublished studies. We contacted relevant authors to obtain further data. We did not apply any language restrictions. Randomised controlled trials (RCT) comparing oral anticoagulants with placebo or no treatment in adults with HF, with treatment duration of at least one month.We made inclusion decisions in duplicate, and resolved any disagreements between review authors by discussion, or a third party. Two review authors independently assessed trials for inclusion, and assessed the risks and benefits of antithrombotic therapy by calculating odds ratio (OR), accompanied by the 95% confidence intervals (CI). We identified three RCTs (5498 participants). One RCT compared warfarin, aspirin, and no antithrombotic therapy, the second compared warfarin with placebo in participants with idiopathic dilated cardiomyopathy, and the third compared rivaroxaban with placebo in participants with HF and coronary artery disease. We pooled data from the studies that compared warfarin with a placebo or no treatment. We are uncertain if there is an effect onall-cause death (OR 0.66, 95% CI 0.36 to 1.18; 2 studies, 324 participants; low-certainty evidence); warfarin mayincreasethe risk of major bleeding events (OR 5.98, 95% CI 1.71 to 20.93, NNTH 17). 2 studies, 324 participants; low-certainty evidence). None of the studies reported stroke as an individual outcome. Rivaroxabanmakes little to no difference to all-cause death compared with placebo (OR 0.99, 95% CI 0.87 to 1.13; 1 study, 5022 participants; high-certainty evidence). Rivaroxaban probably reduces the risk of stroke compared to placebo (OR0.67, 95% CI0.47 to 0.95; NNTB 101; 1 study, 5022 participants; moderate-certainty evidence), and probably increases the risk of major bleeding events (OR1.65, 95% CI1.17 to 2.33; NNTH 79; 1 study, 5008 participants; moderate-certainty evidence). Based on the three RCTs, there is noevidence that oral anticoagulant therapy modifies mortalityin people with HF in sinus rhythm. The evidence is uncertain if warfarin has any effect on all-cause death compared to placebo or no treatment, but it may increase the risk of major bleeding events.There is no evidence of a differencein the effect ofrivaroxabanon all-cause death compared to placebo. It probably reducesthe risk of stroke, but probably increases the risk of major bleedings. The available evidence does not support the routine use of anticoagulation in people with HF who remain in sinus rhythm.

Collaborative city digital twin for the COVID-19 pandemic: A federated learning solution

The novel coronavirus, COVID-19, has caused a crisis that affects all segments of the population. As the knowledge and understanding of COVID-19 evolve, an appropriate response plan for this pandemic is considered one of the most effective methods for controlling the spread of the virus. Recent studies indicate that a city Digital Twin (DT) is beneficial for tackling this health crisis, because it can construct a virtual replica to simulate factors, such as climate conditions, response policies, and people's trajectories, to help plan efficient and inclusive decisions. However, a city DTsystem relies on long-term and high-quality data collection to make appropriate decisions, limiting its advantages when facing urgent crises, such as the COVID-19 pandemic. Federated Learning (FL), in which all clients can learn a shared model while retaining all training data locally, emerges as a promising solution for accumulating the insights from multiple data sources efficiently Furthermore, the enhanced privacy protection settings removing the privacy barriers lie in this collaboration. In this work, we propose a framework that fused city DT with FL to achieve a novel collaborative paradigm that allows multiple city DTs to share the local strategy and status quickly. In particular, an FL central server manages the local updates of multiple collaborators (city DTs), providing a global model that is trained in multiple iterations at different city DT systems until the model gains the correlations between various response plans and infection trends. This approach means a collaborative city DT paradigm fused with FL techniques can obtain knowledge and patterns from multiple DTs and eventually establish a "global view" of city crisis management. Meanwhile, it also helps improve each city's DT by consolidating other DT's data without violating privacy rules. In this paper, we use the COVID-19 pandemic as the use case of the proposed framework. The experimental results on a real dataset with various response plans validate our proposed solution and demonstrate its superior performance.

The potential of nature-based solutions to deliver ecologically just cities: Lessons for research and urban planning from a systematic literature review.

Planning for and implementing multifunctional nature-based solutions can improve urban ecosystems' adaptation to climate change, foster urban resilience, and enable social and environmental innovation. There is, however, a knowledge gap in how to design and plan nature-based solutions in a nonanthropocentric manner that enhances co-benefits for humans and nonhuman living organisms. To address this gap, we conducted a systematic literature review to explore how an ecological justice perspective can advance the understanding of nature-based solutions. We argue that ecological justice, which builds on the equitable distribution of environmental goods and bads, social-ecological interconnectedness, nature's agency and capabilities, and participation and inclusion in decision-making, provides a transformative framework for rethinking nature-based solutions in and for cities. A qualitative analysis of 121 peer-reviewed records shows a highly human-centred worldview for delivering nature-based solutions and a relationship to social justice with no direct reference to the dimensions of ecological justice. There is, however, an underlying recognition of the importance of nonhumans, ecosystem integrity and well-being, and a need to consider their needs and capacities through multispecies nature-based solutions design and planning. We conclude with a discussion of the critical aspects for designing and planning ecologically just cities through nature-based solutions and future research directions to further integrate these fields.

European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years.

Diagnosing asthma in children represents an important clinical challenge. There is no single gold-standard test to confirm the diagnosis. Consequently, over- and under-diagnosis of asthma is frequent in children. A task force supported by the European Respiratory Society has developed these evidence-based clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years using nine Population, Intervention, Comparator and Outcome (PICO) questions. The task force conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full-text articles. All task force members approved the final decision for inclusion of research papers. The task force assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. The task force then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preferences expressed by lay members and test availability. Proposed cut-offs were determined based on the best available evidence. The task force formulated recommendations using the GRADE Evidence to Decision framework. Based on the critical appraisal of the evidence and the Evidence to Decision framework, the task force recommends spirometry, bronchodilator reversibility testing and exhaled nitric oxide fraction as first-line diagnostic tests in children under investigation for asthma. The task force recommends against diagnosing asthma in children based on clinical history alone or following a single abnormal objective test. Finally, this guideline also proposes a set of research priorities to improve asthma diagnosis in children in the future.

Citizen preferences on private-public co-regulation in environmental governance: Evidence from Switzerland

Environmental policy is touching on ever more aspects of corporate and individual behavior, and there is much debate over what combinations of top-down (government-imposed) and bottom-up (voluntary private sector) measures to use. In democratic societies, citizens’ preferences over such combinations are crucial because they shape the political mandates based on which policymakers act. We argue that policy designs that involve private-public co-regulation receive more citizen support if they are based on inclusive decision-making, use strong transparency and monitoring mechanisms, and include a trigger for government intervention in case of ineffectiveness. Survey experiments in Switzerland (N = 1941) provide strong support for these arguments. Our research demonstrates that differences in co-regulation design have major implications for public support. Another key finding is that there seems to be a contradiction between inclusiveness and democratic accountability for policy outcomes. The findings are surprisingly consistent across two very different green economy issues we focus on empirically (decarbonization of finance, pesticides). This suggests that our study design offers a useful template for research that explores public opinion on green economy policy designs for other issues and in other countries.

Exploring patient centredness, communication and shared decision-making under a new model of care: Community rehabilitation in canada.

Patient-centred care and patient engagement in healthcare and health research are widely mandated by funders, health systems and institutions. Increasingly, shared decision-making (SDM) is recognised as promoting patient-centred care. We explore this relationship by studying SDM in the context of integrating novel patient-centred policies in community rehabilitation. There is little research on SDM in rehabilitation, and less so in the critical community context. Patient co-investigators led study co-design. We aimed to describe how patients and providers experience SDM at community rehabilitation sites that adopted a novel, patient-centred Rehabilitation Model of Care (RMoC). Guided by focused ethnography, we conducted focus groups and interviews. Patient and professional participants were recruited from 10 RMoC early-adopter community rehabilitation sites. Sites varied in geography, patient population and provider disciplines. Patient and community engagement researchers used a set-collect-reflect method to document patient perspectives. Researchers captured provider perspectives using a semi-structured question guide. We completed 11 focus groups and 18 interviews (n=45 providers, n=17 patients). We found that most early-adopter providers spoke in a shared, patient-first language that focused on patient readiness, barriers and active listening. Congruent patient perceptions reflected inclusion in decision-making, goal setting and positive relationships. Many patients queried how care would become and remain accessible before and after community rehabilitation care respectively. Remaining connected while in the community was described as important to patients. Providers identified barriers like time, team dynamics and lack of clarity on the RMoC aims, which challenged the initiative's long-term sustainability. Policy innovations can promote SDM and communication through multiple strategies and training to facilitate candid, encouraging conversations. Sustainability of SDM gains is paramount. Most providers moved beyond tokenistic engagement, but competing responsibilities and team member resistance could thwart continuity. Further research is needed to empirically assess respectful and compassionate communication and SDM in community rehabilitation long term.

Mainstreaming gender in REDD+ policies and projects in 17 countries

ABSTRACT REDD+ is recognized in the Paris Agreement as a key mitigation policy for addressing climate change. However, a major challenge that has impeded REDD+ is ensuring gender equity. This paper analyses the policies and progress of gender mainstreaming in REDD+ processes in 17 countries between 2008 and 2019. Findings show that there are increasing political commitment and numerous policies in place that emphasize the need for gender equity in REDD+. There are differences in the level of gender mainstreaming across the 17 countries studied. We found several enabling conditions that would help countries to advance gender mainstreaming, including strong political commitment, clear gender action plans, strong law enforcement, dedicated funding for gender, and inclusive decision-making. The paper also illustrates how countries transform political commitment on gender mainstreaming in REDD+ into action.

Lebanese adolescents' expectations about social inclusion of peers in intergroup contexts.

This study examined the role of group norms, group identity, age, contact, and stereotypes on youths' decisions to include a peer in an intergroup context portraying Lebanese and American adolescents. Lebanese participants (N=275), ages 12 and 16years, were surveyed about expectations for inclusion of an out-group target with similar interests or an in-group target with different interests into their own Lebanese group or another American group. Findings indicated participants focused on shared interests, rather than national identity, when making inclusion decisions for either group and group norms mattered. Older participants expected American peers to be less inclusive towards an out-group peer. Direct contact predicted inclusivity of out-group American peers into one's own Lebanese group, and indirect media-based contact predicted expectations for inclusivity into an American out-group. Findings have implications for interventions aimed at improving cross-national friendships which, in turn, have the potential to reduce prejudicial attitudes.

Water scarcity & procedural justice in Honduras: Community-based management meets market-based policy

Ensuring adequate access to clean water remains a major challenge throughout the world, particularly in rural areas of the Global South. Community-based management (CBM) has been a common policy response to this challenge, whereby communities gain decision-making power over their own natural resources, and are also responsible for financial and technical issues. Household water metering is increasingly proposed as a complement to CBM because it facilitates transparency of use and provides the option of pay-per-use pricing, both of which are thought to help support the sustainable management of water supplies. However, metering and use-based fees are controversial and their implementation across various contexts has led to strong backlash that can undermine the management of community water systems. Drawing on ideas of procedural justice, we conducted a survey experiment with 689 residents across 12 communities in Honduras’ “dry corridor” to examine individual perceptions of the decision process for choosing to implement metering, or not, within the context of CBM. Our results show that more inclusive decision-making leads to higher perceived fairness of the process and appropriateness of the metering decision, irrespective of whether the individual personally agrees with the final decision. While inclusion matters in general, whether that takes the form of voting or deliberation did not make a large difference. The effect of inclusion was stronger among those who already agreed with the decision outcome. Finally, inclusion also had positive spillover effects on more technocratic outcomes, namely ratings of how effective and sustainable the resulting management of the water system was expected to be. This research suggests that the backlash observed against water metering projects around the world may have more to do with procedural injustice in decision-making than with resistance to metering itself.

Participation and influence of REDD+ actors in Vietnam, 2011–2019

Reducing emissions from deforestation and degradation (REDD+) is an important component of the Paris Agreement. Inclusive decision making is essential to ensure REDD outcomes, but there is limited anecdotal and empirical evidence demonstrating that stakeholder participation in REDD+ decision making has improved over time. This paper presents an analysis of the Vietnamese government’s claim that stakeholder participation in REDD+ had been improved over the course of 2011–2019, specifically focusing on various actors’ perceptions of their level of interest, engagement and influence in REDD+ policy events. Findings show that the country’s legal framework on REDD+ demonstrated Vietnam’s political commitment to improve inclusive decision making, and initial effort was made to provide political space for actors to engage in REDD+ decision making. However, momentum has been lost over time. This suggests that understanding the political context, addressing underlying power dynamics in the existing government regime, building up coalitions for change among political elites and civil society, and fostering sustainable political will and commitment are all essential to ensuring inclusive REDD+ decision making in Vietnam.

Forest governance in DRC: an analysis from actors' participation in REDD+ policy development

The Democratic Republic of Congo (DRC) has implemented Reduced Emissions from Deforestation and forest Degradation (REDD+), a process that requires inclusive decision making and accountability. Our research analyses the participation of policy actors in DRC by asking: (1) Who is involved in national REDD+ policy making and what is their interest in participating in core policy events? (2) What level of participation do the different political actors have in core policy events? (3) To what extent do the outcomes, of REDD+ policy events incorporate different preferences of policy actors? We found that although actors' interest in REDD+ policy events have increased over time, their concerns have rarely been taken into account in decision-making processes. The presence of local civil society and indigenous group organizations is weak while international organizations play a major role in the REDD+ arena. REDD+ is treated as a project rather than being embedded in national politics.

Parental Preference for Treatment Location and Inclusion in Decision Making in Painful Pediatric Procedures: Towards an Evidence-Based Clinical Guideline

PurposeTo determine parental preference for treatment location of painful procedures for pediatric patients, and the involvement of parents in decision-making about procedure location. Design and methodA descriptive survey design was applied. Parents of hospitalized children were asked what procedures their child had undergone, where the procedures were performed, who decided on the location, what their preference was, and why. Data was collected over a twelve-day period in seven wards of a tertiary pediatric hospital. ResultsOf 312 different procedures, 244 (78%) were performed in the patient's room. The treatment room was reserved for complex procedures such as lumbar punctures. Seventy-three percent of parents surveyed indicated a strong preference for procedures to be performed in the patient's room, with the most common reason being ‘comfortability’. Parents were only involved in procedure location decision-making in 50% of the reported cases. ConclusionsFor parents, the patient's room is the preferred location for many procedures. The opinion of parents was not always taken into consideration by health care professionals, in contrary to the principles of patient-centered care. These findings are important for health care professionals in pediatric settings to reconsider the location of procedures and how parents are involved in decision making.

A baseline review of the ability of hospitals in Kenya to provide emergency and critical care services for COVID-19 patients.

IntroductionAs the Coronavirus Disease 2019 (COVID-19) cases in Kenya begin to rise, the number of severe and critical COVID-19 patients has the potential to quickly overload the local healthcare system beyond its capacity to treat people.ObjectiveThe purpose of this study was to gather information about the ability of hospitals in Kenya to provide emergency and critical care services and to identify priority actions for use by policymakers and other stakeholders as a roadmap toward strengthening the COVID-19 response in the country.MethodsThis was a comprehensive review of the published and grey literature on emergency and critical care services in Kenya published in the last three years through April 2020. Screening of articles was conducted independently by the authors and the final decision for inclusion was made collaboratively. A total of 15 papers and documents were included in the review.Key recommendationsThere is an urgent need to strengthen prehospital emergency care in Kenya by establishing a single toll-free ambulance access number and an integrated public Emergency Medical Services (EMS) system to respond to severe and critical COVID-19 patients in the community and other emergency cases. Functional 24-h emergency centres (ECs) need to be established in all the level 4, 5 and 6 hospitals in the country to ensure these patients receive immediate lifesaving emergency care when they arrive at the hospitals. The ECs should be equipped with pulse oximeters and functioning oxygen systems and have the necessary resources and skills to perform endotracheal intubation to manage COVID-19-induced respiratory distress and hypoxia. Additional intensive care unit (ICU) beds and ventilators are also needed to ensure continuity of care for the critically ill patients seen in the EC. Appropriate practical interventions should be instituted to limit the spread of COVID-19 to healthcare personnel and other patients within the healthcare system. Further research with individual facility levels of assessment around infrastructure and service provision is necessary to more narrowly define areas with significant shortfalls in emergency and critical care services as the number of COVID-19 cases in the country increase.