HeRAMS Yemen Baseline Report 2023: General clinical and trauma care services

HeRAMSYemen Baselinereport2023 GENErALCLINICALAND trAumACArEsErvICEs Acomprehensivemappingofavailabilityofessentialservicesandbarriersto theirprovision July2023 ©WorldHealthOrganization2023 Somerightsreserved.ThisworkisavailableundertheCreativeCommonsAttribution-NonCommercial-ShareAlike3.0IGOlicence(CCBY-NC-SA3.0IGO;https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Underthetermsofthislicence,youmaycopy,redistributeandadapttheworkfornon-commercialpurposes,providedtheworkisappropri-atelycited,asindicatedbelow.Inanyuseofthiswork,thereshouldbenosuggestionthatWHOendorsesanyspecificorganization,productsorservices.TheuseoftheWHOlogoisnotpermitted.Ifyouadaptthework,thenyoumustlicenseyourworkunderthesameorequivalentCreativeCommonslicence.Ifyoucreateatranslationofthiswork,youshouldaddthefollowingdisclaimeralongwiththesuggestedcita-tion:“ThistranslationwasnotcreatedbytheWorldHealthOrganization(WHO).WHOisnotresponsibleforthecontentoraccuracyofthistranslation.TheoriginalEnglisheditionshallbethebindingandauthenticedition”. AnymediationrelatingtodisputesarisingunderthelicenceshallbeconductedinaccordancewiththemediationrulesoftheWorldIntel-lectualPropertyOrganization(http://www.wipo.int/amc/en/mediation/rules). Suggestedcitation.HeRAMSYemenbaselinereport2023-Generalclinicalandtraumacareservices:Acomprehensivemappingofavailabilityofessentialservicesandbarrierstotheirprovision;2023 Third-partymaterials.Ifyouwishtoreusematerialfromthisworkthatisattributedtoathirdparty,suchastables,figuresorimages,itisyourresponsibilitytodeterminewhetherpermissionisneededforthatreuseandtoobtainpermissionfromthecopyrightholder.Theriskofclaimsresultingfrominfringementofanythird-party-ownedcomponentintheworkrestssolelywiththeuser. Generaldisclaimers.ThedesignationsemployedandthepresentationofthematerialinthispublicationdonotimplytheexpressionofanyopinionwhatsoeveronthepartofWHOconcerningthelegalstatusofanycountry,territory,cityorareaorofitsauthorities,orconcerningthedelimitationofitsfrontiersorboundaries.Dottedlinesonmapsrepresentapproximateborderlinesforwhichtheremaynotyetbefullagreement. Thementionofspecificcompaniesorofcertainmanufacturers’productsdoesnotimplythattheyareendorsedorrecommendedbyWHOinpreferencetoothersofasimilarnaturethatarenotmentioned.Errorsandomissionsexcepted,thenamesofproprietaryproductsaredistinguishedbyinitialcapitalletters. AllreasonableprecautionshavebeentakenbyWHOtoverifytheinformationcontainedinthispublication.However,thepublishedmaterialisbeingdistributedwithoutwarrantyofanykind,eitherexpressedorimplied.Theresponsibilityfortheinterpretationanduseofthemateriallieswiththereader.InnoeventshallWHObeliablefordamagesarisingfromitsuse. HeRAMSYEMEN BASELINEREPORT2023 Generalclinicalandtraumacareservices Acomprehensivemappingofavailabilityofessentialservicesandbarrierstotheirprovision July2023 HeRAMSYemen//Baselinereport2023 CONTENTS Acronymsvi Disclaimervii PartI:Overviewoftheavailabilityofgeneralclinicalandtraumacareservices1 Howtoreadthecharts2 Overviewofhealthfacilitiesassessed3 Availabilityofservicepackageandmainbarriers4 Serviceavailabilitybycatchmentpopulation7 Mainbarriersimpedingservicedelivery9 PartII:In-depthanalysisbyhealthservice16 Howtoreadthechartsandthemaps17 Requestforambulanceservicesbythepatient18 Recognitionofdangersigns20 Acuity-basedformaltriage22 WHObasicemergencycarebyprehospitalprovider24 WHObasicemergencycare26 Advancedsyndrome-basedmanagement28 Monitoredreferral30 Referralcapacity32 Acceptanceofreferrals34 Acceptanceofcomplexreferrals36 Outpatientservicesforprimarycare38 Outpatientdepartmentforsecondarycare40 Homevisits42 Minortraumadefinitivemanagement44 Emergencyandelectivesurgery46 iv Generalclinicalandtraumacareservices Emergencyandelectivesurgerywithatleasttwooperatingtheatres48 Orthopedic/traumaward50 Shorthospitalizationcapacity52 20inpatientbedcapacity54 50inpatientbedcapacity56 Inpatientcriticalcaremanagement58 Intensivecareunit60 Basiclaboratory62 Laboratoryservicessecondarylevel64 Laboratoryservicestertiarylevel66 Bloodbankservices68 Hemodialysisunit70 Basicx-rayservice72 Radiologyunit74 Medicalevacuationprocedures76 Proceduresformasscasualtyscenarios78 Annexes81 AnnexI:Definitionsofessentialservices82 AnnexII:Populationestimations84 v Acronyms HeRAMSHealthResourcesandServicesAvailabilityMonitoringSystem HFHealthfacility WHOWorldHealthOrganization Generalclinicalandtraumacareservices DIscLAIMEr Disruptionstohealthsystemscanimpedeprovisionofandaccesstoessentialhealthservices.Communities’vulnerabilitytoincreasedmorbidityandmortalitysubstantiallyincreaseswhenalackofreliableinformationpreventssounddecision-making,especiallyinrapidlychangingenvironmentsrequiringcontinuedassessment.TheHealthResourcesandServicesAvailabilityMonitoringSystem(HeRAMS)aimstoprovidedecision-makersandhealthstakeholdersatlargewithvitalandup-to-dateinformationontheavailabilityofessentialhealthresourcesandservices,helpthemidentifygapsanddetermineprioritiesforintervention. HeRAMSdrawsonthewealthofexperienceandk