Adapting the emergency first aid responder course for Zambia through curriculum mapping and blueprinting

3 August, 2018

I would be interested to hear your thoughts about how better to meet the first aid information needs of community members so that they are better prepared to deal with injuries and emergencies (which typically occur without a health professional being available). Here is a related paper from BMJ Open.

CITATION: Pigoga JL, Cunningham C, Kafwamfwa M, et al Adapting the emergency first aid responder course for Zambia through curriculum mapping and blueprinting BMJ Open 2017;7:e018389. doi: 10.1136/bmjopen-2017-018389


Objectives: Community members are often the first to witness and respond to medical and traumatic emergencies, making them an essential first link to emergency care systems. The Emergency First Aid Responder (EFAR) programme is short course originally developed to help South Africans manage emergencies at the community level, pending arrival of formal care providers. EFAR was implemented in two rural regions of Zambia in 2015, but no changes were originally made to tailor the course to the new setting. We undertook this study to identify potential refinements in the original EFAR curriculum, and to adapt it to the local context in Zambia.

Design: The EFAR curriculum was mapped against available chief complaint data. An expert group used information from the map, in tandem with personal knowledge, to rank each course topic for potential impact on patient outcomes and frequency of use in practice. Individual blueprints were compiled to generate a refined EFAR curriculum, the time breakdown of which reflects the relative weight of each topic.

Setting: This study was conducted based on data collected in Kasama, a rural region of Zambia’s Northern Province.

Participants: An expert group of five physicians practising emergency medicine was selected; all reviewers have expertise in the Zambian context, EFAR programme and/or curriculum development.

Results: The range of emergencies that Zambian EFARs encounter indicates that the course must be broad in scope. The refined curriculum covers 54 topics (seven new) and 25 practical skills (five new). Practical and didactic time devoted to general patient care and scene management increased significantly, while time devoted to most other clinical, presentation-based categories (eg, trauma care) decreased.

Conclusions: Discrepancies between original and refined curricula highlight a mismatch between the external curriculum and local context. Even with limited data and resources, curriculum mapping and blueprinting are possible means of resolving these contextual issues.


The study highlights the importance of tailoring medical education curriculums to local context.

It adds to a limited evidence base surrounding the refinement of medical education curriculums in low-income and middle-income countries.

The curriculum mapping and blueprinting methodology presented in this study is likely useful in most low-resource settings.

The translatability of the curriculum generated through this study is limited, as data were only collected from a single site in rural Zambia.

These methods did not account for qualitative commentary data and community member input, which might have been useful in informing the final curriculum.


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HIFA profile: Neil Pakenham-Walsh is the coordinator of HIFA-Zambia and the HIFA campaign (Healthcare Information For All - ) and current chair of the Dgroups Foundation (, which supports 700 communities of practice for international development, social justice and global health. Twitter: @hifa_org FB: