ArticleInternational journal of environmental research and public health2021
Improving Access to Healthcare in Sierra Leone: The Role of the Newly Developed National Emergency Medical Service.
Article in International journal of environmental research and public health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
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Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.
- Prehospital Emergency Care in Low- and Middle-Income Countries: A Systematic Review.Prehospital and disaster medicine · 2023Pooled it
- Financial barriers to healthcare access among reproductive-age women in Sierra Leone: evidence from demographic health surveys of 2008, 2013, and 2019.Reproductive health · 2026Article
- Success and opportunities: maternal mortality and health services in Sierra Leone.Frontiers in global women's health · 2026Article
- Emergency, critical and operative care in Afghanistan: pathways to overcoming fragmentation and strengthening access in a post-conflict setting-a mixed-method study.BMJ public health · 2026Article
- Use of digital media device in pediatric adolescents affected by anorexia nervosa.Italian journal of pediatrics · 2025Article
- Economic factors influencing utilization of world health organization recommended ANC visits among women in Jordan: an analysis of Jordan population and family health survey 2023.Archives of public health = Archives belges de sante publique · 2025Article
- Cultural, socioeconomic, and demographic factors contributing to child mortality: evidence from Sierra Leone demographic and health survey 2019.BMC public health · 2025Article
- Inequalities in self-reported problems in accessing healthcare among women aged 15-29 years in Sierra Leone, 2008-2019: a time-trend study.BMC public health · 2025Article
- The Economic Burden of Healthcare Utilization: Findings from a Health and Well-Being Survey in Informal Settlements of Freetown, Sierra Leone.Journal of urban health : bulletin of the New York Academy of Medicine · 2025Article
- Socio-economic and geographical inequalities in infant mortality rates in Sierra Leone, 2008-2019.BMC public health · 2025Article
- Trends and inequalities in full immunisation coverage among one-year-olds in Sierra Leone, 2008-2019.BMC pediatrics · 2025Article
- Determinants of poor access to health care among women of reproductive age in Sierra Leone: a cross-sectional study.BMC health services research · 2025Article
- Inequalities in total fertility rate in Sierra Leone, 2008-2019.BMC public health · 2025Article
- Socioeconomic and geographical inequalities in polio immunisation coverage among two-year-olds in Sierra Leone, 2008-2019.BMC infectious diseases · 2024Article
- Public health system in post-pandemic Sierra Leone: a scoping review.BMC infectious diseases · 2024Article
- Trends and inequalities in modern contraceptive use among women in Sierra Leone, 2008-2019.Reproductive health · 2024Article
- Trends and inequalities in oral rehydration therapy and continued feeding for children under five with diarrhoea in Sierra Leone.Tropical medicine and health · 2024Article
- Optometric challenges in Sierra Leone.Journal of global health · 2024Article
- Predictors of insecticide-treated bed nets use among pregnant women in Sierra Leone: evidence from the 2019 Sierra Leone Demographic Health Survey.Malaria journal · 2024Article
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Authors and funding
13 authors at 5 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
We aim to evaluate whether the first National Emergency Medical Service (NEMS) improved access to hospital care for the people of Sierra Leone. We performed an interrupted time-series analysis to assess the effects of NEMS implementation on hospital admissions in 25 facilities. The analysis was also replicated separately for the area of Freetown and the rest of the country. The study population was stratified by the main Free Health Care Initiative (FHCI) categories of pregnant women, children under 5 years of age, and populations excluded from the FHCI. Finally, we calculated direct costs of the service. We report a 43% overall increase in hospital admissions immediately after NEMS inception (RR 1.43; 95% CI 1.2-1.61). Analyses stratified by FHCI categories showed a significant increase among pregnant women (RR 1.54; 95% CI 1.33-1.77) and among individuals excluded from the FHCI (RR 2.95; 95% CI 2.47-3.53). The observed effect was mainly due to the impact of NEMS on the rural districts. The estimated recurrent cost per ambulance ride and NEMS yearly cost per inhabitant were 124 and 0.45 USD, respectively. To our knowledge, this is the first nationwide study documenting the increase in access to healthcare services following the implementation of an ambulance-based medical service in a low-income country. Based on our results, NEMS was able to overcome the existing barriers of geographical accessibility and transport availability, especially in the rural areas of Sierra Leone.
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