Why Basic Critical Care Is the Missing Piece in Global Health
In global health, some ideas become part of the mainstream conversation: essential medicines, essential surgery, essential diagnostics. These frameworks have shaped investment, policy, and research for years.
Yet one essential component of care has been consistently overlooked, despite being relevant to every hospital, every specialty, and every patient population.
That missing piece is essential critical care.
Critical illness: a universal, but hidden, burden
Critical illness can arise from almost any condition: infection, trauma, childbirth complications, non-communicable diseases, or postoperative deterioration. What defines it is not the diagnosis, but the severity; when vital organs begin to fail and the risk of death becomes imminent.
Research across hospitals in Malawi, Sri Lanka, and Sweden revealed that 12% of all adult in-patients are critically ill at any given time. Yet the majority (more than 90%) are cared for in general wards, not in ICUs.
This means that the global burden of critical illness is both substantial and widely distributed across health systems. But because this burden does not map neatly onto diagnostic categories, it has largely been invisible in global health prioritisation.
The dominance of diagnosis-specific approaches
Over the last two decades, global health has made extraordinary progress through vertical, diagnosis-focused programmes:
HIV
TB
Malaria
Cardiovascular disease
Maternal and neonatal health
These approaches have driven funding, innovation, and service delivery, but they have also created a blind spot.
When health systems focus primarily on treating the cause of illness, they often overlook the immediate threat: the patient’s failing physiology. A woman with postpartum haemorrhage needs definitive treatment of the bleeding, but she also needs airway protection, oxygen and fluid resuscitation. A patient with sepsis needs antibiotics, but also early recognition of shock.
Without basic critical care, even the best disease-specific treatments arrive too late.
Why critical care has been sidelined
Several factors have contributed to critical care being misunderstood or overlooked in global health:
1. Confusion with intensive care
In many settings, “critical care” is mistakenly treated as synonymous with ICU care: expensive, high-tech, and resource-intensive. For low- and middle-income countries, this made critical care appear unattainable.
2. Lack of epidemiological visibility
The Global Burden of Disease framework classifies illness by diagnosis, not severity. This makes the burden of critical illness effectively invisible in global metrics that guide funding and policy.
3. Competing resource priorities
Health budgets are constrained everywhere. When faced with trade-offs, policymakers often gravitate toward interventions with quantifiable impact (such as vaccines or disease-specific therapies) rather than system-wide improvements like vital signs monitoring or oxygen systems.
Why essential critical care changes the picture
Essential Emergency and Critical Care (EECC) reframes critical care entirely. It focuses not on advanced technology, but on a core set of 40 life-saving actions and 66 hospital readiness requirements that every hospital in the world can and should provide.
EECC is built on three principles:
Prioritise the sickest patients
Support failing vital organs early
Use effective, feasible, low-cost interventions
This aligns perfectly with universal health coverage (UHC): care that is accessible, equitable, and capable of improving outcomes for the greatest number of people.
A compelling argument for UHC and global health priorities
EECC deserves a place beside essential medicines, surgery, and diagnostics because it:
1. Saves lives across all diagnoses
Whether the patient has malaria, COVID-19, trauma, or heart failure, the first minutes and hours of critical illness are physiologically similar, and highly treatable.
2. Offers extraordinary value for money
Spending limited resources on advanced intensive care benefits relatively few. Strengthening essential critical care benefits every hospital ward, and therefore far more patients.
3. Addresses equity head-on
Critically ill patients in low-resource settings, rural areas, and general wards are most likely to be missed. EECC directly targets this inequality.
4. Strengthens the system, not just the programme
Unlike vertical initiatives, EECC provides a platform that supports all specialties. It is the connective tissue between emergency care, inpatient care, surgery, obstetrics, and medicine.
A global health priority hiding in plain sight
For too long, preventable hospital deaths have been attributed to late presentation or lack of definitive diagnosis. But this is only part of the story. A major share of avoidable mortality happens because essential actions (giving oxygen, recognising danger signs, supporting a failing airway) were never delivered.
If universal health coverage is to be more than an aspiration, essential critical care must become a core component. Not optional. Not advanced. Essential.
At EECC Global, we believe that no global health strategy is complete without a commitment to providing the basics of life-saving care for every critically ill patient, in every hospital, everywhere.