Estimating the emergency care workforce in South Africa

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Abstract

Background

Emergency care is viewed as a fundamental human right in South Africa’s constitution. In the public sector, all emergency medical services (EMS) come under the Directorate: Emergency Medical Services and Disaster Medicine at the National Department of Health (NDoH), which provides regulation, policy and oversight guidance to provincial structures.

Aim

The aim of the study is to understand the supply and status of human resources for EMS in South Africa.

Setting

This research was undertaken for South Africa using the Health Professions Council of South Africa (HPCSA) database from 2002 to 2019.

Methods

A retrospective record-based review of the HPCSA database was undertaken to estimate the current registered and future need for emergency care personnel forecasted up to 2030.

Results

There are 76% Basic Ambulance Assistants registered with HPCSA. An additional 96 000 personnel will be required in 2030 to maintain the current ratio of 95.9 registered emergency care personnel per 100 000 population. The profile of an emergency care personnel employed in South Africa is likely to be a black male in the age group of 30–39-years, residing in one of the economically better-resourced provinces.

Conclusion

It is time that the current educational framework is revised. Policy interventions must be undertaken to avoid future shortages of the trained emergency care personnel within South Africa.

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Most cited references 26

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Too far to walk: Maternal mortality in context

Sereen Thaddeus, Deborah Maine (1994)

The Prevention of Maternal Mortality Program is a collaborative effort of Columbia University's Center for Population and Family Health and multidisciplinary teams of researchers from Ghana, Nigeria and Sierra Leone. Program goals include dissemination of information to those concerned with preventing maternal deaths. This review, which presents findings from a broad body of research, is part of that activity. While there are numerous factors that contribute to maternal mortality, we focus on those that affect the interval between the onset of obstetric complication and its outcome. If prompt, adequate treatment is provided, the outcome will usually be satisfactory; therefore, the outcome is most adversely affected by delayed treatment. We examine research on the factors that: (1) delay the decision to seek care; (2) delay arrival at a health facility; and (3) delay the provision of adequate care. The literature clearly indicates that while distance and cost are major obstacles in the decision to seek care, the relationships are not simple. There is evidence that people often consider the quality of care more important than cost. These three factors--distance, cost and quality--alone do not give a full understanding of decision-making process. Their salience as obstacles is ultimately defined by illness-related factors, such as severity. Differential use of health services is also shaped by such variables as gender and socioeconomic status. Patients who make a timely decision to seek care can still experience delay, because the accessibility of health services is an acute problem in the developing world. In rural areas, a woman with an obstetric emergency may find the closest facility equipped only for basic treatments and education, and she may have no way to reach a regional center where resources exist. Finally, arriving at the facility may not lead to the immediate commencement of treatment. Shortages of qualified staff, essential drugs and supplies, coupled with administrative delays and clinical mismanagement, become documentable contributors to maternal deaths. Findings from the literature review are discussed in light of their implications for programs. Options for health programs are offered and examples of efforts to reduce maternal deaths are presented, with an emphasis on strategies to mobilize and adapt existing resources.

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Emergency medical care in developing countries: is it worthwhile?

J Razzak, Arthur Kellermann (2001)

Prevention is a core value of any health system. Nonetheless, many health problems will continue to occur despite preventive services. A significant burden of diseases in developing countries is caused by time-sensitive illnesses and injuries, such as severe infections, hypoxia caused by respiratory infections, dehydration caused by diarrhoea, intentional and unintentional injuries, postpartum bleeding, and acute myocardial infarction. The provision of timely treatment during life-threatening emergencies is not a priority for many health systems in developing countries. This paper reviews evidence indicating the need to develop and/or strengthen emergency medical care systems in these countries. An argument is made for the role of emergency medical care in improving the health of populations and meeting expectations for access to emergency care. We consider emergency medical care in the community, during transportation, and at first-contact and regional referral facilities. Obstacles to developing effective emergency medical care include a lack of structural models, inappropriate training foci, concerns about cost, and sustainability in the face of a high demand for services. A basic but effective level of emergency medical care responds to perceived and actual community needs and improves the health of populations.

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Emergency medical systems in low- and middle-income countries: recommendations for action.

David Bishai, Olive C. Kobusingye, Manjul Joshipura … (2005)

Emergency medical care is not a luxury for rich countries or rich individuals in poor countries. This paper makes the point that emergency care can make an important contribution to reducing avoidable death and disability in low- and middle-income countries. But emergency care needs to be planned well and supported at all levels--at the national, provincial and community levels--and take into account the entire spectrum of care, from the occurrence of an acute medical event in the community to the provision of appropriate care at the hospital. The mix of personnel, materials, and health-system infrastructure can be tailored to optimize the provision of emergency care in settings with different levels of resource availability. The misconception that emergency care cannot be cost effective in low-income settings is demonstrably inaccurate. Emergencies occur everywhere, and each day they consume resources regardless of whether there are systems capable of achieving good outcomes. With better planning, the ongoing costs of emergency care can result in better outcomes and better cost-effectiveness. Every country and community can and should provide emergency care regardless of their place in the ratings of developmental indices. We make the case for universal access to emergency care and lay out a research agenda to fill the gaps in knowledge in emergency care.

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Author and article information

Journal

Journal ID (nlm-ta): Afr J Prim Health Care Fam Med

Journal ID (iso-abbrev): Afr J Prim Health Care Fam Med

Journal ID (publisher-id): PHCFM

Title: African Journal of Primary Health Care & Family Medicine

Publisher: AOSIS

ISSN (Print): 2071-2928

ISSN (Electronic): 2071-2936

Publication date (Electronic): 08 December 2021

Publication date Collection: 2021

Volume: 13

Issue: 1

Electronic Location Identifier: 3174

Affiliations

[1 ]Department of Global Health, Faculty of Health and Medical Sciences, Stellenbosch University, Cape Town, South Africa

[2 ]Emergency Medical Services and Disaster Medicine, National Department of Health, Pretoria, South Africa

Author notes

Corresponding author: Ritika Tiwari, ritika.t.za@ 123456gmail.com

Author information

Ritika Tiwari https://orcid.org/0000-0002-5078-8989

Raveen Naidoo https://orcid.org/0000-0002-6712-7474

René English https://orcid.org/0000-0001-9567-8591

Usuf Chikte https://orcid.org/0000-0002-7985-2278

Article

Publisher ID: PHCFM-13-3174

DOI: 10.4102/phcfm.v13i1.3174

PMC ID: 8678951

PubMed ID: 34879696

SO-VID: ba3af828-b93d-43e2-8de3-e529593b123b

License:

Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.

History

Date received : 03 August 2021

Date accepted : 30 September 2021

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Estimating the emergency care workforce in South Africa

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Abstract

Background

Aim

Setting

Methods

Results

Conclusion

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SciELO South Africa

Most cited references 26

Too far to walk: Maternal mortality in context

Emergency medical care in developing countries: is it worthwhile?

Emergency medical systems in low- and middle-income countries: recommendations for action.

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Cited by 4

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