Assessment of a newly developed pre-hospital emergency medical system in a low-income country

The underlying thesis, as depicted in the title, aims to assess the impact of the newly developed national emergency medical service (NEMS) on the health care system of Sierra Leone, one of the poorest low income countries (LICs) with a long historical and geopolitical context of poverty, slowly recovering from a prolonged 11-year civil war that ended in 2002 and the Ebola outbreak in 2014.
The first section of the document provides a brief overview on the health care system of Sierra Leone, which can be described as weak and vulnerable due to a number of systemic issues that have remained unaddressed for a long time, namely a chronic shortage of skilled human resources, gaps in the quality of health care, and common stock-outs of essential medicines. Specifically, the chapter describes the geographical context of the country and the existing barriers that prevented an equitable access to healthcare before NEMS inception, using the four dimensions of geographic accessibility, availability, affordability and acceptability of health services. Additionally, the structure and implementation phase of the NEMS are presented, with details pertaining the management of emergency calls at the national level and the education and training activities provided to all personnel.
The second section analyses the effect of NEMS implementation on access to hospital care. Through an interrupted time-series analysis, focusing on hospital admissions recorded nationwide before and after NEMS implementation, the study demonstrates the ability of NEMS to overcome the barriers of geographic accessibility and service availability, especially for the vulnerable population (pregnant women and children) living in the rural areas of Sierra Leone.
In the third section, data retrieved from the NEMS operation center (OC) and from district hospital were used to analyze NEMS prehospital operational times for obstetric emergencies in relation to specific target (namely access to timely essential surgery within 2 hours). While the study depicts a great heterogeneity within the different area of the country, with rural districts still struggling to reach the abovementioned target, results highlight how maternal and perinatal mortality increased concurrently with prehospital time. This relationship suggests that any reduction in the response and transport time might translate into better patient outcome, even beyond the 2-hour target.