Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Dec 17;3(4):577-90.
doi: 10.9745/GHSP-D-15-00170. Print 2015 Dec.

Barriers to Accessing Emergency Medical Services in Accra, Ghana: Development of a Survey Instrument and Initial Application in Ghana

Nee-Kofi Mould-Millman  1 , Sarah D Rominski  2 , Joshua Bogus  3 , Adit A Ginde  1 , Ahmed N Zakariah  4 , Christiana A Boatemaah  4 , Arthur H Yancey  5 , Samuel Kaba Akoriyea  6 , Thomas B Campbell  7
Affiliations

Barriers to Accessing Emergency Medical Services in Accra, Ghana: Development of a Survey Instrument and Initial Application in Ghana

Nee-Kofi Mould-Millman et al. Glob Health Sci Pract. .

Abstract

Background: Emergency medical services (EMS) systems provide professional prehospital emergency medical care and transportation to help improve outcomes from emergency conditions. Ghana's national ambulance service has relatively low public utilization in comparison with the large burden of acute disease.

Methods: A survey instrument was developed using Pechansky and Thomas's model of access covering 5 dimensions of availability, accessibility, accommodation, affordability, and acceptability. The instrument was used in a cross-sectional survey in 2013 in Accra, Ghana; eligible participants were those 18 years and older who spoke English, French, or Twi. Although the analysis was mainly descriptive, logistic regression was used to identify factors associated with reported intention to call for an ambulance in the case of a medical emergency.

Results: 468 participants completed surveys, with a response rate of 78.4%. Few (4.5%) respondents had ever used an ambulance in prior emergency situations. A substantial proportion (43.8%) knew about the public access medical emergency telephone number, but of those only 37.1% knew it was a toll-free call. Most (54.7%) respondents believed EMTs offered high-quality care, but 78.0% believed taxis were faster than ambulances and 69.2% thought the number of ambulances in Accra insufficient. Many (23.4%) thought using ambulances to transport corpses would be appropriate. In two hypothetical emergency scenarios, respondents most commonly reported taxis as the preferred transportation (63.6% if a family member were burned in a house fire, 64.7% if a pedestrian were struck by a vehicle). About 1 in 5 respondents said they would call an ambulance in either scenario (20.7% if a family member were burned in a house fire, 23.3% if a pedestrian were struck by a vehicle) while 15.5% and 10.2%, respectively, would use any available vehicle. Those aged 18-35 years were more likely than older respondents to prefer an ambulance (odds ratio [OR], 2.27; confidence interval [CI], 1.47 to 3.68), as were those with prior ambulance experience (OR, 1.75; CI, 0.98 to 3.09) (compared with those with no prior experience) and those who believed ambulances were safer than taxis (OR, 2.17; CI, 1.1 to 4.2) (compared with those who did not hold such beliefs).

Conclusions: Perceptions of public ambulance services in Accra, Ghana, are generally favorable, although use is low. Public health education to improve awareness of the toll-free medical emergency number and about appropriate use of ambulances while simultaneously improving the capacity of ambulance agencies to receive increased caseload could improve use of the EMS system.

PubMed Disclaimer

Figures

FIGURE.
FIGURE.
Survey Locations Within the 11 Demographic and Health Survey Enumeration Areas for Accra, Ghana
None
A NAS ambulance on standby at a busy marketplace in central Accra, Ghana.
See this image and copyright information in PMC

References

    1. Kobusingye OC, Hyder AA, Bishai D, Joshipura M, Hicks ER, Mock C.Emergency medical services. : Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, et al., Disease control priorities in developing countries. 2nd ed Washington (DC): World Bank; 2006. Available from: http://www.ncbi.nlm.nih.gov/books/NBK11744/ - PubMed
    1. Mould-Millman NK, Naidoo R, de Vries S, Stein C, Wallis LA. AFEM Consensus Conference, 2013. AFEM Out-of-Hospital Emergency Care Workgroup Consensus Paper: advancing out-of-hospital emergency care in Africa-advocacy and development. Afr J Emerg Med. 2014. Jun;4(2):90–95. 10.1016/j.afjem.2014.02.001 - DOI
    1. Razzak JA, Kellermann AL. Emergency medical care in developing countries: is it worthwhile? Bull World Health Organ. 2002;80(11):900–905. - PMC - PubMed
    1. Henry JA, Reingold AL. Prehospital trauma systems reduce mortality in developing countries: a systematic review and meta-analysis. J Trauma Acute Care Surg. 2012;73(1):261–268. 10.1097/TA.0b013e31824bde1e. - DOI - PubMed
    1. Sasser S, Kellermann AL, Lormand J-D, Prehospital trauma care systems. Geneva: World Health Organization; 2005. Available from: http://www.who.int/violence_injury_prevention/publications/services/04_0...