A mother and her sick child boarding the motor-King ambulance
A mother and her sick child boarding the motor-King ambulance

Saving Lives in Upper East

In July 2013, the Ghana Health Service in Upper East Region launched an emergency referral initiative in three of its most rural districts to ease emergency health referrals. Though the introduction was marked with wide publicity, not much discussion was seen on the wider national front. Even though the innovation is a local initiative emerging evidence already revealed that the intervention could make all the difference in a typically challenged situation such as the present state of Ghana?s emergency referral system.

A mother and her sick child boarding the motor-King ambulance
A mother and her sick child boarding the motor-King ambulance

Named the Sustainable Emergency Referral Care (SERC), the innovation involves the adoption of a customized version of the tricycle, popularly call motor-king as an ambulance. The primary beneficiaries of the intervention, pregnant women and children under-five years do not have to pay for the services of the ambulance; all other persons however pay a token when they use it. The motor-king ambulance is utilized alongside an emergency communication system and a community support component. It also has a GPS device fitted to track emergencies and record time of movement and referral outcome. Both the transport and communication plans are supported with repairs and maintenance regimes. One good thing about the initiative is that it does not involve any extraordinary equipment or complex operational protocols.
With a few simple to follow steps the motor-king ambulance has been packaged as a community-based facility hence ownership will be transferred to communities to operate in partnership with the health service after a successful pilot.

The mode of operations requires any person who is requesting referral to report to the health worker in person or by phone call, provide a brief about the patient in order to determine a medical emergency or otherwise. Once determined, a health worker together with a volunteer driver fetches the patient at the location for immediate referral to the appropriate health facility. An important standard practice is for the health worker making the referral to call the receiving facility before the arrival of an emergency case.

In an emergency, every second counts. A lack of transport can cause significant delays to a patient receiving treatment. Most patients who require emergency care in sub-Saharan Africa including Ghana often have no means to travel quickly and safely to a health facility.

Emergency referral challenges in Ghana include lack of ambulances, lack of reliable vehicle maintenance systems (especially in rural areas), lack of effective communication plan, and fuel shortages. SERC was designed to address these challenges and reduce delays in reaching care in emergency.

A recent review of the SERC pilot showed that the intervention recorded a lot of successes in its brief operations. In the period between July and December 2013, , the 24 motor king vehicles driven by volunteer drivers with support from health staff and 31 community based volunteers made a total of 782 emergency referrals to various high level health facilities within the three districts including the regional referral hospital. These involved some 352 women with labour complications, 199 children under age five, and 231 various emergencies.

The elaborate community sensitization and involvement largely influenced communities? support and ownership of the scheme.

This has reduced delays in decisions to seek care by many community members, a situation which has hitherto been a major contributor to mortality for women and children due to their inability to receive emergency care when they need it most.
While the intervention was found to reduce delays in reaching care significantly it has also greatly improved facility delivery for pregnant women. The emergency communication introduced has also improved emergency preparedness by health workers at receiving facilities thereby contributing significantly in reducing time for receiving care.

The Upper East Region is one of the rural regions in the country with many communities spread out in remote locations without motorable roads that could be accessed by vehicles particularly during the raining season. The lack of good access roads coupled with poor socio-economic factors have over the years been a major challenge that affected the population?s access to health care services especially emergencies. Pregnant women in labour and children especially under five most of whom often suffer illnesses that require urgent medical care at high health facilities but are often located far away from their communities have been the most affected in emergency situations.

As pertaining in many communities across the country, the use of ineffective means of transport for referrals such as donkey carts, bicycle, motor bike, and human transport, among others have delineated emergency referrals in this country to a nightmare. In the midst of the challenges, health staff and community members have borne the brunt of the country?s woeful referral system

The recently established National Ambulance Service is not only highly constrained in covering the nation due to cost of procuring and maintaining large pool of vehicles but does not also seem to address grass root constraints to emergency referrals. There are also huge underlining policy challenges that render the national ambulance service ineffective in adequately addressing the gaps in referrals and this is compounded by the poor road network at the country side.

As the District Director of Health Services for Bongo, one of the beneficiaries of the SERC initiative Madam Juliana Anam-erime recently lamented in an interview: ?Nothing is heart wrenching as to watch a patient whose life could have been saved die just because the process of referral to the appropriate facility has been ineffective?. She remarked that the era where community members struggle so hard to reach the hospital with emergency case in donkey carts or the back of humans is over. She was confident the SERC innovation holds the key to current community referral challenges in the country.

Many, like Madam Juliana believe the current problems facing emergency referrals in the Upper East region and other places in Ghana make the argument for cost effective and results oriented alternatives such as SERC worth scaling up. Apparently the country needs such easy to adopt innovations to contribute to a transformation of the health care delivery system.

The motor-king ambulance pilot has been made possible by a United Kingdom charity, Comic Relief. Comic Relief joined the Doris Duke Charitable Foundation to co-fund the Sustainable Emergency Referral Care pilot in the Upper East Region and an Urban CHPS initiative in Ga East district in the Greater Accra Region under the Ghana Essential Health Intervention Program (GEHIP).

source:?Mathias Aboba-Bolgatanga

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