Sriram V, Gururaj G, Razzak J A, Naseer R, Hyder A A
Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA.
Department of Epidemiology and Centre for Public Health, World Health Organization Collaborating Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neuro Sciences, Bengaluru, India.
Public Health. 2016 Aug;137:169-75. doi: 10.1016/j.puhe.2016.02.022. Epub 2016 Apr 12.
Strengthened emergency medical services (EMS) are urgently required in South Asia to reduce needless death and disability. Several EMS models have been introduced in India and Pakistan, and research on these models can facilitate improvements to EMS in the region. Our objective was to conduct a cross-case comparative analysis of three EMS organizations in India and Pakistan - GVK EMRI, Aman Foundation and Rescue 1122 - in order to draw out similarities and differences in their models.
Case study methodology was used to systematically explore the organizational models of GVK EMRI (Karnataka, India), Aman Foundation (Karachi, Pakistan), and Rescue 1122 (Punjab, Pakistan).
Qualitative methods - interviews, document review and non-participant observation - were utilized, and using a process of constant comparison, data were analysed across cases according to the WHO health system 'building blocks'.
Emergent themes under each health system 'building block' of service delivery, health workforce, medical products and technology, health information systems, leadership and governance, and financing were described. Cross-cutting issues not applicable to any single building block were further identified.
This cross-case comparison, the first of its kind in low- and middle-income countries, highlights key innovations and lessons, and areas of further research across EMS organizations in India, Pakistan and other resource-poor settings.
南亚迫切需要强化紧急医疗服务（EMS）以减少不必要的死亡和残疾。印度和巴基斯坦已经引入了几种EMS模式，对这些模式的研究有助于改善该地区的EMS。我们的目标是对印度和巴基斯坦的三个EMS组织——GVK紧急医疗救援中心（GVK EMRI）、阿曼哈基金会（Aman Foundation）和救援1122（Rescue 1122）——进行跨案例比较分析，以找出它们模式中的异同点。
采用案例研究方法系统地探索GVK紧急医疗救援中心（印度卡纳塔克邦）、阿曼哈基金会（巴基斯坦卡拉奇）和救援1122（巴基斯坦旁遮普省）的组织模式。
运用定性方法——访谈、文件审查和非参与观察——并通过持续比较的过程，根据世界卫生组织卫生系统“构件”对各案例的数据进行分析。
描述了服务提供、卫生人力、医疗产品与技术、卫生信息系统、领导与治理以及筹资等每个卫生系统“构件”下出现的主题。还进一步确定了不适用于任何单个构件的贯穿各领域的问题。
这种跨案例比较是低收入和中等收入国家中的首次此类比较，突出了关键创新和经验教训，以及印度、巴基斯坦和其他资源匮乏地区EMS组织中有待进一步研究的领域。
