Comparing transcripts with audio files and summaries helps in monitoring quality of data.
Open and axial coding helps to conceptualize and label data from KIIS or FGDs that would be subsequently grouped into categories and sub-themes [ 37 ]. Simultaneous data collection and summarization of information helps in identifying the point where saturation is achieved. Based on this approach, the tool was initially validated in Uganda, where a limited PEMS assessment of the Kampala city was conducted, and the results were used to refine the questionnaire and identify solutions to the common logistical barriers during implementation [ 38 ].
Gaps and weaknesses in the infrastructure, resources, or health workforce have been studied previously in LMIC settings, but from an input perspective [ 16 ]. While the WHO health system framework is valuable because of its simplicity, segmented analysis of resources as building blocks without accounting for interaction among inputs may impact understanding of the process and outcomes [ 39 ].
Our proposed approach could overcome this limitation by incorporating quantitative and qualitative measures, triangulating data, and including secondary data spanning over a period of time. In conducting a comprehensive assessment, logistical delays must be kept in mind and could be overcome by pre-implementation planning.
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Early engagement with the stakeholders would expedite the approval processes needed for obtaining secondary data and organization of KIIs and FGDs. It is important to note that the tool is designed for a comprehensive system-wide PEMS assessment, not for service delivery monitoring purposes. The tool covers the entire framework of PEMS; therefore, it is possible to deploy the tool for specific parts which are the focus of planning or evaluation of an intervention instead of conducting a comprehensive assessment.
For instance, FGDs highlight the access, financial barriers, responsiveness, and quality of PEMS; document review to observe trends of service delivery and outcome indicators, etc.
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We have demonstrated that such an assessment could be done by local team including public health practitioners, without extensive guidance from international experts. Most of the document reviews and KIIs are conducted through semi-structured questionnaire, and observational study through checklists. FGDs are the only component that requires training and qualitative data analysis skills.
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Given the fact that neither this method is uncommon in LMICs nor underutilized in answering programmatic and operational questions, it is expected that local teams would be able to conduct the assessment successfully. This paper describes a comprehensive EMS assessment tool with a solid health system foundation.
This tool could enable researchers, policy makers, and administrators alike to apply rigorous methods of PEMS assessment and use the information to set up and monitor benchmarks of health outcomes impacted by an organized EMS system. This tool provides a comprehensive health systems framework and at the same time carries the flexibility to focus on different parts of the PEMS where LMICs could focus, set their own benchmarks, and monitor their progress.
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Establishing a successful pre-hospital emergency service in a developing country: experience from Rescue service in Pakistan. Emerg Med J. Preparedness for mass casualties of road traffic crashes in Uganda: assessing the surge capacity of highway general hospitals. Health Policy Dev. Rural prehospital trauma systems improve trauma outcome in low-income countries: a prospective study from North Iraq and Cambodia.
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