Abstract
Out-of-hospital emergency care (OHEC) should be accessible to all who require it. However
available data suggests that there are a number of barriers to such access in Africa, mainly
centred around challenges in public knowledge, perception and appropriate utilisation of
OHEC. Having reached consensus in 2013 on a two-tier system of African OHEC, the
African Federation for Emergency Medicine (AFEM) OHEC Group sought to gain further
consensus on the narrower subject of access to OHEC in Africa. The objective of this
paper is to report the outputs and statements arising from the AFEM OHEC access consensus
meeting, held in Cape Town, South Africa in April 2015. The discussion was structured
around six dimensions of access to care (awareness, availability, accessibility,
accommodation, affordability and acceptability) and tackled both Tier-1 (community first
responder) and Tier-2 (formal prehospital services and Emergency Medical Services) OHEC
systems. In Tier-1 systems, the role of community involvement and support was emphasised,
along with the importance of a first responder system acceptable to the community in which
it is embedded in order to optimise access. In Tier-2 systems, the consensus group
highlighted the primacy of a single toll-free emergency number , matching of Emergency
Medical Services resource demand and availability through appropriate planning and the
cost-free nature of Tier-2 emergency care, among other factors that impact accessibility.
Much work is still needed in prioritising the steps and clarifying the tools and metrics that
would enable the ideal of optimal access to OHEC in Africa.