Access to timely emergency care can be influenced by the perception of, and the ease of access to prehospital care during emergencies [12]. The present study assessed the perceived barriers to access and solutions to improve access to prehospital care service in Jimma, Ethiopia.
The present study identified limited public awareness about initial care at the scene and available ambulance services as the most common barrier to access in Jimma. Studies in Addis Ababa, Ethiopia[18] and in other African countries have found similar public awareness gaps regarding utilization of prehospital care [10, 11, 19]. The respondents involved in this study suggested interventions such public education and community based first aid training programs to improve awareness. Respondents felt these solutions were essential measures and were similar to solutions recommend by others to improve access to prehospital care across Sub-Saharan Africa [6, 7].
However, knowledge of the existence of a prehospital system and first aid are likely insufficient. The true availability and accessibility of the services, particularly ambulance services has been shown to influence the community decision to seek timely care [12]. Our study identified inadequacies in the pre-hospital care system such as a lack of a uniform organizational structure and lack of a universal emergency. Establishment of a region-specific and context-appropriate emergency medical dispatch (EMD) system has been previously described as a method to improve access to prehospital care in Africa[20].
Hence, we call for the establishment of a region-specific prehospital care system that operates on the toll-free emergency number as key solutions to overcome system wide access barriers in Jimma city. However, this requires advocacy to create awareness and commitment among stakeholders [6, 7, 12]. Fortunately, previously established dispatch systems under fire department [21], and private ambulance service[22] in Addis Ababa, Ethiopia suggest that it is feasible to create a local EMS system in Jimma.
Scarcity of EMS resources including ambulances, medical supplies, and human resources were other system related barriers to access identified by this study, as a result of this commercial transportation methods were the most frequently used means of emergency transportation in the community. Similar findings have been reported across Sub-Saharan Africa[6, 8, 23, 24]. The participants of this study stressed that increasing the number of ambulances was important in order to meet the demands of the community. Therefore, low-cost options such as retrofitted ambulances have been recommended in low resource settings to supplement the currently available commercial and private transportation [2, 25, 26]. In addition, we also recommend increased availability of professional care provider training programs by incorporating these courses into Ethiopian higher education institutions, in order to address growing demands for emergency care as a whole.
Misuse of resources by ambulance providers leads to decreased utilization and mistrust of the system as a whole [6]. In the present study ambulance misuse was commonly felt to be a barrier to access in Jimma; the participants felt this was an impediment to trust in prehospital care and called for legal enforcement. At this time misuse of an ambulance is a prohibited practice under international humanitarian law and administrative actions [27], as well as existing local regulations [28, 29]. There legal enforcement is needed to halt abuse of this scarce resource.
Limitations
The participant interviews were conducted in Afan Oromo and Amharic, then translated and transcribed into English. Therefore, there was potential for mistranslation as many words in Afan Oromo are not directly translatable to English. Furthermore, there are likely opinions that were not represented in this study even though efforts were made to ensure diversity through involving participants from different parts of the community and relevant settings.