Designing, Implementing, and Managing a National Emergency Medical Service in Sierra Leone

  • Prehospital and Disaster Medicine, Volume 36, No. 1, Year 2021

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Study Justification:
– Sierra Leone is a low-income country with a weak healthcare system and high maternal and child mortality rates.
– The country lacks a prehospital emergency medical system, leading to insufficient access to essential healthcare.
– The implementation of a National Emergency Medical Service (NEMS) aims to address these challenges and improve emergency medical care.
Highlights:
– The NEMS project was developed through a joint venture involving Doctors with Africa (CUAMM), Veneto Region, and Research Center in Emergency and Disaster Medicine (CRIMEDIM).
– The NEMS system is one of the few structured, fully equipped, and free-of-charge prehospital services in Africa.
– The design of the NEMS was based on in-depth research, including a preliminary assessment, literature review, and consultations with key stakeholders and managers of similar systems in other African countries.
– After six months of training and operational preparations, the NEMS became fully operational at the national level in May 2019.
– From May 2019 to March 2020, the NEMS operation center and 81 ambulances handled a total of 36,814 emergency calls, 35,493 missions, and 31,036 referrals.
Recommendations:
– Continue to invest in and expand the NEMS to ensure coverage and access to emergency medical care throughout Sierra Leone.
– Strengthen collaboration with international partners, NGOs, and local communities to sustain and improve the NEMS system.
– Allocate resources for ongoing training and capacity building of NEMS staff to maintain high-quality emergency medical services.
– Conduct regular evaluations and assessments to monitor the effectiveness and impact of the NEMS and make necessary adjustments.
Key Role Players:
– Ministry of Health and Sanitation (MOHS)
– Doctors with Africa (CUAMM)
– Veneto Region
– Research Center in Emergency and Disaster Medicine (CRIMEDIM)
– International partners and NGOs
– Local communities
Cost Items for Planning Recommendations:
– Ambulance procurement and maintenance
– Equipment and supplies for emergency medical care
– Training and capacity building programs for NEMS staff
– Operational costs of the NEMS operation center
– Monitoring and evaluation activities
– Collaboration and partnership expenses with international organizations and NGOs

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Sierra Leone is one of the least developed low-income countries (LICs), slowly recovering from the effects of a devastating civil war and an Ebola outbreak. The health care system is characterized by chronic shortage of skilled human resources, equipment, and essential medicines. The referral system is weak and vulnerable, with 75% of the country having insufficient access to essential health care. Consequently, Sierra Leone has the highest maternal and child mortality rates in the world. This manuscript describes the implementation of a National Emergency Medical Service (NEMS), a project aiming to create the first prehospital emergency medical system in the country. In 2017, a joint venture of Doctors with Africa (CUAMM), Veneto Region, and Research Center in Emergency and Disaster Medicine (CRIMEDIM) was developed to support the Ministry of Health and Sanitation (MOHS) in designing and managing the NEMS system, one of the very few structured, fully equipped, and free-of-charge prehospital service in the African continent. The NEMS design was the result of an in-depth research phase that included a preliminary assessment, literature review, and consultations with key stakeholders and managers of similar systems in other African countries. From May 27, 2019, after a timeframe of six months in which all the districts have been progressively trained and made operational, the NEMS became operative at national level. By the end of March 2020, the NEMS operation center (OC) and the 81 ambulances dispatched on the ground handled a total number of 36,814 emergency calls, 35,493 missions, and 31,036 referrals.

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The implementation of a National Emergency Medical Service (NEMS) in Sierra Leone is an innovative approach to improving access to maternal health. This project aims to create the first prehospital emergency medical system in the country, addressing the chronic shortage of skilled human resources, equipment, and essential medicines in the healthcare system. The NEMS design was developed through in-depth research, including a preliminary assessment, literature review, and consultations with key stakeholders and managers of similar systems in other African countries. The NEMS became fully operational at the national level in May 2019, with an operation center and 81 ambulances dispatched on the ground. By the end of March 2020, the NEMS had handled a total of 36,814 emergency calls, 35,493 missions, and 31,036 referrals, significantly improving access to emergency maternal healthcare in Sierra Leone.
AI Innovations Description
The recommendation to improve access to maternal health in Sierra Leone is the implementation of a National Emergency Medical Service (NEMS). This project aims to create the first prehospital emergency medical system in the country. The NEMS system is designed to address the chronic shortage of skilled human resources, equipment, and essential medicines in the healthcare system. It is a structured, fully equipped, and free-of-charge prehospital service.

The NEMS design was developed through an in-depth research phase that included a preliminary assessment, literature review, and consultations with key stakeholders and managers of similar systems in other African countries. The implementation of the NEMS involved training and making all districts operational. By the end of March 2020, the NEMS operation center and the 81 ambulances dispatched on the ground had handled a total of 36,814 emergency calls, 35,493 missions, and 31,036 referrals.

The NEMS system has the potential to significantly improve access to maternal health in Sierra Leone by providing timely emergency medical services and referrals. It addresses the weak and vulnerable referral system in the country, which contributes to high maternal and child mortality rates. The NEMS system is a crucial innovation that can save lives and improve healthcare outcomes for mothers and children in Sierra Leone.
AI Innovations Methodology
Based on the provided description, it seems that the manuscript focuses on the implementation of a National Emergency Medical Service (NEMS) in Sierra Leone to improve access to maternal health. While the description does not explicitly mention innovations or recommendations, we can propose some potential innovations that could be used to further improve access to maternal health in Sierra Leone.

1. Mobile Health (mHealth) Solutions: Implementing mobile health technologies, such as SMS reminders for prenatal care appointments, educational messages about maternal health, and telemedicine consultations, can help overcome geographical barriers and improve access to maternal health services.

2. Community Health Workers (CHWs): Expanding the role of CHWs in maternal health can enhance access to care. CHWs can provide basic antenatal and postnatal care, conduct health education sessions, and facilitate referrals to higher-level facilities when necessary.

3. Transport Solutions: Developing innovative transportation solutions, such as motorcycle ambulances or community-based transportation networks, can help overcome transportation challenges and ensure timely access to emergency obstetric care.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Data Collection: Gather baseline data on maternal health indicators, such as maternal mortality rates, antenatal care coverage, and facility-based deliveries. This data will serve as a reference point for comparison.

2. Define Key Metrics: Identify specific metrics that will be used to measure the impact of the recommendations, such as the increase in antenatal care attendance or the reduction in maternal mortality rates.

3. Simulation Modeling: Use simulation modeling techniques, such as agent-based modeling or system dynamics modeling, to create a virtual representation of the maternal health system in Sierra Leone. This model should incorporate factors such as population demographics, healthcare infrastructure, and the proposed innovations.

4. Input Data: Input relevant data into the simulation model, including the baseline data collected in step 1 and assumptions about the implementation and effectiveness of the recommended innovations.

5. Run Simulations: Run multiple simulations using different scenarios, varying the parameters related to the proposed innovations. For example, simulate the impact of different levels of mHealth adoption or varying numbers of CHWs.

6. Analyze Results: Analyze the simulation results to assess the potential impact of the recommendations on improving access to maternal health. Compare the outcomes of different scenarios to identify the most effective strategies.

7. Refine and Iterate: Based on the analysis, refine the simulation model and repeat the process to further explore different scenarios and optimize the recommendations.

By following this methodology, policymakers and stakeholders can gain insights into the potential impact of different innovations on improving access to maternal health in Sierra Leone. This information can inform decision-making and guide the implementation of effective strategies to address the challenges faced by the healthcare system.

Statistics:
Citations: 5
Authors: 10
Identifiers:
DOI: 10.1017/S1049023X20001442
ISSN: 1049023X
Research Areas:
Environmental, Health System and Policy, Infectious Diseases, Maternal and Child Health, Social Determinants, Workforce
Study Countries:
Sierra Leone
Study Approach:
Mixed-methods, Qualitative, Systematic Review
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