{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T15:06:46Z","timestamp":1789657606919,"version":"4.0.1"},"reference-count":171,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T00:00:00Z","timestamp":1766016000000},"content-version":"unspecified","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,11,5]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>More knowledge and resources are required to strengthen \u2018leadership and governance\u2019 (L+G) as a central building block to further develop emergency care (EC) systems in low-income and middle-income countries (LMICs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This scoping review aimed to examine and map the impact of individual, collective or institutional L+G on the development of EC systems (prehospital and facility-based) in LMICs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>English language publications from January 2005 to April 2024 that linked any L+G action with the development and capacity of everyday EC in LMICs, specifically excluding disaster responses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Sources of evidence<\/jats:title>\n                    <jats:p>Medline (Ovid), Embase (Ovid), CINAHL, Web of Science (Clarivate), Central (Cochrane Central Register of Controlled Trials), Global Health (Ovid) and select grey literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Charting methods<\/jats:title>\n                    <jats:p>\n                      Data from all eligible papers were jointly extracted using a piloted tool developed from the literature and WHO\u2019s EC Systems Framework. L+G descriptors included level (from clinical to national) and components (informed by Siddiqi\n                      <jats:italic>et al<\/jats:italic>\n                      \u2019s LMIC health system \u2018good governance\u2019 framework and a synthesis of EC policy documents). Impact of L+G on EC systems and key lessons were extracted from each publication.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From an initial 9713 items, 129 papers were included for final analysis and divided by EC component: prehospital (n=35), facility-based (n=53) and \u2018whole of EC system\u2019 (n=41). Qualitative and descriptive papers were most common, and 72 out of a possible 131 LMICs were represented. Findings were heterogeneous across all building blocks of EC systems and for different components of leadership and\/or governance. Cross-cutting L+G themes were identified that demonstrated consistent impact across all EC systems development: government recognition, vision and human rights framing; coalition-building for effective partnerships and trained, empowered EC clinicians demonstrating emotionally intelligent, transformational leadership.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Applying new models such as Theories of Change and Social Network Analysis concepts may assist to illuminate how effective L+G is attained, what are the essential components and how these influence EC systems for better patient-centred outcomes. Further understanding the role of L+G for EC systems has utility for future EC clinician leadership training and policy-maker awareness, to strengthen resilience of overall health systems against likely future shocks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-102624","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T11:50:50Z","timestamp":1766145050000},"page":"e102624","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Developing emergency care systems in low-income and middle-income countries: a scoping review to examine the role of leadership and governance"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0414-2802","authenticated-orcid":false,"given":"Georgina","family":"Phillips","sequence":"first","affiliation":[{"name":"School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia"},{"name":"Department of Critical Care, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia"},{"name":"Emergency Department, Saint Vincent\u2019s Hospital Melbourne, Fitzroy, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0202-2751","authenticated-orcid":false,"given":"Deepak","family":"Sharma","sequence":"additional","affiliation":[{"name":"Emergency Department, Colonial War Memorial Hospital, Suva, Fiji"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard","family":"O\u2019Reilly","sequence":"additional","affiliation":[{"name":"School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia"},{"name":"The Alfred Emergency & Trauma Centre, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9884-5463","authenticated-orcid":false,"given":"Lorena","family":"Romero","sequence":"additional","affiliation":[{"name":"Alfred Health Libraries - Ian Potter Library, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Cameron","sequence":"additional","affiliation":[{"name":"School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia"},{"name":"The Alfred Emergency & Trauma Centre, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"key":"2026010703475465000_15.12.e102624.1","unstructured":"World Health Organisation . 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