The state of emergency medical services and acute health facility care in Uganda: findings from a National Cross-Sectional Survey

Abstract

Background: There is limited information on the state of emergency medical services (EMS) in Uganda. The available evidence is from studies that focused on either assessing EMS capacity and gaps at the national level especially in Kampala or identifying risk factors for specific emergency medical conditions (e.g., injuries). In this study, we sought to provide a snapshot of the state of EMS in Uganda by assessing the pre-hospital and hospital emergency care capacity at both national and sub-national (district) levels. Methods: We conducted a cross-sectional national survey administering structured questionnaires to EMS providers and policy makers from 38 randomly selected districts across seven of the 14 health regions of Uganda. This resulted in a study sample of 111 health facilities and 52 pre-hospital service providers. We collected data on six pillars of EMS whose frequencies and percentages were calculated and qualitatively compared for different levels of the health care system. Results: At the time of this study, Uganda did not have any EMS policy or guidelines. In addition, there was no functional toll-free number for emergency response in the country. However, Ministry of Health reported that a taskforce had been set up to lead development of EMS policy, guidelines, and standards including establishment of a toll-free emergency number. At the sub-national level, ambulances lacked the products and supplies needed to provide pre-hospital care, and mainly functioned as emergency transport vehicles, with no capacity for medical care. Only 16 (30.8%) of the 52 pre-hospital providers assessed had standard ambulances with required equipment, medicines, and personnel. The rest of the service providers had improvised ambulances that were not equipped to provide pre-hospital care. Traffic police and bystanders were the first responders to the majority (> 90%) of the emergency cases.

Leveraging tele-mentoring and remote learning to strengthen the emergency care capacity of health workers in Uganda

“…This despite a decline in the crude death rates from 52.9 per 100,000 to 4.1 per 100,000 [2] . In Uganda, acute illnesses and injuries especially from road traffic accidents—which contribute 48% of trauma—constitute most emergency cases significantly causing mortality yet most of them are preventable [ 3 , 4 ]. Investing in a well-planned emergency care system is a proven cost-effective method of reducing preventable death and disability, especially in low and middle-income countries (LMICs) [5] .…”

“…In Uganda, the COVID-19 pandemic highlighted gaps in the system and underscored the need to have a more resilient emergency care system than ever before. As a result, in November 2021, the Ministry of Health Uganda launched the first national emergency medical services policy highlighting 12 pillars of focus among which focuses on building human resource capacity for the provision of evidence-based, safe, and patient-centred pre-hospital and hospital emergency medical care is a priority [ 4 , 8 ].…”

Cost-effectiveness analysis of the multi-strategy WHO emergency care toolkit in regional referral hospitals in Uganda

“…Like most LRS, Uganda faces a high burden of acute illness and injury, which increases the excess morbidity and mortality incurred by the lack of organised emergency care services. There are several local challenges in organising EC, including a lack of systemwide protocols, clinical documentation, equipment, and regulation [ 5 ]. A national assessment of facility-based acute care in Uganda identified inadequate EC in urban settings and no or minimal access to EC in rural settings [ 6 ].…”

Training and certification in first responder care among mountaineering practitioners in east Africa

“…There has been a challenge in the development of out-of-hospital emergency care in low- and middle-income countries, especially in Africa [13] . This has been the case in East Africa, where there has been no local national out-of-hospital emergency care policies or guidelines, especially concerning the wilderness and mountaineering practice [14] , [15] , [16] . The bigger challenge is that even within the hospital settings in developing countries, for example in Kenya [17] , there is shortage of the healthcare workers.…”