There is a strong case for transforming ambulance services in Kenya

In recent months, Kenya has been gripped by emergencies which have beefed up the need for medical emergency services. The prevention of deaths and suffering among victims is heavily dependent on the quality of emergency services which is in turn a product of the efficiency of the reporting systems and procedures for allocating resources earmarked for the emergency response. The constitution apportions this responsibility to county governments. That County government should provide ambulances and emergency services to its people.  We know that many have purchased ambulances, but how many have set up emergency medical agencies? Staying with the theme of devolution, how many counties have set up systems that can allow for diversion and pooling of ambulance services both within and among neighboring counties?

To the best of my knowledge none of the counties have set up a reporting system- a call centre. This suggests that most counties did not put some effort in planning for a supportive communication system, yet application of mobile technology such as a dedicated toll free line can open new horizons in medical emergency services particularly in our rural areas where local facilities have inadequate capacities. To facilitate optimal performance of the control centre, the road network should be clearly mapped and marked to ease navigation within the county. Again, exploitation of information technology particularly GPS mapping would come in handy. 

In respect to how counties have organized ambulance services, the lure of the familiar was powerful.  In complete disregard of the scarcity of emergency services resources most counties went for a highly territorial system where the procured ambulances were allocated to administrative units and labeled appropriately. Their basic presumption was that hospitals would coordinate ambulance services. The result was however, different. Apart from Nairobi where there is a good presence of ‘NGO powered’ ambulance services, most accident victims and patients facing life threatening emergencies arrive late at these hospitals by boda boda, pick-ups or other private means. The inaccessibility of these services runs counter to what the governors had envisaged when they invested millions in purchase of ambulances.

The uncontrolled variability in the design of the ambulance vehicles procured by counties is also a bad signal. When one looks at the state of the ambulances, one gets the feeling that most of the ambulances design are based on faulty ideas of what a real ambulance should look like. For example some of the ambulances are nothing more but a pick up with a stretcher in the trunk developed and purchased for ferrying patients from point A to B. They are poorly equipped making it difficult to provide appropriate level of care. This is a picture redolent of either poor enforcement of standards or the lack of it. The absence of some of these standards is likely to expose the county governments to liability since they have a duty to provide ambulance services. Unfortunately this is an issue that has received very little attention even in policy.

The patients right to these services is also poorly enforced since none of the counties have formulated a client service charter for ambulance services to guide its provision to communities. How much are the county governments willing to subsidize? What is the projected waiting time? Are all aspects of emergency care covered, including cardiac resuscitation and basic diagnostic services? Who should authorize air ambulance services?

Overall, a case for transformation of ambulance services for emergencies is strong if it is to meet the needs of the counties’ population within the current economic and political environment.

By Dr Elesban Kihuba, Is a Health Systems Researcher with SIRCLE. kihubaelesban@yahoo.com