Keck School of Medicine, University of Southern California, Los Angeles, CA.
Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Surgery. 2024 Sep;176(3):968-971. doi: 10.1016/j.surg.2024.05.029. Epub 2024 Jun 15.
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.
在学术文献和公共政策讨论中，将院前紧急护理扩展到中低收入国家，以减少健康差距并改善时间敏感型健康状况的结果，这是全球的当务之急。然而，对于院前系统的战略发展至关重要的治理和法律框架仍然研究不足，也没有得到充分解决。本文深入探讨了治理在院前系统中的关键作用，强调了它对公平、人权和及时、高质量的紧急护理的影响。卫生系统治理，定义为机制、流程和机构的复杂相互作用，是院前护理中被忽视但至关重要的组成部分。通过强调先前描述的障碍，我们强调了通过改善治理来加强院前护理的机会，特别是在领导力和立法标准方面。本文借鉴世界卫生组织的卫生系统构建模块和紧急护理系统框架，阐明了治理在院前环境中的多方面性质，包括协调各种利益相关者、制定标准和建立问责机制。我们强调将人权观点应用于治理的重要性，以确保非歧视性和及时获得紧急护理。通过应用已建立的 10 项原则治理框架来评估院前系统治理，我们为政策制定者和利益相关者提供了一种结构化方法，以识别弱点、提出解决方案，并评估院前系统的进展。为了提供实际见解，我们提出了加纳国家救护车服务法和 2011 年卫生机构和设施法的当代案例研究，该研究建立了一种治理和监督的结构化方法，反映了加纳推进紧急护理的承诺，但在实施这些法律方面面临着共同的挑战。我们主张重新关注治理作为有效院前紧急护理的基本组成部分。本文通过提供全面的框架和案例研究分析，为政策制定者和利益相关者提供了可行的见解，指导他们制定和评估治理举措，以提高全球院前护理的可及性、可及性、可接受性和质量。
