Author : PubMed Central
Site of publication : PubMed Central
Type of publication : Study
Date of publication : 10 September 2021
Multiple barriers prevent an equitable access to healthcare services in low-income countries (LICs), leading to higher morbidity and mortality rates for both acute and chronic diseases, especially in rural communities.
Sierra Leone is one of the least developed countries worldwide, where access to healthcare is mostly constrained by geographical barriers, extremely high out-of-pocket expenditures, lack of skilled medical staff, and poor service quality. Furthermore, the country’s health resources are unevenly distributed, with the vast majority of referral hospitals and more than half of the entire workforce concentrated in the urban area of Freetown, the nation’s capital.
The country’s health resources are unevenly distributed, with the vast majority of referral hospitals and more than half of the entire workforce concentrated in the urban area of Freetown, the nation’s capital.
To tackle the high rates of maternal and neonatal mortality reported in its territory, in 2010, the Sierra Leone government launched the Free Health Care Initiative (FHCI), which waived all medical-related fees for pregnant and breastfeeding women, children under the age of 5 years, and Ebola survivors. Although the FHCI was effective in curbing financial barriers to accessing care, leading to an overall improvement in the utilization rates of healthcare services, wealth-related health inequalities remained prevalent, and people residing in rural areas, accounting for 59% of the total population, were still left underserved.
Similar to most of the other African countries, Sierra Leone has been long devoid of any formalized prehospital care system. Since the limited number of ambulances available in the country were associated with high transport-related fees, the majority of patients used to reach hospital facilities either using private vehicles or public services, therefore bearing the costs of transport fare and often being subjected to delays in care.
In line with recommendations issued by the World Health Organization (WHO), in 2013, the African Federation of Emergency Medicine advocated for the development of prehospital care systems to reduce the high morbidity and mortality rates reported in African countries. Thus, in keeping with both WHO guidelines and national health security policies, in 2016, a government-backed joint venture comprising Doctors with Africa (CUAMM, Padua, Italy), the Regional Government of Veneto (Italy), the Research Center in Emergency and Disaster Medicine (CRIMEDIM, Università del Piemonte Orientale, Italy), and the Sierra Leone Ministry of Health and Sanitation (MOHS), designed the first National Emergency Medical Service (NEMS) in Sierra Leone, one of the very few coordinated, structured, and fully equipped prehospital emergency medical services (EMS) in the African continent. The goal of this newly developed entity is to provide a free-of-charge prehospital service coordinated by a centralized operation center (OC), using part of the ambulances donated to the country during the Ebola outbreak. With seed funding from the World Bank (Washington, DC USA), the service started in October 2018 and reached the full operativity countrywide on the 27th of May 2019, after a gradual process of training sessions and subsequent activation in all the 14 districts of Sierra Leone. After a 26-month work plan, the joint venture released a fully staffed and functional NEMS working all over Sierra Leone, managed by the local MOHS staff and funded through the governmental budget.