ObjectivesWe undertook this study in Kenya to understand the community's emergency care needs and barriers they face when trying to access care, and to seek community members’ thoughts regarding high impact solutions to expand access to essential emergency services.DesignWe used a qualitative research methodology to conduct 59 focus groups with 528 total Kenyan community member participants. Data were coded, aggregated and analysed using the content analysis approach.SettingParticipants were uniformly selected from all eight of the historical Kenyan provinces (Central, Coast, Eastern, Nairobi, North Eastern, Nyanza, Rift Valley and Western), with equal rural and urban community representation.ResultsSocioeconomic and cultural factors play a major role both in seeking and reaching emergency care. Community members in Kenya experience a wide range of medical emergencies, and seem to understand their time-critical nature. They rely on one another for assistance in the face of substantial barriers to care—a lack of: system structure, resources, transportation, trained healthcare providers and initial care at the scene.ConclusionsAccess to emergency care in Kenya can be improved by encouraging recognition and initial treatment of emergent illness in the community, strengthening the pre-hospital care system, improving emergency care delivery at health facilities and creating new policies at a national level. These community-generated solutions likely have a wider applicability in the region.

Facility-based emergency care delivery in low-income and middle- income countries is expanding rapidly, particularly in Africa. Unfortunately, these efforts rarely include measurement of the quality or the impact of care provided, which is essential for improvement of care provision. Our aim was to determine context-appropriate quality indicators that will allow uniform and objective data collection to enhance emergency care delivery throughout Africa. We undertook a multiphase expert consensus process to identify, rank and refine quality indicators. A comprehensive review of the literature identified existing indicators; those associated with a substantial burden of disease in Africa were categorised and presented to consensus conference delegates. Participants selected indicators based on inclusion criteria and priority clinical conditions. The indicators were then presented to a group of expert clinicians via on-line survey; all meeting agreements were refined in-person by a separate panel and ranked according to validity, feasibility and value. The consensus working group selected seven conditions addressing nearly 75% of mortality in the African region to prioritise during indicator development, and the final product at the end of the multiphase study was a list of 76 indicators. This comprehensive process produced a robust set of quality indicators for emergency care that are appropriate for use in the African setting. The adaptation of a standardised set of indicators will enhance the quality of care provided and allow for comparison of system strengthening efforts and resource distribution.

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The theme of the 14th annual Academic Emergency Medicine consensus conference was "Global Health and Emergency Care: A Research Agenda." The goal of the conference was to create a robust and measurable research agenda for evaluating emergency health care delivery systems. The concept of health systems includes the organizations, institutions, and resources whose primary purpose is to promote, restore, and/or maintain health. This article further conceptualizes the vertical and horizontal delivery of acute and emergency care in low-resource settings by defining specific terminology for emergency care platforms and discussing how they fit into broader health systems models. This was accomplished through discussion surrounding four principal questions touching upon the interplay between health systems and acute and emergency care. This research agenda is intended to assist countries that are in the early stages of integrating emergency services into their health systems and are looking for guidance to maximize their development and health systems planning efforts.ACADEMIC EMERGENCY MEDICINE 2013; 20:1278-1288© 2013 by the Society for Academic Emergency Medicine A chieving the highest attainable standard of health requires universal access to essential services that are rationally distributed and utilized. Timely action in response to emergent disease presentations is one such essential health service. At present, many national health systems are oriented to specific diseases rather than cross-cutting "systems" interventions that might have a larger long-term effect by strengthening systemwide capacity. The natural history and epidemiology of emergencies emphasize that highly functional health systems, including intact and codified referral networks, are necessary to improve survival of patients with acute diseases. Failure to prioritize integration across disease-oriented programs and service delivery units, and failure to deliver emergency health services promptly, results in care that is poorly coordinated and poorly applied (e.g., delays in treating sepsis with antibiotics leading to death or disability). Such fragmentation of care reduces the disease burden that can be addressed with a given set of resources. Integration of emergency services has the potential to improve outcomes with fixed resource inputs by improving both organization of services and efficiency of service delivery. Given the nature of the problem, consensus is necessary both to define and to prioritize health problems and to decide which services are essential. Expert consensus conferences may usefully establish the boundaries of common understanding and determine which questions require further investigation; saving lives in times of emergency thus depends on action that is informed by consensus, validated by research, and executed in a standardized manner.,This article presents the research recommendations developed during the breakout session on global emergency care and health systems at the Academic Emergency Medicine consensus ...