Challenges to the Provision of Emergency Services and Critical Care in Resource-Constrained Settings

Abstract

The practice of intensive care unit (ICU) care in Sub-Saharan Africa is challenging and can have a significant impact on the lives of people in the region. Sub-Saharan Africa bears a disproportionate global burden of disease compared with the rest of the world. Inadequate emergency care services and transportation infrastructure; long lead times to hospital admission, evaluation, treatment and transfer to ICU; inadequate ICU and hospital infrastructure and, unreliable consumable and medical equipment supply chains all present significant challenges to the provision of ICU care in Sub-Saharan Africa. These challenges, coupled with an inadequate supply of trained healthcare workers and biomedical technicians and a lack of formal ICU-related research in Sub-Saharan Africa, would seem to be insurmountable. However, ICU care is being provided in district and regional hospitals throughout the region. We describe some of the challenges to the provision of emergency services and critical care in Tanzania.

Severely deranged vital signs as triggers for acute treatment modifications on an intensive care unit in a low-income country

“…Multiple challenges to delivery of critical care in Tanzania have been identified, which may in part explain the results of this study. As well as the lack of financial and human resources at the national level [20], high lead times delaying treatment both pre- and in-hospital have been described [36]. A lack of routines and training for the identification and treatment of acute illness may be more important than availability of basic drugs and equipment [21, 37].…”

The Situation of Safe Surgery and Anaesthesia in Tanzania: A Systematic Review

“…Like surgical and obstetric care, most anaesthesia care is administered by NPCs [16,19]. In 2012, 87% of anaesthesia providers in the country were NPCs [16].…”

Global Critical Care: Moving Forward in Resource-Limited Settings

“…Similarly, there is a higher burden of sepsis and respiratory infection mortality among children [18][19][20][21]. Recent epidemiological changes in global health have created a ' double burden of disease' to resource-limited settings [9,22] due to an increase in the prevalence of non-communicable diseases combined with lack of improvement in the long-recognized higher burden of communicable diseases, maternal and child mortality, malnutrition, and human immunodeficiency virus (HIV)-related complications.…”

“…Similarly, there is a higher burden of sepsis and respiratory infection mortality among children [18][19][20][21]. Recent epidemiological changes in global health have created a ' double burden of disease' to resource-limited settings [9,22] due to an increase in the prevalence of non-communicable diseases combined with lack of improvement in the long-recognized higher burden of communicable diseases, maternal and child mortality, malnutrition, and human immunodeficiency virus (HIV)-related complications.Health care professionals from resource-rich and resource-limited settings should take a global perspective on critical care for both ethical and practical reasons. Ethically, health care professionals, trainees, professional societies, non-governmental organizations (NGOs), and international organizations from resource-rich settings have the capacity of deploying resources to improve outcomes for critically ill patients in resource-limited settings [11,23,24].…”

“…In recent years, challenges arising from limitations of human, technological, infrastructure, and health system resources in resource-poor settings have been well documented [2,3,9,12,21,22,32,33], but less attention has been given to potential solutions [34,35]. In this article, we review the epidemiology and challenges of critical care in these settings and then focus on potential solutions and opportunities for improvement.…”