“Dying due to poverty and lack of easy transport”: A qualitative study on access and availability of pre-hospital emergency medical services in Kampala, Uganda

Abstract

Background Emergency care services in low-and middle-income countries (LMICs) have traditionally received less attention in the dominant culture favouring vertical health programs. The unmet needs of pre-hospital and hospital-based emergency services are high but the barriers to accessing safe and quality emergency medical services (EMS) remain largely unaddressed. Few studies in Sub-Saharan Africa have qualitatively investigated barriers to EMS use, and quality of pre-hospital services from the providers and community perspective. We conducted a qualitative study to describe the patient-centred approach to emergency care in Kampala, Uganda, with specific attention to access to EMS.Methods The data collection was comprised of Key Informant Interviews (KII) and Focus Group Discussions (FGDs) with the community members. KII participants were selected using maximum purposive sampling based on expert knowledge of emergency care systems, and service delivery. FGDs were conducted to understand perceptions and experiences towards access to pre-hospital care, and to explore barriers to utilization of EMS. The respondents of ten KII and seven FGDs included pre-hospital EMS (PEMS) administrators, policy makers, police, health workers and community members. We conducted a directed content analysis to identify key themes and triangulate findings across different informant groups.Results Key themes emerged across interviews and discussions concerning: (1) lack of funds, (2) lack of standards, (3) need for upfront payments for emergency transport and care, 4) corruption, 5) poor quality pre-hospital emergency service, 6) poor quality hospital emergency care, and 7) delay in seeking treatment.Conclusions Patient-centred emergency care should be an integral part of comprehensive health care services. As Uganda and other LMICs continue to strive for universal health coverage, it is critical to prioritize and integrate emergency care within health systems owing to its cross-cutting nature. Community perceptions around access and quality of PEMS should be addressed in national policies covering affordable and safe EMS.

Evaluation of needs and supply of emergency care in Kinshasa, Democratic Republic of Congo: a cross-sectional household survey

“…[6][7][8] A robust ECS is the common safety net that provides lifesaving interventions regardless of the cause of an acute condition. 9 This is…”

“…6–8 A robust ECS is the common safety net that provides lifesaving interventions regardless of the cause of an acute condition. 9 This is why the 72nd World Health Assembly urged member states to prioritise ECSs for Universal Health Coverage. 10 Despite concerning health indicators, 11–14 the Democratic Republic of Congo (DRC) has no formal Emergency Medical Services (EMS).…”

“…Despite evidence showing the positive impact of emergency care on patients outcomes,5 most LMICs lack organised emergency care systems (ECS), therefore, suffer substantial preventable death and disability 6–8. A robust ECS is the common safety net that provides lifesaving interventions regardless of the cause of an acute condition 9. This is why the 72nd World Health Assembly urged member states to prioritise ECSs for Universal Health Coverage 10.…”

Implementation and evaluation of a pilot WHO community first aid responder training in Kinshasa, DR Congo: A mixed method study

“…Lack of organised emergency care systems (ECS) greatly contributes to substantial preventable death and disability in low- and middle-income countries (LMIC) [1] , [2] , [3] . As a key component of an ECS, well organised prehospital care systems save lives [ 4 , 5 ].…”