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Cross-sectional evaluation of emergency care capacity at public hospitals in Zambia
  1. Chancy Chavula1,
  2. Jennifer L Pigoga1,2,
  3. Muhumpu Kafwamfwa3,
  4. Lee A Wallis4
  1. 1 Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
  2. 2 Emory University School of Public Health, Atlanta, Georgia, USA
  3. 3 Zambian Ministry of Health, Lusaka, Zambia
  4. 4 Division of Emergency Medicine, University of Cape Town, Bellville, South Africa
  1. Correspondence to Jennifer L Pigoga, Division of Emergency Medicine, University of Cape Town, Cape Town 7935, South Africa; jennpigoga{at}


Objectives The last decade has seen rapid expansion of emergency care systems across Africa, although they remain underdeveloped. In Zambia, the Ministry of Health has taken interest in improving the situation and data are needed to appropriately guide system strengthening efforts. The Emergency Care Assessment Tool (ECAT) provides a context-specific means of measuring capacity of healthcare facilities in low- and middle-income countries. We evaluated Zambian public hospitals using the ECAT to inform resource-effective improvements to the nation’s healthcare system.

Methods The ECAT was administered to the lead clinician in the emergency unit at 23 randomly sampled public hospitals across seven of Zambia’s 10 provinces in March 2016. Data were collected regarding hospitals’ perceived abilities to perform a number of predefined signal functions - life-saving procedures that encompass the need for both skills and resources. Signal functions (36 for intermediate facilities, 51 for advanced) related to six sentinel conditions that represent a large burden of morbidity and mortality from emergencies. We report the proportion of procedures that each level of hospital was capable of, along with barriers to delivery of care.

Results Across all hospitals, most of the level-appropriate emergency care procedures could be performed. Intermediate level (district) hospitals were able to perform 75% (95% CI 73.2 to 76.8) of signal functions for the six conditions. Among advanced level hospitals, provincial hospitals were able to perform 68.6% (67.4% to 69.7%) and central hospitals 96.1% (95% CI 93.5 to 98.7) Main failures in delivery of care were attributed to a lack of healthcare worker training and availability of consumable resources, such as medicines or supplies.

Conclusion Zambian public hospitals have reasonable capacity to care for acutely ill and injured patients; however, there is a need for increased training and improved supply chains.

  • emergency care systems
  • global health
  • emergency departments

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  • Contributors All authors contributed to the design of this study. CC and JP collected and analysed data. All authors contributed to the writing of the manuscript and have approved of the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval University of Cape Town and University of Zambia Health Research Ethics Committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Additional data can be made available by contacting the corresponding author.

  • Patient consent for publication Not required.