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

Author

Listed:
  • 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
    Luca Ragazzoni and Francesco Barone-Adesi contributed equally to this work.)

  • Francesco Barone-Adesi

    (CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy
    Luca Ragazzoni and Francesco Barone-Adesi contributed equally to this work.)

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.

Suggested Citation

  • 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 Ragaz, 2021. "Improving Access to Healthcare in Sierra Leone: The Role of the Newly Developed National Emergency Medical Service," IJERPH, MDPI, vol. 18(18), pages 1-13, September.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:18:p:9546-:d:632765
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    References listed on IDEAS

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    1. Catharina Hjortsberg, 2003. "Why do the sick not utilise health care? The case of Zambia," Health Economics, John Wiley & Sons, Ltd., vol. 12(9), pages 755-770, September.
    2. Chiara Pittalis & Ruairi Brugha & Jakub Gajewski, 2019. "Surgical referral systems in low- and middle-income countries: A review of the evidence," PLOS ONE, Public Library of Science, vol. 14(9), pages 1-16, September.
    3. Laura Treacy & Håkon A Bolkan & Mette Sagbakken, 2018. "Distance, accessibility and costs. Decision-making during childbirth in rural Sierra Leone: A qualitative study," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-17, February.
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