Governance and legal considerations supporting prehospital emergency care in low and middle-income countries-For the Special Series on Prehospital Care in LMICs.
Surgery · 2024-06-15 · Other / unclear
Abstract
The global imperative to expand prehospital emergency care in low and middle-income countries to reduce health disparities and improve outcomes for time-sensitive health conditions is well established in academic literature and public policy discussions. However, the governance and legal frameworks essential for the strategic development of prehospital systems remain understudied and inadequately addressed. This paper delves into the critical role of governance in prehospital systems, emphasizing its impact on equity, human rights, and the provision of timely, quality emergency care. Health system governance, defined as a complex interplay of mechanisms, processes, and institutions, is a neglected yet pivotal component of prehospital care. By highlighting previously described barriers, we underscore the opportunity to strengthen prehospital care through improved governance, particularly in leadership and legislative standards. Drawing on the World Health Organization's Health System Building Blocks and the Emergency Care System Framework, we elucidate the multifaceted nature of governance in the prehospital context, including the coordination of diverse stakeholders, the establishment of standards, and the creation of accountability mechanisms. We emphasize the importance of applying a human rights perspective to governance, ensuring non-discriminatory and timely access to emergency care. Through the application of an established governance framework of 10 principles to assess prehospital system governance, we offer policymakers and stakeholders a structured approach to identify weaknesses, propose solutions, and evaluate progress in the prehospital system. To provide practical insights, we present a contemporary case study of Ghana's National Ambulance Service Act and the Health Institutions and Facilities Act of 2011, which establish a structured approach to governance and oversight while reflecting Ghana's commitment to advancing emergency care yet faces common challenges to operationalizing the laws. We advocate for a renewed focus on governance as an essential building block for effective prehospital emergency care. By providing a comprehensive framework and case study analysis, the paper offers actionable insights to guide policymakers and stakeholders in developing and evaluating governance initiatives that improve the availability, accessibility, acceptability, and quality of prehospital care globally.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Equity & disparities · Interagency collaboration · Low- and middle-income settings
Related articles
- Towards sustainable emergence transportation system for maternal and new born: Lessons from the m-mama innovative pilot program in Shinyanga, Tanzania. (PLOS Glob Public Health, 2023)
- The Tanzanian trauma patients' prehospital experience: a qualitative interview-based study. (BMJ Open, 2015)
- When ambulances are not enough: An interview-based needs assessment of governance and accountability gaps in prehospital emergency care in Hawassa, Ethiopia. (Surgery, 2026)
- EMCON: A Comprehensive Emergency Response System for Low- and Middle-Income Countries. (Disaster Med Public Health Prep, 2025)
- Emergency medical services infrastructure development and operations in low- and middle-income countries: Community first responder-driven (Tier-1) emergency medical services systems. (Surgery, 2024)
- Emergency medical services impact evaluation approaches in low and middle-income countries. (Surgery, 2024)