Emergency care capacity in Africa: A clinical and educational initiative in Tanzania

Sub-Saharan Africa faces a disproportionate burden of acute injury and illness where few clinical facilities are configured for an integrated approach to resuscitation and stabilization. The authors describe the development of the emergency medicine residency program at Tanzania's national hospital; program development was part of Muhimbili University's curricular reform.

Emergencies occur everywhere, and each day they consume resources regardless of whether there are systems capable of achieving good outcomes.
Kobusingye et al , Bulletin of WHO¹

Introduction

This article briefly reviews the need for emergency care in Africa and barriers to its integration into health systems in the region. We describe an example of an emergency care initiative at Muhimbili National Hospital (MNH) in Dar es Salaam that has integrated a multi-cadre training program with development of a dedicated emergency department in the largest public hospital in Tanzania. We focus on the development of an emergency medicine residency program within this initiative. This article should be of interest to those concerned with prevention and treatment of acute illness in the sub-Saharan region, and those with a particular interest in global emergency care and physician training initiatives in resource-limited settings.

Background

Low-income countries suffer the highest rates of every category of injury - from road traffic to drowning; the highest rates of maternal death from acute complications of pregnancy; and the highest rates of acute complications of communicable diseases including tuberculosis, malaria, and HIV.² The rapidly growing prevalence of cardiovascular and diabetic disease has only increased the burden of acute illness, as patients with chronic disease in low-income countries also have the highest rates of mortality from acute complications.^{3, 4} The Disease Control Priorities in Developing Countries project estimates that 45 per cent of deaths and 36 per cent of Disability-Adjusted Life Years (DALYs) in low- and middle-income countries could be addressed by the implementation of emergency care systems.⁵

While definitive specialty care will never be available at all times in all places, several studies suggest that emergency care is an effective and cost-effective means of secondary prevention: prioritizing an integrated approach to early resuscitation and stabilization of acutely ill patients greatly reduces the morbidity and mortality associated with a range of medical, surgical, pediatric, and obstetric conditions.^{5, 6}