In a recent study conducted in Tanzania, scientists have identified critical gaps in hospitals in the provision of Essential Emergency and Critical Care (EECC) to patients. 

The study, conducted across five selected hospitals in Dar es Salaam and Pwani regions in Eastern Tanzania, found that while resources for EECC were available within the hospitals, there was often a lack of readiness for immediate use in the wards where critically ill patients are treated.

Led by Dr. Karima Khalid, a critical care specialist at Muhimbili University of Health and Allied Sciences (MUHAS) and a research scientist at Ifakara Health Institute, the study aimed to assess both the hospital availability and ward readiness of essential resources for EECC and advanced critical care. Dr. Karima worked alongside colleagues at Ifakara, Karolinska Institutet in Stockholm, the University of Nairobi and the KEMRI-Wellcome Trust Research Programme – both in Kenya and the University of Oxford in the UK.

Understanding critical illness
Critical illness, defined as a state of ill health with vital organ dysfunction and a high risk of imminent death, poses a significant burden, particularly in low- and middle-income countries like Tanzania. On the other hand, EECC encompasses the care that all critically ill patients should receive in hospitals, and it has been shown to be a low-cost option, compared to advanced critical care.

Despite EECC being defined as the care that all critically ill patients should receive in all hospitals, the study revealed a readiness rate of only 56% in the hospitals surveyed, posing a potential risk to the lives of critically ill patients. These findings published in the BMC Health Services Research journal, underscore a critical barrier to the provision of critical care in Tanzania.

Assessing readiness scores
After assessing the readiness in the five hospitals, scores exposed shortcomings in infrastructure, routines, and training for basic emergency and critical. Notably, low readiness was also observed in the categories of human resources, training, guidelines, and routines for identifying and treating critically ill patients.

According to the scientists, these shortcomings align with previous research conducted in Tanzania and other African countries. They suggest that the arrangement of hospital wards by specialty rather than by the seriousness of patients' conditions may explain the inadequacy in preparedness for Essential Emergency and Critical Care (EECC).

“Why are hospitals not ready for the provision of such essential care? One possible explanation could be that while the health system is set up to refer patients from lower-level facilities to higher-level facilities, this is most frequently utilized for complex conditions or for patients requiring specialized or advanced care that is not available in the lower levels, rather than for critical illness, and within hospitals the wards are structured by specialty rather than by severity of illness.”

Wards structured by specialty rather than severity of illness may prioritize diagnostic and definitive treatment over life-saving supportive care like EECC, leading to missed opportunities for timely, effective treatment at the bedside, they noted.

Low readiness score despite resource availability
Further findings revealed that while the availability of EECC resources in hospitals was relatively high at 84%, the readiness of these resources in the wards was only at 56% while readiness for advanced critical care was significantly lower at 31%. Moreover, district hospitals exhibited lower readiness scores, falling below 50%, compared to regional and tertiary hospitals. 

Concluding the study, the scientists emphasize that ward readiness, rather than mere availability in the hospital, is crucial for providing timely and effective care to critically ill patients, highlighting the importance of prioritizing improvements in EECC readiness.

“Critical illness can occur at any time and place, and readiness for EECC should be 100% at all times in all wards of a hospital,” they warned.

Urgent need for improvement
Additionally, the scientists underscore the urgent need for improvements in the readiness of hospitals to provide essential emergency and critical care in Tanzania. By addressing deficiencies in infrastructure, training, and protocols, healthcare systems can enhance their ability to deliver timely and effective care to critically ill patients, ultimately saving lives.

“Hospitals in Tanzania lack readiness for the provision of essential emergency and critical care– the low-cost, life-saving care for critically ill patients. The resources for EECC were available in hospitals, but they were not ready for the immediate needs of critically ill patients in the wards. In order to provide effective EECC to all patients, improvements are needed around the essential, low-cost resources in hospital wards that are essential for decreasing preventable deaths.”

Read the full publication here.