Around half of the road traffic mortality cases in low- and middle-income countries take place post-crash. The quality and the response time of emergency medical services (EMS) are crucial factors in determining a patient’s ultimate outcome. In particular, the time between a road crash and the provision of first professional emergency care is crucial in reducing the fatality rates from road trauma.

In FY23, GRSF funded assessments of the state of emergency medical services (EMS) for the provision of post-crash care in Mozambique, Nigeria, Senegal, and Uganda. The assessments evaluated the effectiveness of these systems and identify areas for improvement.

A qualitative survey instrument developed as part of an earlier regional evaluation—The State of Emergency Medical Services in Sub-Saharan Africa—was used to frame the respective assessments. The assessments found that countries must make a continuous and coordinated effort on the fundamentals for effectively delivering urgent medical care that is operationally and financially sustainable.

A summary of key findings and recommendations is below:

Governance and Standards:

• All four countries need stronger legal and regulatory frameworks for EMS.
• Specific legislation is needed in Mozambique for pre-hospital and in-hospital emergency services.
• Nigeria lacks national standards for communication, technology, and asset management.
• Senegal needs to reinforce the 1515 emergency call center and establish dedicated funding mechanisms.
• Uganda requires an EMS Act to codify the availability of the 912-emergency call center.

Financing Arrangements:

• Sustainable financing mechanisms for EMS are crucial in all four countries.
• Mozambique needs policy reforms to ensure effective fiscal governance for EMS.
• Nigeria can leverage existing health insurance schemes and consider adjusting telecommunication taxes.
• Senegal needs to explore additional funding sources beyond donor support and public expenditure.
• Uganda can incorporate emergency care into ongoing results-based financing mechanisms and revitalize the dialogue on a National Health Insurance Scheme.

Skills and Human Resources:

• All four countries need to develop or strengthen their EMS training programs.
• Mozambique needs national requirements for first aid training certification processes.
• Nigeria needs a standardized curriculum for Emergency Medicine, as well as national guidelines for EMS training.
• Senegal needs a specialized school for paramedics and official recognition for the role of Medical Regulation Assistants.
• Uganda requires a standardized curriculum for Emergency Medicine and a comprehensive needs assessment of the EMS workforce.

Communication and Information Management Systems:

• All four countries need to improve their communication infrastructure and data management systems.
• Mozambique needs to operationalize its Integrated Center for Guidance and Coordination of Medical Emergencies.
• Nigeria needs a National Integrated Emergency Management Solution and national standards for communication and technology.
• Senegal needs to streamline multiple short codes into a single public service access point and improve communication systems between call centers and hospitals.
• Uganda needs to mandate the operation of the 912 short code and should install vehicle location devices in all ambulances.

Common Challenges and Opportunities: