An extract from the Evaluation Report – Gloucestershire Hospitals (UK) and Kambia District Hospital (Sierra Leone) Link, Nov to Dec 2008
In March 2007, the (Gloucestershire Kambia) Link began funding a pilot motorcycle ambulance service scheme. Five motorcycle ambulances have been supplied so far; three are based at Barmoi PHU, and two are based at Maselleh PHU. An additional motorbike ambulance is kept as a spare at the Kambia Appeal office. Before the service was fully launched, drivers from the local community were identified and trained. A mechanic was also identified and sent to Freetown to train on motorcycle maintenance. The motorbike ambulances then came into use from July 2008. Between July and November 2008 the ambulances were used to take at least 139 patients either to the PHUs or to hospital (see Graph 5). The usage could be higher still; at the time of the evaluation, the PHU heads reported that they had run out of the forms used to record details of ambulance usage, and were waiting to receive more forms from the KA (Kambia) office. In general, however, the PHUs keep an up-to-date record of the use of the ambulances, with mileage covered, the location where patients were collected, and where they were taken.
This is a pilot intervention by the Link: there are plans to increase the number of motorcycle ambulances, if they are found to be having a positive impact on health outcomes. During focus group discussions held as part of the evaluation, community members expressed deep appreciation for the ambulance service, stating that the vehicles have saved the lives of many patients in their villages, particularly pregnant women. The ambulances were used for taking patients either to the PHU or (when referred) to Kambia District Hospital. A variety of patients had made use of the service, including pregnant women, those with injuries and patients with malaria. Feedback regarding the service was positive; it was clear that an expansion of such services would be welcome.
The Link has clearly been successful in its objective of introducing a pilot motorcycle ambulance service; the scheme has helped to expand access to health services (including maternity services) for those living in remote areas. Overall, the service was operating well. However, one shortcoming was noted. The motorcycle ambulance drivers were not always paid regular fees for their services. Under the pilot scheme, fees for the drivers were raised from local community contributions. At Barmoi, the drivers received 5000 Leones monthly from the PHU; however, community collections appear to have been limited—it is likely that the PHU itself is making up the shortfall. At Maselleh, community collections appear to have been effective; however, the drivers were not being paid anything at all, and were providing their services on a voluntary basis. Maselleh PHU reported that they had transferred funds to the KA (Kambia) office, where they had been placed in the bank—but a smooth system for making payouts to the drivers was not in place. This was demoralizing to the drivers, particularly given the importance placed locally on the service they provided. In short, neither PHU yet has a smooth system to making regular payments to the motorbike ambulance drivers, funded by the local community.
Further field reports will be posted here.