title: Comparative analysis of three prehospital emergency medical services organizations in India and Pakistan.
abstract: OBJECTIVE
  Strengthened emergency medical services (EMS) are urgently required in South Asia to reduce needless death and disability. Several EMS models have been introduced in India and Pakistan, and research on these models can facilitate improvements to EMS in the region. Our objective was to conduct a cross-case comparative analysis of three EMS organizations in India and Pakistan - GVK EMRI, Aman Foundation and Rescue 1122 - in order to draw out similarities and differences in their models.
  
  
  METHODS
  Case study methodology was used to systematically explore the organizational models of GVK EMRI (Karnataka, India), Aman Foundation (Karachi, Pakistan), and Rescue 1122 (Punjab, Pakistan).
  
  
  METHODS
  Qualitative methods - interviews, document review and non-participant observation - were utilized, and using a process of constant comparison, data were analysed across cases according to the WHO health system 'building blocks'.
  
  
  RESULTS
  Emergent themes under each health system 'building block' of service delivery, health workforce, medical products and technology, health information systems, leadership and governance, and financing were described. Cross-cutting issues not applicable to any single building block were further identified.
  
  
  CONCLUSIONS
  This cross-case comparison, the first of its kind in low- and middle-income countries, highlights key innovations and lessons, and areas of further research across EMS organizations in India, Pakistan and other resource-poor settings.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA. Electronic address: vsriram1@jhu.edu.
authors.forename: V
authors.initials: V
authors.lastname: Sriram
authors.affiliation: Department of Epidemiology and Centre for Public Health, World Health Organization Collaborating Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neuro Sciences, Bengaluru, India. Electronic address: epiguru@yahoo.com.
authors.forename: G
authors.initials: G
authors.lastname: Gururaj
authors.affiliation: Department of Emergency Medicine, Johns Hopkins School of Medicine, 5801 Smith Ave, Ste 202, Baltimore, MD 21209, USA. Electronic address: junaid.razzak@hopkins.edu.
authors.forename: J A
authors.initials: JA
authors.lastname: Razzak
authors.affiliation: Pakistan Red Crescent Society, Islamabad, Pakistan. Electronic address: drnaseer@hotmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Naseer
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA. Electronic address: ahyder1@jhu.edu.
authors.forename: A A
authors.initials: AA
authors.lastname: Hyder
mesh_terms: D004632:Emergency Medical Services / Q000458:organization & administration*; D006801:Humans; D007194:India; D017146:Models, Organizational; D010154:Pakistan; D036301:Qualitative Research
keywords: Ambulances; Case studies; Emergency medical services; Health system building blocks; India; Pakistan