Ambulance services as part of the district health system in low‐income countries: a feasibility study from Cambodia

Jacobs, Bart; Men, Cheanrithy; Sam, Oeun Sam; Postma, Sjoerd

doi:10.1002/hpm.2285

Cited by 7 publications

(12 citation statements)

References 17 publications

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“…The higher costs of HCBs in comparison to health centres without beds – 53% more per contact and 63% more per OPD consultation – coupled with the low bed occupancy rates (0–19%)- challenge the economic rationale for sustaining such facilities. Instead, it may be worthwhile considering alternative investments in ambulance services or other vehicles to facilitate the efficient transportation of patients to higher level health facilities, especially in areas with accommodating road infrastructure [40]. However, costing health services for a small number of health facilities makes generalisations challenging [7], and there is a need to further investigate the use of HCBs.…”

Section: Discussionmentioning

confidence: 99%

Costing for universal health coverage: insight into essential economic data from three provinces in Cambodia

Jacobs

Hui

et al. 2019

Health Econ Rev

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BackgroundKnowledge of the costs of health services improves health facility management and aids in health financing for universal health coverage. Because of resource requirements that are often not present in low- and middle-income countries, costing exercises are rare and infrequent. Here we report findings from the initial phase of establishing a routine costing system for health services implemented in three provinces in Cambodia.MethodsData was collected for the 2016 financial year from 20 health centres (including four with beds) and five hospitals (three district hospitals and two provincial hospitals). The costs to the providers for health centres were calculated using step-down allocations for selected costing units, including preventive and curative services, delivery, and patient contact, while for hospitals this was complemented with bed-day and inpatient day per department. Costs were compared by type of facility and between provinces.ResultsAll required information was not readily available at health facilities and had to be recovered from various sources. Costs per outpatient consultation at health centres varied between provinces (from US$2.33 to US$4.89), as well as within provinces. Generally, costs were inversely correlated with the quantity of service output. Costs per contact were higher at health centres with beds than health centres without beds (US$4.59, compared to US$3.00). Conversely, costs for delivery were lower in health centres with beds (US$128.7, compared to US$413.7), mainly because of low performing health centres without beds. Costs per inpatient-day varied from US$27.61 to US$55.87 and were most expensive at the lowest level hospital.ConclusionsEstablishing a routine health service costing system appears feasible if recording and accounting procedures are improved. Information on service costs by health facility level can provide useful information to optimise the use of available financial and human resources.

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Section: Discussionmentioning

confidence: 99%

Costing for universal health coverage: insight into essential economic data from three provinces in Cambodia

Jacobs

Hui

et al. 2019

Health Econ Rev

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“…Further selection followed, and finally 14 papers were included in the narrative synthesis (Table 3). [28][29][30][31][32][33][34][35][36][37][38][39][40][41] Overview of Analyzed Studies Of the 14 studies that were included in this review, most were concerned with emergency transport, especially ambulances. Study settings varied across reports from Asia (India, Pakistan, and Cambodia), the Middle East (Iranmost common), and Africa (Ghana -West, Zambia -South, and Kenya -East).…”

Section: Processing Informationmentioning

confidence: 99%

“…Tran © 2019 Prehospital and Disaster Medicine staff due to moonlighting, and a generally negative attitude were common complaints across the studies. [29][30][31][33][34][35] Higher level care centers were thought to be generally better than centers at lower levels. 29,31,35 This meant that patients had to bypass the local health centers in order to obtain "satisfactory" levels of care.…”

Section: General Injurymentioning

confidence: 99%

“…29 The convenience and the cheaper price of bonesetters offered additional incentives, 29 considering that patients living in LMICs are often poor. [29][30][31]35,38,40,41 Bonesetters were often situated closer to home and patients were able to leave straight after treatment, allowing them and their family to continue with their daily life. Meanwhile, hospital treatments of fracture often required extended periods of in-patient stay at a hospital.…”

Section: General Injurymentioning

confidence: 99%

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Putting Culture into Prehospital Emergency Care: A Systematic Narrative Review of Literature from Lower Middle-Income Countries

Tran

Lee

Sleigh

et al. 2019

Prehosp. Disaster med.

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Background:Prehospital emergency care is cost-effective for improving morbidity and mortality of emergency conditions. However, such care has been discounted in the public health system of many lower middle-income countries (LMICs). Where it exists, the Emergency Medical Service (EMS) system is grossly inadequate, unpopular, and misrepresented. Many EMS reviews in developing countries have identified systemic problems with infrastructure and human resources, but they neglected impacts of sociocultural factors. This study examines the sociocultural dimensions of LMICs’ prehospital emergency systems in order to improve the quality and impact of emergency care in those countries.Methods:Qualitative studies on EMS systems in LMICs were systematically reviewed and analyzed using Kleinman’s health system theory of folk, popular, and professional health sectors. Also, the three-delay model of emergency care – seeking, reaching, and receiving – provided a guiding framework.Results:The search yielded over 3,000 papers and the inclusion criteria eventually selected 14, with duplicates and irrelevant papers as the most frequent exclusion. Both user and provider experiences with emergency conditions and the processes of prehospital care were described. Sociocultural factors such as trust and beliefs underlay the way emergency care was experienced. Attitudes of family and community shaped service-seeking behaviors. Traditional medicine was often the first point of care. Private vehicles were the main transportation for accessing care due to distrust and misunderstanding of ambulance services.Conclusion:The findings led to the discussion on how culture is woven into the patients’ pathway to care, and the recommendation for any future development to place a far greater emphasis on this aspect. Instead of relying purely on the biomedical sector, the health system should acknowledge and show respect for popular knowledge and folk belief. Such strategies will improve trust, facilitate information exchange, and enable stronger healer-patient relationships.

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“…20 Previous assessments into the feasibility and potential impact of referral-system-strengthening efforts in Cambodia found strong support among Cambodians, many of whom are frustrated with their current level of access to appropriate care and are interested in seeing the referral system's reach expanded. 21 Prior work has also noted that although the system resources are constrained, progress is feasible by using innovative approaches to maximize the impact of current resources. Nakahara et al performed a review in 2009 of the Cambodian trauma system and its resources noting:…”

mentioning

confidence: 99%

Strengthening the emergency referral system in Cambodia for women and children under five: a description of interventions and impact analysis

Acker¹,

Matheson²,

Tuon³

et al. 2019

Journal of Global Health Reports

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Background Background Many factors align to reduce access to quality emergency services in Cambodia, resulting in unnecessary morbidity and mortality among the country's most vulnerable populations. The lack of a well-coordinated emergency referral system acts as a critical barrier for many seeking emergency care, limiting overall referral frequency and quality. To increase the effectiveness of the Cambodian healthcare system, the Quality Health Services (QHS) project implemented a spectrum of targeted, low-cost, locally-tailored interventions, including: triage systems, provincial clinical guidelines and referral hotlines, standardized referral-communication slips, and referral-feedback forms. To inform future health-system-strengthening efforts, the primary aim of this study is to describe the challenges facing the Cambodian referral system and the interventions applied to address these challenges. Secondarily, this study aims to characterize the frequency of emergency referrals in the post-intervention period and the utilization patterns of the implemented referral-system-strengthening tools. Methods Methods Data was collected prospectively on a quarterly basis at 35 government referral hospitals in six Cambodian provinces between March 2016 and June 2017, data from 25 of these facilities was analyzed. Data on overall numbers of referrals was collected from each facility's referral logbook. The frequency and thoroughness of standardized referral-communication slip and standardized referral-feedback form use was ascertained by reviewing copies of these tools collected at each facility during the preceding quarter. Results Results The average number of emergency referrals to target facilities increased from 114.4 to 190.4 per quarter, a 66% increase. Target facilities also received 86% more standardized referral-communication slips and sent 200% more standardized referral-feedback forms per quarter during the monitoring period. Conclusions Conclusions After receiving a package of referral-system-strengthening interventions the 25 hospitals analyzed in this study noted a significant increase in the frequency of emergency referral receipt. The frequency and quality of referral related communication improved consistently during the observation period as well. This data suggests that the interventions implemented addressed ongoing gaps in the Cambodian health system, and improved access to emergency referrals. These developments create a foundation upon which to build future health system strengthening interventions can be built and may provide guidance to implementors in other similarly resourced settings. During the late 1970's, under the rule of the Khmer Rouge, the Cambodian medical system was dismantled, and the country's health workforce decimated. Although the Khmer Rouge were ousted from Phnom Penh in 1979, violence and political unrest continued for many years, draining aid resources and hindering reconstruction efforts. As a result, during the 1980's and early 1990's, the country suffered some of the worst...

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Ambulance services as part of the district health system in low‐income countries: a feasibility study from Cambodia

Abstract: When certain conditions are met, effective ambulance services can be an integral part of the district health system and positively contribute to the population's appreciation of the hospital services and respective district health system. Copyright © 2015 John Wiley & Sons, Ltd.

Cited by 7 publications

References 17 publications

Costing for universal health coverage: insight into essential economic data from three provinces in Cambodia

Costing for universal health coverage: insight into essential economic data from three provinces in Cambodia

Putting Culture into Prehospital Emergency Care: A Systematic Narrative Review of Literature from Lower Middle-Income Countries

Strengthening the emergency referral system in Cambodia for women and children under five: a description of interventions and impact analysis

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