Relevance of the One Constituency, One Ambulance Programme to Ghana’s Emergency Healthcare System

A country with quality Healthcare is often assured of increased efficiency and productivity; and eventual growth in her economic activities in desired proportions.

The success story of modelled advanced economies such as the United States of America (USA), United Kingdom (UK), Canada, Germany, and France, to mention a few, revolves around the establishment and maintenance of strong and effective healthcare delivery systems.

The foregoing affirms the need for effective general healthcare, and for that matter, efficient emergency healthcare delivery system to be established in Ghana to facilitate the realisation of desired economic objectives.

The need for the establishment of a National Ambulance Service (NAS) in Ghana was conceived in 2004 under former President John Agyekum Kufour’s administration.

Some health experts believe the establishment of the NAS ostensibly followed recommendations from the disaster or stampede recorded at the Accra Sports Stadium on 9th May, 2001 during a league match between Accra Hearts of Oak and Kumasi Asante Kotoko in which many lives were lost.

Through the collaborative efforts of the Ministry of Health, Ghana National Fire Service, Office of the State Attorney, and other government agencies, the National Ambulance Service was established in 2004.

In the same year, the NAS commenced pilot operations with seven (7) ambulance stations in three (3) regions.

Fifty-seven (57) members of the Ghana National Fire Service and six (6) drivers were trained as emergency medical technicians (EMTs) to ensure efficient and effective service delivery during the pilot phase.

However, only 9% of the country was covered by the NAS in 2004. The NAS started full-scale operations in 2006 with additional twelve (12) ambulance stations.

As at 2014, the NAS was operating 128 ambulance stations; and had 199 ambulances, which were operated by 1,651 emergency medical technicians (EMTs), and 47 administrative and maintenance staff.

During the period, the operations of the NAS were expanded to cover about 81% of the country (Zakariah, Stewart, Boateng, Achena, Tansley, & Mock, 2017).

The foregoing notwithstanding, one of the numerous socio-economic challenges that confronted the nation under the leadership of the erstwhile National Democratic Congress (NDC), and believed to have been inherited by the current leadership of the New Patriotic Party (NPP) is the limited number of ambulances available nation-wide for the treatment of emergency healthcare cases.

As part of her flagship programmes, Ghana’s current political administration led by Nana Addo Dankwa Akufo-Addo seeks to ensure the availability of an ambulance in each of the two hundred and seventy-five (275) constituencies across the country.

This is termed as the One Constituency, One Ambulance initiative and falls under the Ministry of Special Development Initiatives in the Office of the President.

Procurement of the new ambulances forms part of the Infrastructure for Poverty Eradication Programme (IPEP) rolled out by the President Nana Akufo-Addo-led administration to bridge the poverty and infrastructure gap in the country.

President Nana Akufo-Addo has affirmed his administration’s resolve and preparedness to improve the well-being of Ghanaians through the establishment of strong and accessible state-of-the-art healthcare system. 

Standard Ratio

Statistics shared by the Vice President, Alhaji Dr. Mahamudu Bawumia, at the recent Town Hall Meeting at the Kwame Nkrumah University of Science and Technology (KNUST) in Kumasi revealed the Nana Akufo-Addo-led government inherited only fifty-five (55) semi-functional ambulances from the previous NDC government.

Ambulances play an indispensable role in the overall success of emergency healthcare systems and delivery across the globe.

According to the World Bank, Ghana’s estimated total population in 2017 was 28.83 million. However, the global standard ratio is 25,000 people to one ambulance.

Suppose forty (40) of the 55 semi-functional ambulances were fully functional in 2017. The ratio would be 720,750 people to one ambulance; this was about 28.83 times (720,750 people ÷25,000 people = 28.83 times) the standard ratio.

As at December 2019, there were 50 fully-functioning national ambulances throughout the country with an estimated population of 29.78 million.

The foregoing suggests the nation recorded a ratio of 595,600 people (29,780,000 people ÷ 25,000 people = 595,600 people) to an ambulance in the previous year.

Again, this was about 23.82 times (595,600 people ÷ 25,000 people = 23.824 = 23.82 times) the standard ratio.

In September 2019, first batch that is, 48 of the new three hundred and seven (307) ambulances procured by the government arrived in the country.

The respective second and third batches of the ambulances arrived in the country in October 2019 and December 2019.

On 28th January, 2020 President Nana Akufo-Addo commissioned the new 307 ambulances.

An earlier date that is, 6th January, 2020 set for the commissioning was postponed due to a number of factors.

These include non-arrival of all the ambulances in the country, ongoing installation of tracking devices, lack of adequate human resource, training of emergency medical technicians, embossment of constituency names, and preparation of stations or receiving points for the ambulances.

Further, the delay was intended to ensure fair and equitable distribution; and effective functioning of the ambulances in the 275 constituencies across the country.

As at 6th January, 2020 there were about two hundred and eleven (211) ambulances in the country.

Prof. Zakariah, Chief Executive Officer (CEO) of the NAS noted the postponement of the initial commissioning date was borne out of an appeal to President Nana Akufo-Addo by his outfit owing to a number of technical and administrative challenges.

As at the commissioning date, Ghana had 130 ambulance stations and 10 regional control rooms across the country.

On 28th January, 2020 President Nana Akufo-Addo assured the nation of the establishment of additional 145 ambulance stations to increase the number to 275, implying an ambulance station for each constituency in the country.

The 145 new ambulance stations remain the single highest addition in the history of ambulance service in the country.

The current total number of ambulances in Ghana is three hundred and fifty-seven (357) (50 + 307 = 357).

Ghana’s estimated population as at January 2020 was 30.50 million, representing about 2.39% increase over the estimated population (29.78 million) for 2019.

The current population (30.50 million) relative to the total number of ambulances indicates a ratio of about 85,435 people to one ambulance.

The current ratio is about 3.42 times (85,435 people ÷ 25,000 people = 3.4174 = 3.42 times) the standard ratio.

The arrival of the 307 new ambulances has reduced the ratio (23.82 times) recorded in 2019 by 20.4 times (23.82 times – 3.42 times = 20.4 times), but still fall short of the standard ratio, implying more ambulances are needed.

Further computations suggest 1,220 ambulances (30,500,000 people ÷ 25,000 people = 1,220 ambulances) would be required to meet the standard ratio of 25,000 people to an ambulance.

One thousand two hundred and twenty ambulances would mean at least four (4) ambulances (1,220 ambulances ÷ 275 constituencies = 4.436 ambulances) for each of the 275 constituencies in the country.

However, the operations of private ambulances are expected to complement the efforts of the Ghana National Ambulance Service in the various constituencies to enhance efficiency and effectiveness in service delivery.

The total number of national ambulances coupled with private ambulances in the country is expected to reduce the extent to which injured persons and severely ill people are conveyed to health facilities by commercial vehicles such as Taxis and minibuses; and to improve the efficiency of Ghana’s pre-hospital care system.

Arguably, the 307 new ambulances procured by the President Akufo-Addo-led government are the highest fleet in the history of procurement of ambulances for emergency healthcare delivery in Africa.

Personnel and Skills Training

Generally, challenges saddled with Ghana’s emergency healthcare system are onerous; they range from lack of adequate number of emergency doctors, limited number of emergency rooms, lack of tools and equipment, and limited number of ambulances and emergency medical technicians, among others.

The Ghana National Ambulance Service is responsible for the management of personnel, ambulances, and other essentials for effective functioning of ambulances in the country.

On 28th January, 2020, the Ministry of Information revealed NAS has secured clearance for the recruitment of 575 EMTs, of which 450 have been recruited.

This followed an earlier disclosure by Prof. Zakariah on 10th January, 2020 which suggested the National Ambulance Service has received clearance from the Finance Ministry for the recruitment of 900 staff to augment and strengthen its personnel size.

About 2,000 of the existing staff have also been detailed to undergo in-service training to sharpen their skills and enhance their ability to use the ambulances effectively.

The new recruits include paramedics and drivers; these recruits are categorised into advanced and basic service providers.

Earlier test drives by the NAS drivers in Accra were intended to build their capacity to ensure effective use and management of the ambulances.

Specifically, the test drives helped the NAS drivers to familiarise themselves with the distinctive features, and to learn more about the performance of the ambulances.

A special in-service training organised by the manufacturers for staff of the NAS sought to enhance efficiency in maintenance and operations of the ambulances.

As noted earlier, ambulance stations are expected to be established in all the 275 constituencies as part of measures aimed at improving efficiency in service delivery of the National Ambulance Service.

However, the CEO revealed each ambulance station throughout the country would require at least 15 employees to assure effectiveness in operation; and efficiency in service delivery.

This translates into a minimum of 4,125 employees (275 constituencies x 15 employees = 4,125 employees) for the 275 constituencies. Available figures on existing workforce and recruitments sum up to about 3,477.

This estimated number (2,000 + 900 + 577 = 3,477) constitutes about 84.30% (3,477 ÷ 4,125) x 100% = 0.842909 x 100% = 84.29 = 84.30%) of the total minimum number of employees (4,125) required by the National Ambulance Service to assure its functionality nationwide.

Processes to fully engage the services of the 900 professionals in addition to the 577 are expected to commence soon.

This notwithstanding, it is hoped the current total workforce would facilitate effective operationalisation of the National Ambulance Service in each of the 275 constituencies.

The necessary steps have been taken to provide comprehensive insurance coverage for all the ambulances.

This is unique in that in time past, the national ambulances were not insured, and this posed challenges to the NAS.

A Bill on the National Ambulance Service is expected to be forwarded to Parliament for passage into law.

The Bill would identify sources of funding for the NAS. Meanwhile, the President Nana Akufo-Addo-led government has taken the necessary steps to address the infrastructure, logistics, and funding challenges confronting the National Ambulance Service to assure efficiency and effectiveness in its operations and service delivery to the people.

These and other initiatives not cited in this narrative affirm the strong commitment of the current leadership towards improving emergency healthcare system and delivery in the nook and cranny of the country.   

By Ebenezer M. Ashley (PhD)

The Writer is a Fellow Chartered Economist & CEO of EBEN Consultancy

Email: ebenezer.ashley@gmail.com

Website: www.ebenezerashley.org

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