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Advancing research on emergency care systems in low-income and middle-income countries: ensuring high-quality care delivery systems
  1. Rachel T Moresky1,2,
  2. Junaid Razzak3,
  3. Teri Reynolds4,
  4. Lee A Wallis5,
  5. Benjamin W Wachira6,
  6. Mulinda Nyirenda7,8,
  7. Waldemar A Carlo9,
  8. Janet Lin10,
  9. Shama Patel2,
  10. Sanjeev Bhoi11,
  11. Nicholas Risko3,
  12. Lily A Wendle1,
  13. Emilie J Calvello Hynes12
  14. National Institute of Health Fogarty International Center convened the Collaborative on Enhancing Emergency Care Research in LMICs (CLEER)
    1. 1sidHARTe—Strengthening Emergency Systems Program, Columbia University Heilbrunn Department of Population and Family Health, New York, New York, USA
    2. 2Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
    3. 3Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
    4. 4Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
    5. 5Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
    6. 6Accident and Emergency Department, Aga Khan University, Nairobi, Kenya
    7. 7Adult Emergency and Trauma Centre, Queen Elizabeth Central Hospital, Ministry of Health, Blantyre, Malawi
    8. 8Emergency Medicine Section, Internal Medicine Department, College of Medicine, University of Malawi, Blantyre, Malawi
    9. 9Department of Pediatrics, Division of Neonatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
    10. 10Department of Emergency Medicine and Center for Global Health, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA
    11. 11Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
    12. 12Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
    1. Correspondence to Dr Rachel T Moresky; rachel.moresky{at}


    Emergency care systems (ECS) address a wide range of acute conditions, including emergent conditions from communicable diseases, non-communicable diseases, pregnancy and injury. Together, ECS represent an area of great potential for reducing morbidity and mortality in low-income and middle-income countries (LMICs). It is estimated that up to 54% of annual deaths in LMICs could be addressed by improved prehospital and facility-based emergency care. Research is needed to identify strategies for enhancing ECS to optimise prevention and treatment of conditions presenting in this context, yet significant gaps persist in defining critical research questions for ECS studies in LMICs. The Collaborative on Enhancing Emergency Care Research in LMICs seeks to promote research that improves immediate and long-term outcomes for clients and populations with emergent conditions. The objective of this paper is to describe systems approaches and research strategies for ECS in LMICs, elucidate priority research questions and methodology, and present a selection of studies addressing the operational, implementation, policy and health systems domains of health systems research as an approach to studying ECS. Finally, we briefly discuss limitations and the next steps in developing ECS-oriented interventions and research.

    • health systems
    • Emergency medicine
    • Emergency care systems
    • global health

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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    • Handling editor Seye Abimbola

    • Collaborators Jamie M.S. Greenberg, National Institute of Health Fogarty International Center convened the Collaborative on Enhancing Emergency Care Research in LMICs (CLEER).

    • Contributors All listed authors contributed to the planning, conduct and reporting of the work presented in the manuscript.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.