Strengthening hospital emergency services in Guinea

Guinean hospital emergency services suffer from many shortcomings: lack of human resources, inadequate training and command of care protocols, unavailability of biomedical treatment and equipment, poor organisation of care… They lead to delayed diagnoses, a poor treatment of diseases, and avoidable deaths.

To restore people’s confidence in the health system, the Guinean Ministry of Health and Public Hygiene has made the reorganisation of hospital emergency services, the first point of contact with health-care providers for patients, a priority, as set out in the authorities’ roadmap in 2022.

The HIV/AIDS, tuberculosis and malaria pandemics continue to weigh heavily on Guinean people. This can be clearly seen in hospital emergency services, which are faced with complications caused by these three diseases and receive HIV and TB patients with chronic diseases (diabetes, high blood pressure…).

• Malaria is the leading cause of mortality among children under the age of five and accounts for 45% of hospitalisations in public health facilities. In 2022, malaria was the main cause of in-hospital mortality
• Tuberculosis patients can have complications requiring an emergency admission, especially in cases of pleural effusion with respiratory distress
• Despite a rapid increase in the number of people living with HIV on antiretroviral treatment, there is a widespread HIV/AIDS epidemic, and the disease accounts for 9% of medical consultations. Emergency admissions for HIV/AIDS complications are related to opportunistic infections (tuberculosis, toxoplasmosis, candidiasis, pneumocystis…) and liver failure, which emergency medical staff are unfamiliar with.

Expertise France worked on the issue of hospital emergency services in Guinea between 2018 and 2022 during a pilot project financed by the French Government. This pilot project was implemented in the regions of Kankan, Labé and Conakry and aimed to strengthen pre-, per- and post-hospital emergency services. One of its major achievements has been the development of a national strategy on hospital emergency services and its Master Plan, which were published in March 2022.

Following on from these activities, the “Hospital Emergency Services” project, financed in the context of L’Initiative, aims to scale up the action. Its objective is to improve emergency care related to malaria, tuberculosis and HIV/AIDS in the emergency services of ten sites: the Ignace Deen National Hospital, the eight regional hospitals (Boké, Conakry, Faranah, Kankan, Kindia, Labé, Mamou, Nzérékoré) and the Siguiri Prefectoral Hospital.

The project will be coordinated with other ongoing initiatives, which include the purchase of some 30 ambulances, the construction and equipment of a national centre for emergency management, and the construction of four university hospital centres, in Kankan, Kindia, Labé and Nzérékoré.

This project is based on three specific objectives.

1. Improve the quality of care for life-threatening emergencies related to the three pandemics:

• Human health resources will be permanently strengthened in terms of care for life-threatening emergencies, including for cases related to the three pandemics, with a gender-responsive approach
• The reception conditions in hospital emergency services will be improved, through the rehabilitation of services and the provision of the equipment and inputs required for quality care for life-threatening emergencies related to the three pandemics, with a gender-responsive approach  

2. Facilitate early treatment and post-emergency follow-up for cases of life-threatening emergencies related to the three pandemics

• Referrals of cases of life-threatening emergencies related to the three pandemics will be improved through capacity building for community actors
• Links between hospitals and community actors will be strengthened, in particular for cases of HIV and multi-drug resistant tuberculosis

3. Contribute to the implementation of corrective measures to support quality care for life-threatening emergencies related to the three pandemics

Gender-specific scientific data on the role of emergency services in therapeutic treatment will be made available to hospital technical operators and policy makers by conducting studies. This will give them a better understanding of the role of emergency services in therapeutic treatment.

The project will take account of the specific needs of women and men at the practical and strategic levels. The gender dimension will be mainstreamed in the entire project management system (contractual, HR, monitoring-evaluation, steering), and in the activities implemented (beneficiaries, training arrangements and content, partnerships).