[The experience in emergency medical care in Lagos (Nigeria): cost-benefit analysis ... politics?]. / L'experience du SAMU de Lagos (Nigeria): rapport cout-efficacite ... politique?

In both the South and North, meeting the demand for health care services is a major issue in establishing political stability for sustainable development. Neither the need for emergency medicine nor the emergency need for medical care can escape this reality. At first glance, "bringing medical care outside hospitals ... to the bottom of the tree" by implementing an advanced rescue system would seem to overstep the usual goal of providing basic health services and capabilities in a developing country. However, the operational, tactical and strategic implications of a "French style SAMU" medical controlled system may contribute to the fair and equitable distribution of emergency health care resources during critical situations in a given environment. In this respect, such system cannot only become a measurable component in responding to increasingly intolerable health disasters, but also an institutional tool for health resources management in any insecure environment, where access to medical facilities usually involves a number of economic, structural, and ethical obstacles. In France, the effectiveness of such a system is still under evaluation with good results in terms of overall health performance for the year 2000. In 1997 the Nigerian authorities with the support of the French Embassy began a novel experience by setting up a state run SAMU services in Lagos. The purpose of this prospective approach was to answer the question "what emergency care system, for what environment?" with an ultimate goal: developing a sustainable service, not only in terms of medical and economic factors, but also ethical and political considerations.