IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v18y2021i18p9546-d632765.html
   My bibliography  Save this article

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
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/18/18/9546/pdf
    Download Restriction: no
    File URL: https://www.mdpi.com/1660-4601/18/18/9546/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    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.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Eva Deuchert, 2011. "The Virgin HIV Puzzle: Can Misreporting Account for the High Proportion of HIV Cases in Self-reported Virgins?," Journal of African Economies, Centre for the Study of African Economies, vol. 20(1), pages 60-89, January.
    2. Noah Kaiser & Christina K. Barstow, 2022. "Rural Transportation Infrastructure in Low- and Middle-Income Countries: A Review of Impacts, Implications, and Interventions," Sustainability, MDPI, vol. 14(4), pages 1-48, February.
    3. Ziwei Zhang & Pu Ge & Mengyao Yan & Yuyao Niu & Diyue Liu & Ping Xiong & Qiyu Li & Jinzi Zhang & Wenli Yu & Xinying Sun & Zhizhong Liu & Yibo Wu, 2022. "Self-Medication Behaviors of Chinese Residents and Consideration Related to Drug Prices and Medical Insurance Reimbursement When Self-Medicating: A Cross-Sectional Study," IJERPH, MDPI, vol. 19(21), pages 1-19, October.
    4. Nadeem A. Burney & Mohammad Alenezi & Nadia Al-Musallam & Ahmed Al-Khayat, 2016. "The demand for medical care services: evidence from Kuwait based on households’ out-of-pocket expenses," Applied Economics, Taylor & Francis Journals, vol. 48(28), pages 2636-2650, June.
    5. Ligane Séne & Momath Cissé, 2015. "Catastrophic out-of-pocket payments for health and poverty nexus: evidence from Senegal," International Journal of Health Economics and Management, Springer, vol. 15(3), pages 307-328, September.
    6. Felix Masiye & Oliver Kaonga & Joses M Kirigia, 2016. "Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from Zambia," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-15, January.
    7. Hesham Ali Behary Aboelkhir & Adel Elomri & Tarek Y. ElMekkawy & Laoucine Kerbache & Mohamed S. Elakkad & Abdulla Al-Ansari & Omar M. Aboumarzouk & Abdelfatteh El Omri, 2022. "A Bibliometric Analysis and Visualization of Decision Support Systems for Healthcare Referral Strategies," IJERPH, MDPI, vol. 19(24), pages 1-27, December.
    8. Michael Grossman, 2022. "The demand for health turns 50: Reflections," Health Economics, John Wiley & Sons, Ltd., vol. 31(9), pages 1807-1822, September.
    9. Aswathy Rachel Varughese & Indrajit Bairagya, 2023. "Socio-economic inequalities in spending on various levels of education across Indian households: an update," Indian Economic Review, Springer, vol. 58(1), pages 197-229, June.
    10. Pokhrel, Subhash, 2007. "Determinants of parental reports of children's illnesses: Empirical evidence from Nepal," Social Science & Medicine, Elsevier, vol. 65(6), pages 1106-1117, September.
    11. Meike Irene Nakovics & Stephan Brenner & Paul Jacob Robyn & Ludovic Deo Gracias Tapsoba & Manuela De Allegri, 2019. "Determinants of individual healthcare expenditure: A cross‐sectional analysis in rural Burkina Faso," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1478-1494, October.
    12. McLean, Kristen E., 2020. "Men's experiences of pregnancy and childbirth in Sierra Leone: Reexamining definitions of “male partner involvement”," Social Science & Medicine, Elsevier, vol. 265(C).
    13. Kumar, Santosh & Dansereau, Emily & Murray, Chris, 2012. "Does Distance matter for Institutional Delivery in Rural India? An Instrumental Variable Approach," MPRA Paper 45762, University Library of Munich, Germany, revised 01 Jan 2013.
    14. Atkure Defar & Kassahun Alemu & Zemene Tigabu & Lars Åke Persson & Yemisrach B. Okwaraji, 2021. "Caregivers’ and Health Extension Workers’ Perceptions and Experiences of Outreach Management of Childhood Illnesses in Ethiopia: A Qualitative Study," IJERPH, MDPI, vol. 18(7), pages 1-11, April.
    15. Zacharia S. Masanyiwa & Anke Niehof & Catrien J. A. M. Termeer, 2015. "A gendered users′ perspective on decentralized primary health services in rural Tanzania," International Journal of Health Planning and Management, Wiley Blackwell, vol. 30(3), pages 285-306, July.
    16. Finn McGuire & Noemi Kreif & Peter C. Smith, 2021. "The effect of distance on maternal institutional delivery choice: Evidence from Malawi," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2144-2167, September.
    17. Evguenii Zazdravnykh & Andrey Aistov & Ekaterina Aleksandrova, 2024. "Total expenditure elasticity of spending on self-treatment and professional healthcare: a case of Russia," International Journal of Health Economics and Management, Springer, vol. 24(1), pages 81-105, March.
    18. Qian, Dongfu & Lucas, Henry & Chen, Jiaying & Xu, Ling & Zhang, Yaoguang, 2010. "Determinants of the use of different types of health care provider in urban China: A tracer illness study of URTI," Health Policy, Elsevier, vol. 98(2-3), pages 227-235, December.
    19. Idrissa Beogo & Chieh-Yu Liu & Yiing-Jenq Chou & Chuan-Yu Chen & Nicole Huang, 2014. "Health-Care-Seeking Patterns in the Emerging Private Sector in Burkina Faso: A Population-Based Study of Urban Adult Residents in Ouagadougou," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-11, May.
    20. Coast, Ernestina & Murray, Susan F., 2016. "“These things are dangerous”: Understanding induced abortion trajectories in urban Zambia," Social Science & Medicine, Elsevier, vol. 153(C), pages 201-209.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:18:y:2021:i:18:p:9546-:d:632765. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.