Kenyatta National Hospital in Nairobi: Shortage of ambulances is one of the challenges in sub-Saharan Africa. FILE PHOTO | NMG
Nearly half of all deaths and about a third of disabilities in
low and middle-income countries could be avoided if people had access to
emergency care.
In Africa the main causes of
emergencies are road accidents, obstetric complications, severe
illnesses and non-communicable diseases.
Over the past
18 years the African Federation for Emergency Medicine, an advocacy
group, has been encouraging the development of emergency care systems on
the continent. The gaps it has identified include decent transport and
hospital services.
But to address these challenges data is needed on the number of
hospitals, their locations as well as the population marginalised. Most
countries in Africa don’t have this information. They lack basic
inventories of health care service providers, including the number of
hospitals.
This study set out to address this problem
by producing the first ever assessment of hospital services in
sub-Saharan Africa, and used it to work out peoples’ access to care.
The
results – including how long it takes to get to a hospital – show where
investment is needed in improving access. Various interventions are
necessary. These should include building new hospitals, improving
ambulatory care, building new roads and fixing existing ones.
But
the most urgent action is that countries must update their hospital
lists, including assessment of capacity and capability to provide
emergency care and updating of the private sector. The research goes
someway to helping them start this process.
The study has built a database that can be accessed for free and used to assess service availability at nationa
The hospital list covers 48 countries and islands of sub-Saharan Africa.
Numerous
sources of data was used to develop the list, including ministries of
health, health information systems, national and international
organisations from all the countries and islands.
In
most cases, the sources were available online but the study also relied
on personal contacts to obtain hospital data in some countries.
Close
to 50 per cent of the hospitals on the list didn’t have GPS coordinates
that could aid in precisely locating them. To overcome the problem we
assigned them unique location attributes using online mapping tools such
as Google earth and OpenStreetMaps.
This audit located 4908 public sector hospitals which were precisely assigned location attributes (Figure 1).
Nigeria,
which accounts for close to a fifth of sub-Saharan Africa’s population
had the highest number of hospitals at 879. Other countries with
significantly high numbers of public hospitals were the Democratic
Republic of Congo (435), Kenya (399) and South Africa (337).
The
least were in smaller countries such as Cape Verde, Zanzibar, and São
Tomé and Príncipe. This information was used as a starting point to
calculate the geographic access to the hospital services.
The
study then measured geographic accessibility by travel time to the
nearest public hospital by calculating how long it would take to travel
by road based on the major means of transport in the region.
Road
networks was assembled from Google earth and OpenStreetMaps, and
assigned travel speeds along the roads. We then developed a model that
calculates the time it would take for a patient to travel from any 100m
by 100m square grid of location to the nearest hospital.
More
specifically, a significant proportion of women need access to hospital
care when in labour and it was additionally determined how long they
would take to get to the nearest hospital.
Results
reveal that, less than a third (29 per cent) of the total population and
28 per cent of the women of child bearing age, lived more than two
hours from the nearest hospitals.
The two-hour
threshold is a widely used recommendation by the WHO and the Lancet
Commission for global surgery for defining access to emergency obstetric
and surgical care respectively.
In addition,
international benchmarks by the Lancet commission for global surgery
recommends having 80 per cent of any given population within two hours
as critical in ensuring universal health coverage by 2030.
The
most surprising outcome was the huge differences between countries. For
example, more than 75 per cent of the population in South Sudan lived
outside the two-hour threshold. Other poorly served countries included
Central African Republic, Chad and Eritrea. More than half of their
populations lived outside the two-hour threshold.
The
best served countries were mostly islands like Zanzibar, Comoros and São
Tomé and Príncipe. More than 95 per cent of their populations were
within two hours of a hospital. Large countries such as Kenya, South
Africa and Nigeria also had good access indices, with more than 90 per
cent within the two-hour band.
All 48 countries in our
survey have signed up to the sustainable development goal of delivering
universal health care by 2030, part of which involves access to
hospitals.
This study can help countries work out what
they need to do to make this a reality when it comes to emergency care.
There’s still a long way to go. Only 16 countries in our survey achieved
80 per cent coverage in access to a hospital within two hours.
Ouma is a PhD Fellow at Kenya Medical Research Institute, while Okiro heads Population Health Unit at same institute. -THE CONVERSATION
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