Improving Access to Healthcare in Sierra Leone: The Role of the Newly Developed National Emergency Medical Service
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Setting and Design
2.2. Data Collection
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Ouma, P.O.; Maina, J.; Thuranira, P.N.; Macharia, P.M.; Alegana, V.A.; English, M.; Okiro, E.A.; Snow, R.W. Access to emergency hospital care provided by the public sector in sub-Saharan Africa in 2015: A geocoded inventory and spatial analysis. Lancet Glob. Health 2018, 6, e342–e350. [Google Scholar] [CrossRef] [Green Version]
- Strasser, R.; Kam, S.M.; Regalado, S.M. Rural Health Care Access and Policy in Developing Countries. Ann. Rev. Public Health 2016, 37, 395–412. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Rutherford, M.E.; Mulholland, K.; Hill, P.C. How access to health care relates to under-five mortality in sub-Saharan Africa: Systematic review. Trop. Med. Int. Health 2010, 15, 508–519. [Google Scholar] [CrossRef]
- Human Development Reports. Sierra Leone. 2020. Available online: http://hdr.undp.org/en/countries/profiles/SLE (accessed on 22 July 2021).
- Ministry of Health and Sanitation, Republic of Sierra Leone. National Health Sector Strategic Plan 2017–2021. 2017. Available online: https://extranet.who.int/countryplanningcycles/sites/default/files/planning_cycle_repository/sierra_leone/sierra_leone_nhssp_2017-21_final_sept2017.pdf (accessed on 22 July 2021).
- Donnelly, J. How did Sierra Leone provide free health care? Lancet 2011, 377, 1393–1396. [Google Scholar] [CrossRef]
- Jalloh, M.B.; Bah, A.J.; James, P.B.; Sevalie, S.; Hann, K.; Shmueli, A. Impact of the free healthcare initiative on wealth-related inequity in the utilization of maternal & child health services in Sierra Leone. BMC Health Serv. Res. 2019, 19, 352. [Google Scholar] [CrossRef]
- Statistics Sierra Leone. Population and Housing Census Statistics. 2015. Available online: https://www.statistics.sl/index.php/census/census-2015.html (accessed on 22 July 2021).
- Mould-Millman, N.K.; Dixon, J.M.; Sefa, N.; Yancey, A.; Hollong, B.G.; Hagahmed, M.; Ginde, A.A.; Wallis, L.A. The State of Emergency Medical Services (EMS) Systems in Africa. Prehosp. Disaster Med. 2017, 32, 273–283. [Google Scholar] [CrossRef]
- Maxmen, A. Sierra Leone’s free health-care initiative: Work in progress. Lancet 2013, 381, 191–192. [Google Scholar] [CrossRef]
- Calvello, E.; Reynolds, T.; Hirshon, J.M.; Buckle, C.; Moresky, R.; O’Neill, J.; Wallis, L.A. Emergency care in sub-Saharan Africa: Results of a consensus conference. Afr. J. Emerg. Med. 2013, 3, 42–48. [Google Scholar] [CrossRef] [Green Version]
- Sasser, S.; Varghese, M.; Kellermann, A.; Lormand, J.D. Prehospital Trauma Care Systems; World Health Organization: Geneva, Switzerland, 2005. [Google Scholar]
- World Health Organization. Sixtieth World Health Assembly. Resolution WHA 60.22: Emergency-Care Systems; World Health Organization: Geneva, Switzerland, 2007. [Google Scholar]
- Ragazzoni, L.; Caviglia, M.; Rosi, P.; Buson, R.; Pini, S.; Merlo, F.; Della Corte, F.; Vandy, M.J.; Jambai, A.; Putoto, G. Designing, Implementing, and Managing a National Emergency Medical Service in Sierra Leone. Prehosp. Disaster Med. 2021, 36, 115–120. [Google Scholar] [CrossRef]
- Medical Priority Dispatch System. Available online: https://www.emergencydispatch.org/what-we-do/emergency-priority-dispatch-system/medical-protocol (accessed on 22 July 2021).
- Youkee, D.; Bangura, T.; O’Neill, K.; Hartshorn, L.; Samura, S. An Observational Study of a National Referral System: An Analysis of 14,266 Referrals in Sierra Leone; Research Square: Durham, NC, USA, 2020. [Google Scholar]
- Bernal, J.L.; Cummins, S.; Gasparrini, A. Interrupted time series regression for the evaluation of public health interventions: A tutorial. Int. J. Epidemiol. 2017, 46, 348–355. [Google Scholar] [CrossRef]
- Hategeka, C.; Ruton, H.; Karamouzian, M.; Lynd, L.D.; Law, M.R. Use of interrupted time series methods in the evaluation of health system quality improvement interventions: A methodological systematic review. BMJ Glob. Health 2020, 5, e003567. [Google Scholar] [CrossRef]
- Jacobs, B.; Ir, P.; Bigdeli, M.; Annear, P.L.; Van Damme, W. Addressing access barriers to health services: An analytical framework for selecting appropriate interventions in low-income Asian countries. Health Policy Plan. 2012, 27, 288–300. [Google Scholar] [CrossRef]
- Hjortsberg, C. Why do the sick not utilise health care? The case of Zambia. Health Econ. 2003, 12, 755–770. [Google Scholar] [CrossRef]
- Afful-Mensah, G.; Nketiah-Amponsah, E.; Boakye-Yiadom, L. Rural-Urban Differences in the Utilization of Maternal Healthcare in Ghana: The Case of Antenatal and Delivery Services. Afr. Soc. Sci. Rev. 2013, 6, 4. [Google Scholar]
- Yaya, S.; Uthman, O.A.; Okonofua, F.; Bishwajit, G. Decomposing the rural-urban gap in the factors of under-five mortality in sub-Saharan Africa? Evidence from 35 countries. BMC Public Health 2019, 19, 616. [Google Scholar] [CrossRef] [Green Version]
- Okoli, C.; Hajizadeh, M.; Rahman, M.M.; Khanam, R. Geographical and socioeconomic inequalities in the utilization of maternal healthcare services in Nigeria: 2003–2017. BMC Health Serv. Res. 2020, 20, 849. [Google Scholar] [CrossRef] [PubMed]
- Shanker, A. Equity Case Study: Sierra Leone—Removing Health Care User Fees to Improve Prospects for Mothers and Children. 2012. Available online: https://www.unicef.org/equity/archive/index_65330.html (accessed on 22 July 2021).
- World Health Organization. Millennium Development Goals 4 and 5. 2020. Available online: https://www.who.int/pmnch/about/about_mdgs/en/ (accessed on 22 July 2021).
- Treacy, L.; Sagbakken, M. Exploration of perceptions and decision-making processes related to childbirth in rural Sierra Leone. BMC Pregnancy Childbirth 2015, 15, 87. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Treacy, L.; Bolkan, H.A.; Sagbakken, M. Correction: Distance, accessibility and costs. Decision-making during childbirth in rural Sierra Leone: A qualitative study. PLoS ONE 2018, 13, e0196523. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Tsawe, M.; Sathiya Susuman, A. Factors associated with the upsurge in the use of delivery care services in Sierra Leone. Public Health 2020, 180, 74–81. [Google Scholar] [CrossRef]
- Anto-Ocrah, M.; Cushman, J.; Sanders, M.; De Ver Dye, T. A woman’s worth: An access framework for integrating emergency medicine with maternal health to reduce the burden of maternal mortality in sub-Saharan Africa. BMC Emerg. Med. 2020, 20, 3. [Google Scholar] [CrossRef] [Green Version]
- De Ramirez, S.S.; Doll, J.; Carle, S.; Anest, T.; Arii, M.; Hsieh, Y.H.; Okongo, M.; Moresky, R.; Sachs, S.E.; Millin, M. Emergency response in resource-poor settings: A review of a newly-implemented EMS system in rural Uganda. Prehosp. Disaster Med. 2014, 29, 311–316. [Google Scholar] [CrossRef] [PubMed]
- Tayler-Smith, K.; Zachariah, R.; Manzi, M.; Van den Boogaard, W.; Nyandwi, G.; Reid, T.; De Plecker, E.; Lambert, V.; Nicolai, M.; Goetghebuer, S.; et al. An ambulance referral network improves access to emergency obstetric and neonatal care in a district of rural Burundi with high maternal mortality. Trop. Med. Int. Health 2013, 18, 993–1001. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Mahama, M.N.; Kenu, E.; Bandoh, D.A.; Zakariah, A.N. Emergency response time and pre-hospital trauma survival rate of the national ambulance service, Greater Accra (January–December 2014). BMC Emerg. Med. 2018, 18, 33. [Google Scholar] [CrossRef] [PubMed]
- Mould-Millman, N.K.; Oteng, R.; Zakariah, A.; Osei-Ampofo, M.; Oduro, G.; Barsan, W.; Donkor, P.; Kowalenko, T. Assessment of Emergency Medical Services in the Ashanti Region of Ghana. Ghana Med. J. 2015, 49, 125–135. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Venkatraman, C.; Odusola, A.O.; Malolan, C.; Kola-Korolo, O.; Olaomi, O.; Idris, J.; Nwariaku, F.E. Lagos state ambulance service: A performance evaluation. Eur. J. Trauma Emerg. Surg. 2020. [Google Scholar] [CrossRef] [Green Version]
- Scott, J.W.; Nyinawankusi, J.D.; Enumah, S.; Maine, R.; Uwitonze, E.; Hu, Y.; Kabagema, I.; Byiringiro, J.C.; Riviello, R.; Jayaraman, S. Improving prehospital trauma care in Rwanda through continuous quality improvement: An interrupted time series analysis. Injury 2017, 48, 1376–1381. [Google Scholar] [CrossRef]
- Pittalis, C.; Brugha, R.; Gajewski, J. Surgical referral systems in low- and middle-income countries: A review of the evidence. PLoS ONE 2019, 14, e0223328. [Google Scholar] [CrossRef]
- Daniels, A.A.; Abuosi, A. Improving emergency obstetric referral systems in low and middle income countries: A qualitative study in a tertiary health facility in Ghana. BMC Health Serv. Res. 2020, 20, 32. [Google Scholar] [CrossRef]
- Somigliana, E.; Sabino, A.; Nkurunziza, R.; Okello, E.; Quaglio, G.; Lochoro, P.; Putoto, G.; Manenti, F. Ambulance service within a comprehensive intervention for reproductive health in remote settings: A cost-effective intervention. Trop. Med. Int. Health 2011, 16, 1151–1158. [Google Scholar] [CrossRef]
- Accorsi, S.; Somigliana, E.; Solomon, H.; Ademe, T.; Woldegebriel, J.; Almaz, B.; Zemedu, M.; Manenti, F.; Tibebe, A.; Farese, P.; et al. Cost-effectiveness of an ambulance-based referral system for emergency obstetrical and neonatal care in rural Ethiopia. BMC Pregnancy Childbirth 2017, 17, 220. [Google Scholar] [CrossRef] [Green Version]
- Ministry of Health and Sanitation, Republic of Sierra Leone. Human Resources for Health Country Profile. 2016. Available online: https://www.afro.who.int/sites/default/files/2017-05/hrhprofile16.pdf (accessed on 22 July 2021).
- Wagner, A.K.; Soumerai, S.B.; Zhang, F.; Ross-Degnan, D. Segmented regression analysis of interrupted time series studies in medication use research. J. Clin. Pharm. Ther. 2002, 27, 299–309. [Google Scholar] [CrossRef] [PubMed]
Pre NEMS (12-Months Timeframe) | Post NEMS (6-Months Timeframe) | |
---|---|---|
Gender, n (%) | ||
Female | 10,741 (72.1) | 9805 (71.7) |
Male | 4150 (27.9) | 3878 (28.3) |
FHCI category, n (%) | ||
Pregnant | 6799 (45.6) | 6104 (44.6) |
Lactating | 533 (3.6) | 573 (4.2) |
Under 5 | 5865 (39.4) | 4398 (32.1) |
Ebola Survivors | 71 (0.5) | 0 (0) |
Non-Free Healthcare | 1623 (10.9) | 2608 (19) |
Districts, n (%) | ||
Bo | 692 (4.6) | 1129 (8.2) |
Bombali | 658 (4.4) | 941 (6.9) |
Bonthe | 335 (2.2) | 341 (2.5) |
Kailahun | 574 (3.8) | 668 (4.9) |
Kambia | 574 (3.8) | 678 (4.9) |
Kenema | 837 (5.6) | 1000 (7.3) |
Koinadugu | 531 (3.6) | 480 (3.5) |
Kono | 450 (3.0) | 902 (6.6) |
Moyamba | 417 (2.8) | 457 (3.3) |
Port Loko | 882 (5.9) | 833 (6.0) |
Pujehun | 2019 (13.6) | 1643 (12.0) |
Tonkolili | 270 (1.8) | 1501 (10.9) |
Western Area | 6652 (44.7) | 3100 (22.6) |
Total, n | 14,891 | 13,683 |
Group | Effect of the Intervention | Rate Ratio (RR) | 95% CI | p-Value |
---|---|---|---|---|
All | Immediate | 1.43 | 1.26 to 1.61 | <0.001 |
Gradual | 1.02 | 0.99 to 1.05 | 0.103 | |
Pregnant | Immediate | 1.54 | 1.33 to 1.77 | <0.001 |
Gradual | 1.01 | 0.98 to 1.04 | 0.505 | |
Under 5 | Immediate | 0.90 | 0.72 to 1.13 | 0.362 |
Gradual | 1.05 | 0.99 to 1.10 | 0.062 | |
Non-FHCI 1 | Immediate | 2.95 | 2.47 to 3.53 | <0.001 |
Gradual | 1.01 | 0.97 to 1.05 | 0.603 |
Group | Effect of the Intervention | Rate Ratio (RR) | 95% CI | p-Value |
---|---|---|---|---|
All | Immediate | 0.80 | 0.65 to 0.99 | 0.041 |
Gradual | 1.05 | 1.02 to 1.09 | <0.001 | |
Pregnant | Immediate | 1.39 | 1.05 to 1.84 | 0.021 |
Gradual | 1.06 | 1.02 to 1.11 | 0.001 | |
Under 5 | Immediate | 0.36 | 0.27 to 0.47 | <0.001 |
Gradual | 1.03 | 0.99 to 1.07 | 0.090 | |
Non-FHCI | Immediate | 0.95 | 0.63 to 1.44 | 0.825 |
Gradual | 1.09 | 1.04 to 1.16 | 0.001 |
Group | Effect of the Intervention | Rate Ratio (RR) | 95% CI | p-Value |
---|---|---|---|---|
All | Immediate | 1.77 | 1.49 to 2.11 | <0.001 |
Gradual | 0.98 | 0.94 to 1.02 | 0.358 | |
Pregnant | Immediate | 1.59 | 1.40 to 1.82 | <0.001 |
Gradual | 0.98 | 0.95 to 1.00 | 0.179 | |
Under 5 | Immediate | 1.36 | 0.88 to 2.11 | 0.154 |
Gradual | 1.01 | 0.92 to 1.12 | 0.751 | |
Non-FHCI | Immediate | 3.82 | 2.96 to 4.92 | <0.001 |
Gradual | 0.85 | 0.81 to 0.90 | <0.001 |
Title 1 | Title 2 | Title 3 |
---|---|---|
NEMS Generator Fuel | 7 | 561 |
Ambulance Fuel | 439 | 35,567 |
Ambulance Maintenance | 336 | 27,207 |
GPS | 23 | 1903 |
Mobile Phones Air-time 1 | 32 | 2626 |
Medical Material and PPEs 2 | 94 | 7574 |
Insurance | 16 | 1296 |
Paramedics salary 3 | 1406 | 113,850 |
OC 4 operators’ salary | 94 | 7590 |
Drivers’ salary | 1178 | 95,400 |
Total | 3624 | 293,574 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Caviglia, M.; Dell’Aringa, M.; Putoto, G.; Buson, R.; Pini, S.; Youkee, D.; Jambai, A.; Vandy, M.J.; Rosi, P.; Hubloue, I.; et al. Improving Access to Healthcare in Sierra Leone: The Role of the Newly Developed National Emergency Medical Service. Int. J. Environ. Res. Public Health 2021, 18, 9546. https://doi.org/10.3390/ijerph18189546
Caviglia M, Dell’Aringa M, Putoto G, Buson R, Pini S, Youkee D, Jambai A, Vandy MJ, Rosi P, Hubloue I, et al. Improving Access to Healthcare in Sierra Leone: The Role of the Newly Developed National Emergency Medical Service. International Journal of Environmental Research and Public Health. 2021; 18(18):9546. https://doi.org/10.3390/ijerph18189546
Chicago/Turabian StyleCaviglia, Marta, Marcelo Dell’Aringa, Giovanni Putoto, Riccardo Buson, Sara Pini, Daniel Youkee, Amara Jambai, Matthew Jusu Vandy, Paolo Rosi, Ives Hubloue, and et al. 2021. "Improving Access to Healthcare in Sierra Leone: The Role of the Newly Developed National Emergency Medical Service" International Journal of Environmental Research and Public Health 18, no. 18: 9546. https://doi.org/10.3390/ijerph18189546