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    • dhpg Emergency care inherently addresses the

    2019-04-20

    Emergency care inherently addresses the wide array of illness and injury, including traumatic injuries, surgical disease, acute complications of chronic illness (eg, strokes, myocardial infarction, diabetic ketoacidosis, complications of HIV, tuberculosis, hepatitis C, and other chronic infections), and communicable diseases. Evidence from the Global Burden of Disease Study shows that mortality from non-communicable diseases and injuries continue to rise (the increase from 1990 to 2010 was 30% for non-communicable diseases and 24% for injuries). For the 34·5 million annual deaths due to non-communicable diseases, timely emergency care could address many of the time-sensitive causes. Despite a long tradition of medical training, which began in 1861 with the establishment of the National Medical School, Haiti is not an exception to this dhpg general pattern of inattention to emergency care. Little recognition and few public resources are dedicated to these services in the Haitian health system. For example, residency-training programmes for emergency medicine to prepare physicians for the practice of emergency care do not exist. We have seen in Haiti, as elsewhere in low-income countries, that the focus on a basic minimum package has created a spurious dichotomous choice, in which primary care is deemed mutually exclusive of emergency and acute care. By 2030, road-traffic accidents will be the 5th leading cause of death worldwide with a disproportionate number of deaths occurring in poor countries like Haiti. Estimates suggest that implementation of basic trauma care at the facility level could potentially avert 21% of the total injury burden in low-income and middle-income countries (LMICs). Additionally, basic interventions—many of which are done in emergency departments, such as trauma resuscitation, wound management, laceration repair, and tube thoracostomy—for a limited set of surgical diagnoses can reduce 18% of the total global burden of disease in LMICs. Further research is needed, in Haiti and elsewhere, to better estimate the number of deaths averted and DALYs reduced by emergency care. However, high-quality emergency services are likely to have a substantial effect by addressing acute presentations of communicable, non-communicable, and traumatic disease. In more developed settings, emergency care provided by trained providers in an emergency department has been shown to improve quality and cost-effectiveness of the general health system. Further, by addressing the growing burden of non-communicable disease and trauma, emergency care serves as part of the public health system. Both of these effects are magnified in LMICs, where the magnitude of effect is potentially greater and the primary care systems are often weaker.
    An insufficient surgical workforce is a major barrier to safe surgical care for billions of people worldwide. Although a critical shortage of a spectrum of surgical providers has been described in many countries, the global number and distribution remain poorly assessed. Meanwhile, more data on the surgical workforce are crucial for international comparisons and the development of national workforce plans tailored to populations needs. We aimed to quantify the global surgical specialist workforce by country, and to build a WHO surgical workforce database in the process. Data on the number of licensed, qualified physician surgeons, anaesthesiologists, and obstetricians (see for full definitions) were retrieved from Ministries of Health, WHO country offices, professional societies, members of the WHO Global Initiative for Emergency & Essential Surgical Care, and from publicly available sources (see ) for full details of data sources). Data were entered in the WHO Global Surgical Workforce Database. Data were obtained for 167 countries representing 92% of the global population (for characteristics see ). Estimates of missing values were developed using multiple imputation based on national health system indicators (). Median and IQR were calculated from the imputed data, and used together with primary data to provide global estimates. Estimated total number of providers and density per 100 000 population were calculated and tabulated and heat maps were created to show the surgical specialist workforce density by country.