Emergency, critical and operative care (ECO) represent a people-centred continuum. Integrated people-centred service delivery requires ECO services that are linked to communities through primary care by communication, transportation, referral and counter-referral mechanisms.

Operative care is understood to span both anaesthesia and surgery services in theatres and ambulatory centres, while surgeons and anaesthesia professionals may deliver emergency, critical and operative care, including obstetric care, as part of comprehensive peri-operative care and beyond. Emergency and critical care may be delivered in an ambulance or in an emergency unit, an intensive care unit or a theatre by technicians, nurses or specialist doctors. Nurses deliver as much emergency care around the world as doctors, and both may be trained as specialists of the first hours of care.

Robust ECO services are at the foundation of national health systems’ ability to meet people’s health needs across the life course and to respond effectively to emergency events.  The COVID-19 pandemic revealed pervasive gaps in ECO service provision that led to millions of avoidable deaths and left communities vulnerable.

Only a coordinated and strategic approach to the entire ECO continuum, including rehabilitative and palliative services, can deliver effective care for people with key high-burden conditions, such as injury, sepsis or complications of pregnancy. The distinction between emergency and critical care, between emergency and operative care or between critical and operative care is highly variable by context, and these services are highly interdependent in all contexts.

The Core Clinical Care Readiness (C3R) planning tool is designed to help health systems deliver vital services through a structured approach to key clinical pathways. It identifies essential functions for acute response and continuity of health services, enabling countries to identify gaps, assess barriers, and develop strategic actions to mitigate them.

In collaboration with ACT-A partners, the Covid-19 C3R tool was developed in 2021; it was piloted and revised with inputs from stakeholders in nine countries in Africa and Asia in 2022. Adopting an all-hazard approach and focusing on maintaining essential health services, the C3R Tool is being expanded to include pathways for high-risk respiratory pathogens, sepsis, injury, and generic acute and chronic care