title: [Emergency departments: do they have any future in West Africa? Example of the Principal Hospital of Dakar].
abstract: The principal hospital of Dakar is a military institution whose interest in endemic tropical disease is well established in Western Africa. Since the beginning of the 21st century, this institution began to offer emergency care with the opening of the emergency department (Service d'Accueil des Urgences [SAUD in 2000. This 2007-2008 study aimed to determine the exact place of this ward within the institution. An analysis of patient trajectories and referrals shows that with nearly 40,000 emergency cases per year, the SAU was responsible for one-third of all hospital consultations and hospitalizations. Two-thirds of patients whose condition was urgent were hospitalized in the intensive care unit or surgical department. For these patients, the system proves to be efficient. For the patients whose condition was not urgent, twice the number of patients than those remaining on site were transferred to another hospital. For patients who remained on site, one-third were placed in the mother and baby care department, another third remained in the emergency department's short-stay unit (Unité d'Hospitalisation de Courte Durée) and the remaining third were moved to other wards, medical wards taking 18% of the whole. Thus, the medical ward recruited 12% of their patients in the SAU. This study shows two models of care in the hospital: the traditional one, rooted in direct recruitment; and the emergency one, politically established during the 2000s as a modern evolution of this health institution, which appears to be population-based, emergency centered and respectful of equity in health access. These two models question the institutional policy and the success of its recent evolution toward emergency issues.
authors.affiliation: French Embassy (AFD), PO Box 2349, Dar es Salaam, Tanzanie. imonkamd@gmail.com
authors.forename: Angélique
authors.initials: A
authors.lastname: Sentilhes-Monkam
mesh_terms: D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006757:Hospital Units / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D010360:Patient Transfer; D012675:Senegal