Interaction and coordination of stakeholders

As previously indicated, EsTC builds on two foundations: the essential services approach of international health and the development of systems for trauma management of individual countries. Each of these involves a variety of political modes of implementation:

— central planning through ministries of health;

— promotion through professional societies and networks (such as the Prevention of Maternal Mortality Network in West Africa);

— technical assistance from WHO headquarters, regional offices and country offices;

— laypeople in grass-roots lobbying, as involved in promoting essential drugs programmes.

It is envisioned that the EsTC process in individual countries might involve similar interplays. This might involve such activities as professional societies involved with trauma care in individual countries meeting with members of the Ministry of Health. One or both might draw up a preliminary plan for what needs to be promoted on the basis of a local adaptation of the Guidelines for essential trauma care. This might result in widespread and, hopefully, low-cost improvements in trauma services. It might also result in pilot projects in limited geographic areas with appropriate research into operations and assessment of outcomes to decide how best to scale up such activities nationwide.

Throughout all of this, there could be a role for lay groups, including survivors or relatives of people killed or disabled by trauma. Such concerned citizens might help to exert the needed influence to help promote implementation of these guidelines. Unfortunately, there is a growing number of such individuals worldwide.

When efforts to improve trauma services according to the Guidelines for essential trauma care are undertaken, we must consider how these will ultimately be provided and how they are to be integrated into existing governmental administrative structures. The current guidelines focus on facility-based trauma care. However, the trauma care delivery system in a country, a province or a given geographical area encompasses all phases of care, from pre-hospital care to acute care and rehabilitation. It is important that good coordination be ensured between all components of trauma care. In addition, the success of a programme for essential trauma care in a given country will depend on its implementation and dissemination at the grass-roots level, enactment of the guidelines in national policies, and constant monitoring and evaluation of the programme. To facilitate the above-mentioned tasks, it is recommended that appropriate institutional mandates be created at national, provincial and local levels, where such authority does not already exist. National governments need enhanced capacity to be able to focus upon and act to upgrade their trauma services.

In many countries, emergency services, including those for trauma care, are monitored collectively by an EMS authority. Diverse arrangements are operational in some health systems in some countries, and even provinces within a country. Local circumstances may require an existing apex agency to adopt EsTC as an additional responsibility.

An EsTC programme in a country should preferably be led by a national agency, which should build broad consensus about the Guidelines for essential trauma care nationally and allow accommodation of local ideas and innovations. The Guidelines constitute a flexible template. Innovative ideas to augment physical or human resources with local input will ensure a sense of ownership among local stakeholders. Such an agency should represent all stakeholders in the delivery of trauma care, including representatives with political, administrative, professional and technical backgrounds. Donor agencies, voluntary organizations and community groups may be included. Larger countries and provinces may wish to organize an appropriate hierarchy for EsTC in smaller geopolitical areas to maintain smooth functioning and coordination.

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