Nepal has made significant strides in enhancing its emergency health-care systems by implementing the World Health Organization's (WHO) Global Emergency and Trauma Care Initiative (GETI). Launched in 2016, the initiative aims to deliver quality emergency care, improve system efficiencies and increase health outcomes while strengthening policies and preparedness for health emergencies.
Building on these goals, the Ministry of Health and Population (MoHP) conducted a national Emergency Care System Assessment (ECSA) in 2019, identifying 39 priority actions for improvement. Following this, a two-day national workshop held in December 2022 brought together health-care professionals from hub hospitals key stakeholders across the country to review the Emergency Care Tools (ECT). The tools were subsequently endorsed by the MoHP for implementation in seven provincial facilities: Koshi Hospital, Narayani Hospital, Bharatpur Hospital, Pokhara Academy of Health Sciences, Bheri Hospital, Provincial Hospital Surkhet and Seti Provincial Hospital.
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A team from the Ministry of Health and Population and WHO engaging in discussions on the implementation of the Emergency Care Toolkit at Province Hospital in Surkhet, Karnali province. Photo Credit: WHO Nepal/B. Bist
In early 2023, a team of experts and trainers visited these seven facilities to conduct Hospital Emergency Assessment Tools (HEAT) assessments and review ECT implementation plans. The assessments aimed to identify key gaps in emergency care provision and provide recommendations for basic emergency care improvement. Trainers then provided an orientation of integration of ECT, focusing on triage, checklists and resuscitation areas. The implementation process involved detailed observations and walkthroughs of the Emergency Units at each site to understand the current state and identify areas for improvement. Collaboration with hospital leadership and key stakeholders was essential to review HEAT data and address ongoing challenges. Engagement with on-site champions, including directors, medical superintendents, department heads and staff, helped develop site-specific low-cost interventions for integration and implementation of the tools. Recommendations were made to optimize Emergency Unit layouts to enhance patient care.
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A medical officer at Narayani Hospital, Madesh Province, utilizing the WHO Trauma Emergency Checklist and Medical Emergency Checklist. Photo Credit: WHO Nepal/B. Bist
"We hope this Emergency Care tools will be a model for improving emergency care. We are committed to standardizing Emergency Care Service system in our hospital," said Dr Hem Raj Pandey, Medical Superintendent of Seti Provincial Hospital.
Designed to guide the management of acutely ill and injured individuals, the Emergency Care Tools include 3 key components:
- The Trauma Care Checklist ensures a systematic and structured approach to every injured or acutely ill person, streamlining data collection without creating duplicate work,
- The Interagency Integrated Triage Tool (IITT) offers a common approach to facility-based routine triage, mass casualty triage, and pre-hospital triage and
- The Emergency Care Checklist which helps clinicians review key actions at critical points during patient care.
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An orientation session on Emergency Care Tools conducted by WHO for health-care workers and leadership at Provincial Hospital in Surkhet, Karnali province. Photo Credit: WHO Nepal/B. Bist
Similarly, Basic Emergency Care (BEC) provides a systematic initial approach to managing acute, potentially life-threatening conditions in resource-limited settings. Since trainings began in 2022 under the GETI Initiative, about 900 frontline health-care providers in Nepal have been trained on the BEC course.
The initiative's implementation phases include the collection of baseline data on pre-designated health outcomes from all seven facilities, in 2022. This phase also included training at provincial GETI sites, led by certified national trainers. The ECT tools were standardized to the Nepali context and officially endorsed by the MoHP in 2022. Ongoing data collection following the implementation aims to assess the impact and effectiveness of the ECT.
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Participants from the national workshop on Emergency Care Tools held in Kathmandu, Bagmati Province. Photo Credit: WHO Nepal/B. Bist
“All frontliners, including those in primary level health facilities, should undergo Basic Emergency Care training to ensure they are equipped with essential life-saving skills. BEC should be a mandatory course for all health workers before they join their workstations,” Dr Dipendra Raman Singh, Additional Secretary, MoHP, Government of Nepal.
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Dr Rajesh Sambhajirao Pandav, WHO Representative to Nepal, providing his remarks at the national workshop on Emergency Care Tools in Kathmandu, Bagmati province. Photo: WHO Nepal/B. Bist.
“The Global Emergency and Trauma Care Initiative helps countries like Nepal identify gaps in emergency care systems and implement effective, low-cost solutions, and the insights from these efforts will be invaluable in enhancing health-care quality for years to come," said Dr Rajesh Sambhajirao Pandav, WHO Representative to Nepal.
With the implementation of the ECT tools under GETI project, Nepal has set an example for other low-and middle-income countries to transform emergency health-care through innovation, partnership and determination.