Emergency Care Policies & Legislation
The Emergency Medicine Kenya Foundation advocates for universal emergency care to be prioritised within the healthcare system in Kenya by working alongside national and county governments and stakeholders to develop comprehensive policies and frameworks.
On 23rd July 2020, the Emergency Medicine Kenya (EMK) Foundation presented this report to The Senate Standing Committee on Health, The Republic of Kenya that summarises the current practice of emergency medical care in Kenya and identifies priority actions for use by policymakers and other stakeholders as a roadmap toward strengthening emergency care in the country.
Delegates to the 72nd World Health Assembly have adopted a resolution on emergency and trauma care aimed at helping countries to ensure timely care for the acutely ill and injured. It is estimated that more than half of deaths in low- and middle-income countries result from conditions that could be treated with prehospital and emergency care, including injuries; infections; acute exacerbations of cancer, diabetes and other noncommunicable diseases; and complications of pregnancy. Effective emergency care systems save lives.
During the discussions, 22 Member States spoke in support of the resolution, which was tabled by the Governments of Ethiopia and Eswatini and co-sponsored by over 30 countries. In their remarks, they praised the sponsoring countries for bringing attention to this area, committed to the recommended actions and requested near-term WHO support for specific activities, including: training for all cadres of health workers, system- and facility-level assessments, implementing standards for essential equipment and processes at each level of the health system, and data collection and quality improvement. They also emphasized the importance of fully integrating emergency care into ongoing universal health coverage planning processes.
“No one should die for the lack of access to emergency care, an essential part of universal health coverage,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “We have simple, affordable and proven interventions that save lives. All people around the world should have access to the timely, life-saving care they deserve.”
Recent studies have ranked components of emergency care as among the most cost-effective public health interventions. Strengthening prehospital care by training community-based providers and using staffed community ambulances has been estimated to cost less than US$ 100 per life saved, and has been shown to reduce mortality by 25-50% in some low- and middle-income country contexts.
The World Health Assembly resolution seeks to overcome some of the main challenges facing countries, including poor coordination of prehospital and facility-based care; limited or no coverage of prehospital systems, especially in rural areas; shortage of fixed staff assigned to emergency units; lack of standards for clinical management and documentation; and insufficient funding. In addition, a lack of security for prehospital and facility-based emergency care staff remains a challenge in many countries.
The resolution suggests that all Member States, regardless of available resources, can take steps towards strengthening their emergency care systems. Recommended activities for Member States include creating policies to ensure universal access to emergency care for all; conducting a WHO emergency care system assessment to identify gaps and priorities for action; developing clinical protocols identified in the WHO Emergency Care Systems Framework; and providing emergency care training for all relevant health providers. The WHO Secretariat is invited to expand its technical support to Member States.
In the coming years much of WHO’s support to Member States on emergency and trauma care will be provided through the Global Emergency and Trauma Care Initiative, launched with the AO Foundation in December 2018. The Initiative seeks to rapidly increase capacities to provide quality emergency care in countries and to foster awareness through a global advocacy campaign about its potential to save lives.
Well-organized emergency care is a key mechanism for achieving a range of Sustainable Development Goal targets, including those on universal health coverage, road safety, maternal and child health, noncommunicable diseases, infectious diseases, disasters and violence. It also helps WHO to fulfill the mandate of its Thirteenth General Programme of Work 2019-2023 to strengthen health systems, widen coverage of essential health services and improve integrated service delivery.
The Government of Kenya is committed to fulfilling the requirements in the Constitution that guarantees all citizens the right of access to quality healthcare, including reproductive health and emergency treatment. The Ministry of Health has developed the Emergency Medical Care Policy 2018–2030 which provides a framework for the provision of an Emergency Medical Care Fund and establishment of an efficient Emergency Medical Care System for all.
The Government of Kenya today launched the Universal Health Coverage (UHC) Pilot Program dubbed Afya Care – Wema Wa Mkenya that will enable Kenyans to access affordable healthcare without financial hardship.
The President highlighted that with the UHC card, Kenyan residents in the four pilot counties will now access health services ranging from Emergency Services, Child Health Services, Maternal Health Services, Mental Health Services, Infectious Disease Management, Non-communicable Disease Management, Inpatient and Outpatient Services and Community Health Services across county public health facilities.
8 December 2018 | GENEVA/DAVOS: Today with the generous support of the Davos-based AO Foundation, WHO launches the Global Emergency and Trauma Care Initiative. Around the world, acutely ill and injured people die every day due to a lack of timely emergency care. Among them are children and adults with injuries and infections, heart attacks and strokes, asthma and acute complications of pregnancy. Many countries have no emergency access telephone number to call for an ambulance or no trained ambulance staff. Many hospitals lack dedicated emergency units and have few providers trained in the recognition and management of emergency conditions. These gaps result in millions of avoidable deaths every year.
“No one should die for the lack of access to emergency care, an essential part of universal health coverage,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “We have simple, affordable and proven interventions that save lives. This initiative will ensure that millions of people around the world have access to the timely, life-saving care they deserve.”
The goal of the WHO Global Emergency and Trauma Care Initiative is to save millions of lives over the next five years through improvements to emergency care systems. Its aims are two-fold: to rapidly increase capacities to provide quality emergency care in countries around the world, and to foster awareness through a global advocacy campaign about its potential to save lives.
In an initial phase, WHO and partners will support 10 low- and middle-income countries to assess their national emergency care systems, identify any shortcomings and implement proven interventions to address these gaps. Activities at the national level include the development of national plans and key policies, such as laws addressing the role of bystanders and access to care without regard to ability to pay; and implementation of WHO standards addressing the way emergency care systems are organized and resourced.
WHO and partners will also facilitate low-cost improvements in the way that emergency care is delivered. These include implementing triage and WHO checklists that ensure a systematic approach to the care of every patient. In addition, frontline providers will be trained through WHO-ICRC Basic Emergency Care and other courses. The initiative will support systematic data collection on acutely ill and injured people and how their conditions are managed, including via the WHO International Registry for Trauma and Emergency Care.
The launch of this initiative is made possible through a CHF 10 million grant from the AO Foundation, which promotes excellence in patient care through a network of thousands of practitioners in 100 countries. It is one of a number of partners poised to contribute to the WHO Global Emergency and Trauma Care Initiative, including others in the WHO Global Alliance for Care of the Injured. This work executes the mandate established by the World Health Assembly resolution WHA 60.22 on emergency-care systems.
WHO Global Emergency and Trauma Care Initiative https://www.who.int/emergencycare/en/
WHO Trauma Care Checklist https://www.who.int/emergencycare/trauma-care-checklist-launch/en/
WHO-ICRC Basic Emergency Care (BEC): Approach to the acutely ill and injured https://www.who.int/emergencycare/publications/Basic-Emergency-Care/en/
WHO International Registry for Emergency and Trauma Care https://www.who.int/emergencycare/irtec/en/
WHO Global Alliance for Care of the Injured https://www.who.int/emergencycare/gaci/en/
World Health Assembly Resolution WHA 60.22 http://apps.who.int/gb/ebwha/pdf_files/WHASSA_WHA60-Rec1/E/reso-60-en.pdf?ua=1
- Medical institutions that fail to provide health care services necessary to prevent and manage the damaging health effects due to an emergency situation are culpable.
- Facilities that have systems that are inappropriately designed and invariably cause a patient deserving of emergency medical treatment not to receive such treatment, are also culpable.
- Hospitals that prioritize monetary security prior to admission can also be held in violation of the Constitution as well as the Kenya National Patients’ Rights Charter.
- The liability of the government arises from its duties as stipulated in the Constitution as well as sections 15 and 112 of the Health Act. Where the government thus fails to enact policies; mobilize financial resources, regulate, train and accredit emergency care providers or ensure compliance with already existing guidelines by medical institutions, then it is liable in law. This, must, of course, be done in consultation with county governments and other stakeholders in the health sector acknowledging that health is now a devolved function.