We will undertake a series of quantitative and qualitative studies to gain a deep understanding of essential emergency and critical care (EECC)in hospitals in Tanzania, Uganda, Ethiopia and South Africa. Methods will include policy analyses; system readiness assessments in terms of resources, staff and equipment; review of medical records; interviews with healthcare staff and key stakeholders; and observation of care provision. The studies will identify the bottlenecks for effective coverage of EECC, the underlying determinants and drivers of these bottlenecks, and recommend optimal solutions for interventions designed to increase coverage.