The Prehospital Emergency Resources (PER) Program; An Innovative Approach to Health System Development in Rural Uganda

The Prehospital Emergency Resources (PER) Program; An Innovative Approach to Health System Development in Rural Uganda

UgandaChicago, United States
Organization type: 
nonprofit/ngo/citizen sector
Project Stage:
Start-Up
Budget: 
$10,000 - $50,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

GECC is a 501c3 nonprofit that develops sustainable, scalable emergency care systems for resource limited countries.

About Project

Problem: What problem is this project trying to address?

Most developed countries have a “continuum” of emergency care; patients who seek care at clinics that can recognize acute illness, trained transport teams, and emergency specialists to provide definitive care. This “continuum” is absent in Uganda, where nearly one in five children die before 5yo from illnesses or injury treatable by inexpensive, but nonexistent, emergency care. GECC built Uganda’s first Emergency Department in rural Uganda and created a ground-breaking training program in resource limited emergency care. However, most people have no knowledge about which conditions require medical or traditional care, and no referral criteria for clinics exist. Efforts to promote access to these quality services are as important to saving lives as training actual emergency providers.

Solution: What is the proposed solution? Please be specific!

GECC’s Emergency Care Practitioner (ECP) program utilizes a train-the-trainer model to teach nurses to become independent providers of emergency care in resource-limited, rural settings. GECC believes this same method can be applied to the prehospital arena. Our PER project seeks to increase the community’s utilization of the ED and strengthen the prehospital emergency care system to create the ‘front side’ of the emergency care continuum. One project portion delivers outreach education to the lay-community on recognition of acute illnesses and utilization of available health services. A parallel component conducts workshops for outpatient clinics on the early recognition of emergencies, appropriate management of patients, and referral of sicker patients to the ED. A third segment utilizes innovative SMS auto categorization technology to create two-way communication between the ED and both the community and clinics.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

PER is a district-level model for sustainably integrating ECP services into a public-private system of health service delivery. The PER program will be integrated into the national GECC model. Community outreach is designed to improve public knowledge of the signs of emergent conditions and the available options for treatment. This education targets married couples of reproductive age in an environment that seeks to transcend gender specific constraints on access to care. Participants are mobilized by utilizing embedded community-level systems of local council leaders, priests, and community health workers. Outpatient clinics are critical control points for delays to appropriate emergency care. GECC ECPs will hold workshops on emergency recognition, management and referral protocols. Referral criteria will mirror the conditions addressed in community outreach. Continuing medical education (CME) workshops will identify community and clinic leaders as PER Trainers for continued PER education. With existing phone resources, cutting-edge SMS technology will connect ED ECPs to both clinic PER Trainers (for two-way interfacility communication on emergent patients) and to community PER Trainers for interval, text-based education. Radio is the only viable means to sensitize large numbers of people to the existence of emergency services and outreach activities. Three hours of radio will be hosted by the chief physician of the Hospital, with ECPs appearing as guests, and will provide information on emergent conditions based on listener-generated questions.
Sustainability

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

A global vision of an emergency care continuum for resource limited countries is matchless internationally. GECC’s program will expand regionally in partnership with the Mbarara Schools of Medicine and Community Health, Hospital administrations and the District Health Office, and expand nationally in partnership with the Ugandan Ministries of Health and Education. Competitors include private clinics that vie for patients and profit, which motivates provision of care that can be inappropriate. Traditional healers could be proactive advocates and given their influence, disregarding this role could hamper our efforts and perpetuate behaviors that contribute to fatal delays to care. Instead, we are seeking to understand their role and gain support via cultural anthropology assessments.
Team

Founding Story

While at a local Health Center, rain drummed down on the tin roof. A crowd of fifty soon packed into the dim room to help us assess gaps in residents’ knowledge about emergency illness and available care options. My most vivid memory is not the heavy rain or the engaged crowd, but rather later, when the in-charge nurse led me to a severely malnourished child, who had begun refusing to eat just like her older brother had done before he died. Her mother wanted help, which I explained was available at the nearby hospital’s Emergency Department. She said had exhausted her resources paying for “prayers”. At that moment I realized the profound impact that basic outreach education could have. This mother could have found treatment at the hospital for a fraction of what she had already spent. The nurse could have confidently referred her to the Emergency Department earlier had she known what services existed. Not least, the little girl, who died within days, would have survived
About You
Organization:
Global Emergency Care Collaborative
About You
About Your Organization
Organization Name

Global Emergency Care Collaborative

Organization Country

, XX

Country where this project is creating social impact

, RUK

How long has your organization been operating?

1‐5 years

The information you provide here will be used to fill in any parts of your profile that have been left blank, such as interests, organization information, and website. No contact information will be made public. Please uncheck here if you do not want this to happen..

Innovation
How long have you been in operation?

Operating for 1‐5 years

Which of the following best describes the barrier(s) your innovation addresses? Choose up to two

Access, Quality.

Social Impact
Please describe the goal of your initiative; outline what you are trying to achieve

PER will improve time to appropriate care, reduce resources spent by families on ineffective treatments, and ultimately save lives.

PER is a societal component for GECC's current hospital-based emergency programming and supports it’s collaborations with the Ministry of Health and Ugandan universities to scale the ECP program nationally. By developing a system for the appropriate use of emergency services, PER can effectively integrate the services of the new ECP health worker cadre into existing public and private health sectors.

PER also ensures the sustainability of emergency care in Uganda with an effective peer-to-peer process for educating lay-people and clinic providers and allows the integration of ECP services into the social, economic and politic fabric of communities.

What has been the impact of your solution to date?

In two years, the GECC ECP program has recruited 13 ECPs and has 5 graduated ECP trainers, and effectively treated more than 11,000 patients in the Nyakibale Emergency Department (serving a rural impoverished population of over 300,000). The outcomes for these patients are impressive, with the mortality of admitted children at only 2.2% (comparable hospital in Kenya = 9.9%). Similarly, the case-fatality for children <5yo admitted through the our ED with malaria is 0.9%, compared to Uganda’s published case fatality of 3%. Additionally, GECC’s data shows that 15% of all ED patients are screened for new diagnoses of HIV/AIDS with 9% screening positive. Once found to be positive, patients are then referred to the HIV clinic for additional care. GECC expects that with the PER project, the numbers of patients from the hospital’s catchment presenting for treatment at the ED will increase significantly, and that delays in care that increase morbidity/mortality will be further minimized.

What is your projected impact over the next five years?

In 5 years GECC will be training 30 new ECPs per year in a national certification program at Mbarara University and will have expanded to two additional training hospitals. It is projected that each new ECP can treat over 312,000 children during his/her career for as little investment as $1.60 per child. The PER program will integrate into this expansion. Community education will have directly touched the lives of tens of thousands of people, and provider workshops will have raised awareness of and participation in a new type of health service. Ongoing radio programming will have reached listeners numbering into the hundreds of thousands. PER can create a network that will connect over one million residents of rural Uganda to these previously unknown, life saving emergency services

What barriers might hinder the success of your project? How do you plan to overcome them?

Building trust and maintaining collegial relationships with local is the biggest barrier to the success of the PER pilot phase. Overcoming cultural differences in areas of communication and role expectations will be actively addressed to move forward collaboratively. Our participatory approach has ensured that the pilot addresses goals that are common to all stakeholders. Additionally, GECC has a long standing administrative and personal relationship with the pilot Hospital and has strong support from the Hospital Management Team. Continued personal and cultural dialogue, and a participatory approach to design and implementation, will continue to be essential, given that the deeper into the community the program reaches, the more complex relationships and cultural differences may be.

Winning entries present a strong plan for how they will achieve and track growth. Identify your six-month milestone for growing your impact

Complete 20 community outreaches, 5 CME workshops, 3 hours of radio. Initiate referral protocol and monitoring.

Identify three major tasks you will have to complete to reach your six-month milestone
Task 1

Conduct pre-implementation reviews of all stakeholder group responsibilities and ECP led workshops for outreach educators.

Task 2

Collaborate with 2 clinics and 2 communities to create clinical referral protocols, SMS procedures, continuing education

Task 3

Locally devise scripts for radio and education materials for community outreach and workshops

Now think bigger! Identify your 12-month impact milestone

Integration of PER into GECC’s overall model, administratively and clinically, to streamline logistics and assure sustainability

Identify three major tasks you will have to complete to reach your 12-month milestone
Task 1

Ensure site-based and process monitoring tools are understood and properly utilized

Task 2

Select and train ECP(s) for administrative duties and refine administrative task descriptions.

Task 3

Assess effect of PER pilot on ED attendance and provide hospital with cost effectiveness analysis of the PER program

Sustainability
Tell us about your partnerships

Sustainable project success is achieved by leveraging strengths and interests of collaborating organizations. GECC partners with the Ugandan MoH, Mbarara and Makerere Universities, and US universities. The MoH and GECC formed a multidisciplinary Task Force on Emergency Care to explore barriers to implementation of a national emergency care system. The PER program was designed with the local Health District and it’s referral hospital, which possess human and material resources that will be utilized to develop locally and have stakes in the success of public / private health system utilization.

Are you currently targeting other specific populations, locations, or markets for your innovation? If so, where and why?

GECC is partnering with regional and national leaders to expand their emergency care programming nationally within Uganda. Additionally, GECC is developing partnerships with Mulago Hospital in Kampala to integrate physician level and ECP level emergency training, as well as a Harvard affiliated hospital for plans to replicate the ECP program in Gabon. A successful PER program would allow a third level of integration into these cross-border collaborations, community based emergency recognition and utilization and appropriate outpatient management and referral.

What type of operating environment and internal organizational factors make your innovation successful?

GECC has a defined administrative and communication structure that provides the flexibility and accountability necessary for a decentralized organization supporting field operations. A high level of autonomy allows decision making in the field to fluidly respond to unforeseen needs and challenges and is governed by at the Board level. Stakeholder responsibilities are aligned with sociocultural norms, drawing on unique stakeholder expertise and resources to produce mutually agreeable outputs. The PER project operates within GECC’s collegiate environment where stakeholder domains are well defined and both common and divergent purposes are acknowledged. GECC takes great care to develop best practices for inter-organizational communication and understanding between the partners.

Please elaborate on any needs or offers you have mentioned above and/or suggest categories of support that aren't specified within the list

GECC’s forte is building a collaborative approach with experts in public health, emergency medicine, and organizational development to implement health curricula and quality improvement/outcomes data collection. We are passionate about the human condition and seek the like-spirited from across sectors, especially as we grow an expanding scope of projects.