SEVENTY-SECOND WORLD HEALTH ASSEMBLY WHA72.

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Agenda item 12.9 28 May 2019

Emergency care systems for universal health

coverage: ensuring timely care for the
acutely ill and injured

The Seventy-second World Health Assembly,

Having considered the report on emergency care systems for universal health coverage: ensuring
timely care for the acutely ill and injured;1

Noting the importance of the organization of the health system as a whole, including by
distinguishing between elective services and care, non-elective services and care, and emergency
services and care in order to address the health needs of populations in a sustainable, effective and
appropriate manner;

Recognizing that many proven health interventions are time-dependent and that emergency care
is an integrated platform for delivering accessible, quality and time-sensitive health care services for
acute illness and injury across the life course;

Emphasizing that timeliness is an essential component of quality, and that millions of deaths and
long-term disabilities from injuries, infections, mental disorders and other mental health conditions,
acute exacerbations of noncommunicable diseases, acute complications of pregnancy, and other
emergency conditions could be prevented each year if emergency care services exist and patients reach
them in time;

Noting that injury alone accounts for nearly 5 million deaths per year and that road traffic injury
is the top killer of all those in the age group of 5–29 years;2

Noting also that emergency care is an essential part of health service delivery in health systems,
and that well-designed emergency services facilitate timely recognition, treatment management and,
when needed, continued treatment of the acutely ill at the appropriate level of the health system;

Acknowledging Sustainable Development Goal 3 (Ensure healthy lives and promote well-being
for all at all ages), and recognizing that well-organized, safe and high-quality emergency care is a key
mechanism for achieving a range of associated targets – including those on universal health coverage,
road safety, maternal and child health, noncommunicable diseases, mental health, and infectious disease;

1 Document A72/31.
2Global Health Estimates 2016: deaths by cause, age, sex, by country and by region, 2000–2016. Geneva, World
Health Organization; 2018
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Acknowledging further Sustainable Development Goal 11 (Make cities and human settlements
inclusive, safe, resilient and sustainable) and Goal 16 (Promote peaceful and inclusive societies for
sustainable development, promote access to justice for all and build effective, accountable and inclusive
institutions at all levels), and noting that a strong and well-prepared everyday emergency care system is
vital for mitigating the impact of disasters and mass casualty events and for maintaining delivery of
health services in fragile situations and conflict-affected areas;

Recalling resolutions WHA56.24 (2003) on implementing the recommendations of the World

report on violence and health, WHA57.10 (2004) on road safety and health (echoed by United Nations
General Assembly resolution 72/271 (2018) on improving global road safety), WHA60.22 (2007) on
health systems: emergency-care systems, WHA64.10 (2011) on strengthening national health
emergency and disaster management capacities and resilience of health systems, WHA66.8 (2013) on
the comprehensive global mental health action plan 2013–2020, WHA68.15 (2015) on strengthening
emergency and essential surgical care and anaesthesia as a component of universal health coverage, and
WHA69.1 (2016) on strengthening essential public health functions in support of the achievement of
universal health coverage, in which the Health Assembly prioritized integrated service-delivery models
and identified the lack of access to timely emergency care as a cause of extensive and serious public
health problems;

Recalling also the mandate of WHO’s Thirteenth General Programme of Work, 2019–2023 to
improve integrated service delivery and to serve in particular the most disadvantaged, marginalized and
hard-to-reach populations, to ensure that no one is left behind;1

Noting that providing non-discriminatory access to all people in need of timely care in well
organized, safe and high-quality emergency care services can contribute to the reduction of health
inequalities;

Noting further that in many countries the emergency care system serves as the major health system
safety net and the primary point of access to health services, in particular for marginalized populations,
which is not an optimal use of health system resources;

Recognizing that the lack of organized emergency care in many countries leads to wide global
discrepancies in outcomes across the range of emergency conditions;

Noting that many emergency care interventions are both effective and cost effective, and that
integrated emergency care delivery can save lives and maximize impact across the health system;

Concerned that the lack of investment in frontline emergency care is compromising effectiveness,
limiting impact and increasing cost in other parts of the health system;

Acknowledging that frontline health workers, nurses in particular, provide care for the acutely ill
and injured, often without the benefit of dedicated training in the management of emergency conditions,
and with limited possibilities for consultations;

1 Thirteenth General Programme of Work, 2019–2023. Geneva: World Health Organization; 2018; as contained in
document A71/4 (http://apps.who.int/gb/ebwha/pdf_files/WHA71/A71_4-en.pdf?ua=1or, accessed 19 March 2019) and
adopted in resolution WHA71.1 (2018).

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Noting that improving outcomes requires an understanding of the potential and actual utilization
of emergency care, and that existing data do not provide adequate support for effective planning and
resource allocation for emergency care;

Considering that WHO has a range of guidance that allows policy-makers, planners and
administrators to develop action plans that are best suited to their national contexts, along with resources
for training, as well as standards for essential emergency care services and resources at each level of the
health system,

1. CALLS FOR near-term additional efforts globally to strengthen the provision of emergency care
as part of universal health coverage so as to ensure the timely and effective delivery of life-saving health
care services to those in need;1

2. URGES Member States:2

(1) to create policies for sustainable funding, effective governance and universal access to safe,
high-quality, needs-based emergency care for all, without regard to sociocultural factors, without
requirement for payment prior to care, and within a broader health system that provides quality
essential care and services and financial risk protection as part of universal health coverage;

(2) as appropriate, to conduct voluntary assessments using the WHO emergency care system
assessments tool to identify gaps and context-relevant action priorities;

(3) to work towards, or promote, at appropriate levels of governance, the inclusion of routine
prehospital and hospital emergency unit care into health strategies, and in other relevant planning
documents, such as emergency response plans and obstetric and surgical plans;

(4) to develop a governance mechanism, as appropriate to their national context, for the
coordination of routine prehospital and hospital-based emergency care services, including
linkages with other relevant actors for disaster and outbreak preparedness and response, including
the capacity of personnel in other sectors;

(5) to promote more coherent and inclusive approaches to safeguard effective emergency care
systems as a pillar of universal health coverage in fragile situations and conflict-affected areas,
ensuring the continuum and provision of essential health services, and public health functions, in
line with humanitarian principles;

(6) to promote as appropriate, according to the level of health care services, from first level
and above, the establishment of a dedicated area or unit for emergency services and care with
appropriate equipment and capacity for management and diagnosis;

(7) to promote access to timely prehospital care for all, by using informal or formal systems,
as resources allow, including by establishing, where they do not exist, toll-free universal access
numbers that meet international standards;

1 See Emergency and trauma care [website]. Geneva: World Health Organization; 2019

(https://www.who.int/emergencycare/en/, accessed 20 May 2019).

2 And, where applicable, regional economic integration organizations.

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(8) to implement key processes and protocols as identified in WHO guidance on emergency
care systems, such as triage and checklists,1 as appropriate;

(9) to provide dedicated training in the management of emergency conditions for all relevant
types of health providers, including developing post-graduate training programmes for doctors
and nurses, training frontline providers in basic emergency care, and integrating dedicated
emergency care training into undergraduate nursing and medical curricula, and establishing
certification pathways for prehospital providers, as appropriate to their national context;

(10) to increase awareness and capacity in communities to deal with emergency situations,
including through campaigns, and through training of standard practices across educational and
occupational settings, adapted to their corresponding target populations, so they can identify,
mitigate and refer potential emergencies;

(11) to implement mechanisms for standardized data collection to characterize the local acute
disease burden and identify high-yield mechanisms for improving the coordination, safety and
quality of emergency care;

(12) to support efforts to ensure, based on local risks, that prehospital and hospital emergency
units have plans in place to protect providers, patients and infrastructure from violence and to
protect providers and patients from discrimination; and that they have in place clear protocols for
the prevention and management of hazardous exposures;

3. REQUESTS the Director-General:

(1) to enhance WHO’s capacity at all levels to provide necessary technical guidance and
support for the efforts of Member States and other relevant actors to strengthen emergency care
systems, including to ensure preparedness in all relevant contexts;

(2) to foster multisectoral networks, partnerships and action plans, and to facilitate
collaboration among Member States, to support the effective dissemination and implementation
of best practices in emergency care;

(3) to promote equitable and non-discriminatory access to safe, quality emergency care
services for all people as part of universal health coverage;

(4) to renew efforts outlined in resolution WHA60.22 to provide support to Member States,
upon request, for needs assessments, facility inspection, quality- and safety-improvement
programmes, review of legislation, and other aspects of strengthening the provision of emergency
care;

(5) to support Member States to expand policy-making, administrative and clinical capacity in
the area of emergency care, by the provision of policy options and technical guidance, supported
by educational strategies and materials for providers and planners;

1 See Emergency and trauma care [website]. Geneva: World Health Organization; 2019

(https://www.who.int/emergencycare/en/, accessed 20 May 2019).

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(6) to strengthen the evidence base for emergency care by encouraging research on the burden
of acute disease and emergency care delivery, and by providing tools, protocols, indicators and
other needed standards to support the collection and analysis of data, including on cost-
effectiveness;

(7) to facilitate awareness and international and domestic resource mobilization, in line with
the Addis Ababa Action Agenda of the Third International Conference on Financing for
Development1 by providing advocacy resources;

(8) to report to the Seventy-fourth World Health Assembly in 2021 on progress in the
implementation of this resolution.

Seventh plenary meeting, 28 May 2019

A72/VR/7

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1 United Nations General Assembly resolution 69/313 (2015).