“When we talk about emergency care advocacy, we talk about advocating for resources, connecting with government, and raising public awareness. NGOs are critical to achieving this,” says Dr. Charles Mock, University of Washington and Global Alliance for Care for the Injured (GACI), and one of the authors of WHO’s recent publication Advocating for Emergency Care: a guide for nongovernmental organizations.
Post-crash care, which is closely linked to emergency care, is one of the key components of the Global Plan for the Decade of Action for Road Safety 2021–2030.1 It says, “post-crash care and survival is extremely time-sensitive: delays of minutes can make the difference between life and death. Therefore, appropriate, integrated and coordinated care should be provided as soon as possible after a crash occurs.” The Global Plan sets out evidence-based recommendations for post-crash care that contribute to reducing road deaths and injuries. This involves well-trained personnel, well-equipped ambulances or other suitable means of pre-hospital transportation, and efficient communication networks to ensure timely arrival at the crash scene, proper triage of patients, and quick transportation to appropriate medical facilities.2
Emergency care is the provision of rapid assessment and initial management of acute illness and injury. It is an essential component of health systems and is critical for improving the quality of care provided to patients with acute illness or injury, including those from road traffic crashes.2
However, there is a lack of emphasis on providing adequate care for the injured, particularly emergency and surgical care, compared to other health issues. This is worse in low- and middle-income countries (LMICs) and the funding for health development assistance, which includes support from high-income countries, foundations, and philanthropic organizations, reflects this disparity. For instance, while US$41 is allocated per disability adjusted life year (DALY) lost due to HIV/AIDS, only a fraction of that amount, US$0.04 per DALY, is allocated for injury-related issues. Individual country expenditures also reflect this poor prioritization. The prioritization of HIV/AIDS and other health conditions can be attributed, in part, to the influence of advocacy efforts by concerned individuals and organizations. However, advocacy for trauma care has received limited attention thus far.3
Globally, there is considerable expertise among civil society organizations that can fill some of the neglected gaps in implementing evidence-based actions and policy measures necessary to improve road safety and reduce road trauma, including emergency response and care. Civil society can serve as advocates, “acting as an independent voice to influence social change, support the development of policies by augmenting the evidence base, and bringing the perspectives of affected individuals and communities to the table.”2
Advocating for Emergency Care: a guide for nongovernmental organizations, which was written collaboratively between the WHO, GACI, and the Alliance, provides simple steps that can be followed by NGOs to identify effective interventions and to advocate for their implementation. The steps are backed up by practical case studies, including a number from Alliance members.
According to Charles, there is a lot of value that NGOs can add to advocacy for emergency care and it doesn’t have to be complicated. “When discussing advocacy for emergency care, at local level, we can emphasize the need to advocate for resources, engage with government entities, and raise public awareness. At the national level, the enactment of laws and legislation plays a crucial role.” He points to an example of national advocacy by an NGO for emergency care from the guide: In India, SaveLIFE Foundation (SLF) advocated for a Good Samaritan Law to protect bystanders assisting road crash victims. On one hand, engaging with parliamentarians and elected representatives was pivotal. At the same time, SLF brought a public litigation case before the High Court, tackling the problem from two angles at once. Charles notes that this can be a powerful form of advocacy but requires substantial effort to yield results.
At the local level, NGOs can push for the allocation of resources for provider training and emergency equipment in communities. NGOs can also engage in continuous advocacy that seeks gradual changes over time. In this regard, Charles noted that “advocacy can be continuous and ongoing with a focus on addressing the needs of emergency care through incremental actions over time. Resource mobilization and fundraising, as seen in Seattle, Washington, where a tax/levy is utilized to fund emergency medical services, exemplifies this approach.” He also advised NGOs to acknowledge that the effectiveness of community advocacy and incremental approaches may vary depending on the specific context in which NGOs operate, as there is no one-size-fits-all approach.
A crucial element of advocacy for emergency care is to find the right advocacy partners by involving care professionals. Charles suggests that one of the most valuable sources of information would be the professionals and providers of emergency care within their society, such as emergency physicians and trauma surgeons, as well as nurses, other healthcare professionals, ambulance services, pre-hospital providers, and paramedics. “These individuals are well-informed about the state of emergency care in their respective contexts and are aware of the specific needs. It is crucial for road safety NGOs to promote communication with these groups. For instance, one of the road safety NGOs in Lebanon established an advisory board that included medical professionals, enabling them to establish a link and gain expertise and input from a professional in the field. In general, NGOs can form a small committee or board consisting of emergency service providers from their local area.”
Collaborating and communicating with these groups can also provide the critical data needed to inform advocacy to ensure that it is evidence-based. Data collection doesn’t need to be complex. “The data to inform advocacy can be derived from direct experiences of the providers, and there is also data available from hospitals. These data are not complex and provide information on infrastructure, resource deficiencies, and the frequency of emergency care needs. Even simple data can be utilized for straightforward processes and can make a significant difference. However, if you have the capacity to work with more complex data, you can leverage that as well. For example, an NGO in Iran utilized mapping of crash data as part of their advocacy.”
Road safety NGOs are key to these advocacy efforts because, according to Charles, “road safety and health, in terms of emergency and trauma care, are one and the same”. With the WHO and the Alliance’s publication that offers guidance to NGOs and the public on effectively advocating for care of road traffic crash victims, the key lies in collaborating with professionals to ensure that interventions are evidence-based, affordable, and sustainable over time.”
“Road traffic crashes are a huge health problem. Alliance members have key roles to play in addressing this problem, both through primary prevention (road safety) and through improved care for injured people.”