Improving Access to Healthcare in Sierra Leone: The Role of the Newly Developed National Emergency Medical Service

Marta Caviglia, Marcelo Dell’Aringa, Giovanni Putoto, Riccardo Buson, Sara Pini, Daniel Youkee, Amara Jambai, Matthew Jusu Vandy, Paolo Rosi, Ives Hubloue, Francesco Della Corte, Luca Ragazzoni and Francesco Barone-Adesi
Additional contact information
Marta Caviglia: CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy
Marcelo Dell’Aringa: CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy
Giovanni Putoto: Research Section, Doctors with Africa CUAMM, 35121 Padua, Italy
Riccardo Buson: Research Section, Doctors with Africa CUAMM, 35121 Padua, Italy
Sara Pini: Research Section, Doctors with Africa CUAMM, 35121 Padua, Italy
Daniel Youkee: School of Population Health and Environmental Sciences, King’s College London, London SE5 9NU, UK
Amara Jambai: Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
Matthew Jusu Vandy: Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
Paolo Rosi: SUEM 118 Venezia, Azienda ULSS 3 Serenissima, 30174 Mestre, Italy
Ives Hubloue: Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussels, 1050 Brussels, Belgium
Francesco Della Corte: CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy
Luca Ragazzoni: CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy
Francesco Barone-Adesi: CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy

IJERPH, 2021, vol. 18, issue 18, 1-13

Abstract: We aim to evaluate whether the first National Emergency Medical Service (NEMS) improved access to hospital care for the people of Sierra Leone. We performed an interrupted time-series analysis to assess the effects of NEMS implementation on hospital admissions in 25 facilities. The analysis was also replicated separately for the area of Freetown and the rest of the country. The study population was stratified by the main Free Health Care Initiative (FHCI) categories of pregnant women, children under 5 years of age, and populations excluded from the FHCI. Finally, we calculated direct costs of the service. We report a 43% overall increase in hospital admissions immediately after NEMS inception (RR 1.43; 95% CI 1.2–1.61). Analyses stratified by FHCI categories showed a significant increase among pregnant women (RR 1.54; 95% CI 1.33–1.77) and among individuals excluded from the FHCI (RR 2.95; 95% CI 2.47–3.53). The observed effect was mainly due to the impact of NEMS on the rural districts. The estimated recurrent cost per ambulance ride and NEMS yearly cost per inhabitant were 124 and 0.45 USD, respectively. To our knowledge, this is the first nationwide study documenting the increase in access to healthcare services following the implementation of an ambulance-based medical service in a low-income country. Based on our results, NEMS was able to overcome the existing barriers of geographical accessibility and transport availability, especially in the rural areas of Sierra Leone.

Keywords: Free Health Care Initiative (FHCI); National Emergency Medical Service (NEMS); emergency medical service (EMS); primary health units (PHUs); operation center (OC) (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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