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 · 2021-09-10 · Quasi-experimental
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.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Children · Cost & cost-effectiveness · Low- and middle-income settings · Pregnant patients · Rural & remote
Related articles
- Using geospatial techniques to develop an emergency referral transport system for suspected sepsis patients in Bangladesh. (PLoS One, 2018)
- Paediatric use of emergency medical services in India: A retrospective cohort study of one million children. (J Glob Health, 2022)
- The impact of introducing ambulance and delivery fees in a rural hospital in Tanzania. (BMC Health Serv Res, 2021)
- Helicopter and Fixed-Wing Air Medical Transport in a Resource-Limited Region of Eastern Anatolia: Epidemiological Patterns and Operational Challenges in Van Province, Turkey (2022-2025). (Air Med J, 2026)
- Cross-context qualitative synthesis of a mobile obstetric referral emergency system (MORES) in Ghana and Liberia. (PLoS One, 2026)
- The Relationship between Poverty and Healthcare Seeking among Patients Hospitalized with Acute Febrile Illnesses in Chittagong, Bangladesh. (PLoS One, 2016)