EDO STATE GOVERNMENT PARTNERSHIP WITH EMERGENCY RESPONSE AFRICA TO DEVELOP EDO EMS

EXECUTIVE SUMMARY

In a landmark move towards enhancing and advancing the healthcare system in Edo, in alignment and fulfillment of Sustainable Development Goals (SDG 3), Governor Godwin Obaseki launched the pilot phase of Edo Emergency Medical Services Project (Edo EMS) on March 5th, 2024. This initiative is a collaborative effort between the Edo State government, the Fund for Innovation in Development (FID), and Emergency Response Africa, an innovative healthcare technology organization.

The Edo EMS project aims to revolutionize healthcare and emergency response across Edo State. It seeks to provide rapid and reliable emergency medical care, especially to vulnerable and hard-to-reach communities, through the strategic use of technology. A key component of this initiative is the training and capacity building of Community-Based First Responders (CBFRs) to enhance local healthcare support services. Governor Obaseki reiterated the government’s commitment to delivering high-quality healthcare services to its citizens during the launch of the project.

 

 

Key Achievements:

1. CBFRs Training Commencement: Training for 135 Community-Based First Responders (CBFRs) began on March 8th and concluded on the 18th, it encompassed a seven-day theoretical course followed by a two-day practical session.
2. Graduation of CBFRs: the inaugural batch of the CBFRs graduated on March 20th, with the Governor emphasizing the gravity of their roles and responsibilities.
3. Project Kick-off: The project officially commenced on April 1st following a comprehensive two-week simulation program.
4. Second Batch Training: A second batch of CBFRs began training on April 22nd, expanding the initiative’s reach and making up the numbers not met during the first training exercise. 35 additional CBFRs were trained to make the total number 170 that met the quota.
5. Based set-up with Primary Healthcare Centers: Collaborations were established with Primary Healthcare Centers (PHCs) in Ugbeku PHC, Arougba PHC and the Command-and-Control Centre, creating ambulance bases that ensure medical services are accessible within a 10-minute timeframe. This innovation has provided and revitalized 4 ambulances for the purpose of stabilization and medical transportation to hospitals nearby which allows residents to get medical services, thereby strengthening the project’s efficiency.

 

 

This intervention aims to reduce preventable deaths from road accidents and sudden illnesses, as well as provide emergency obstetric care. It promises to improve and transform the healthcare sector, and significantly lower the rate of preventable deaths in the state therefore ensuring that everyone has access to rapid, timely and reliable care.

 

INTRODUCTION

Health is regarded as a basic and fundamental concern for humans, with quality life heavily dependent on quality healthcare. Medical/Health emergency as defined by the National Health Service of the United Kingdom is a life threatening illness or accident which requires immediate intensive treatment. Therefore, emergency care means inpatient or outpatient health services necessary to prevent death or serious impairment of the health of the recipient. Increasingly, the global health community is recognizing the important role that emergency care plays in delivery of health services. The emergency healthcare system in developing countries like Nigeria is faced with challenges such as inadequate structures, insufficient training, and high costs.

Research shows that every year millions of Africans die due to poor medical responses, only about 9% of the population has access to emergency services. In Nigeria, 54% of the country’s deaths could be prevented with timely emergency medical response; poor emergency medical services contribute to 1.2 million preventable deaths annually, caused by cardiovascular conditions, road accidents, and maternal health issues. Factors such as declining government healthcare expenditure, lack of basic medical equipment and inadequate health facilities as well as high service cost are responsible for poor quality of healthcare. Establishing a robust emergency pre-hospital care system can have an immediate and significant impact, hence the need for projects like Edo EMS in Nigeria. The FID-EMS project spearheaded by the Edo state government is a response to Nigeria’s significant emergency healthcare crisis; the government of Edo stated that the project was aimed at tackling challenges such as low public health trust, broken communication channels, and inefficient data collection, among many others. The partnership was birth through the genuine efforts of the government of Edo to bridge emergency medical gaps, enhance emergency healthcare response and boost health insurance enrolment in the state. The sole focus is to provide effective medical service to the people of Edo State.

 

OBJECTIVES

The Edo EMS initiative primarily aims to transform healthcare and emergency response in Edo State. Its secondary objectives include enhancing emergency response times, reducing preventable deaths, and improving public health engagement. The project also promotes enrollment in the Edo State Health Insurance Scheme to increase health insurance adoption across the state

 

PROJECT DESCRIPTION

The first pilot phase of the Edo EMS project focuses on implementing a technology-enabled Community-Based First Responders programme in Oredo, Egor, and Ikpoba-Okha Local Government Areas of Edo State. Selected community members were trained as first responders, utilizing Emergency Response Africa’s proprietary technology platform, the Command and Control Centre for rapid dispatch of CBFRs.  Ambulances and hospitals were also aggregated through the technology platform for efficient patient transportation.

The project was initiated in October 2023, with its implementation officially kicking off in December 2023; the project will run for a period of 15 months, with its official conclusion in December 2024.

Key stakeholders include Emergency Response Africa, Fund for Innovation in Development, the Edo State government, various State ministries such as the Ministry of Health, led by the Honourable Commissioner for Health, Dr. Samuel Alli, the Ministry of Public Safety and Security, led by the Honourable Commissioner for Public Safety and Security, Mr. Kingsley Uwagbale, and critical healthcare agencies such as the Edo State Health Insurance Scheme (EDOHIS), under the leadership of Director General, Dr Rock Amegor, the Edo State Primary Healthcare Development Agency, under the leadership of Executive Secretary, Dr Omo Izedonmwen and the John Odigiye-Oyegun Public Service Academy, led by Director General, Mrs Precious Imuwahen Anjoonu. Several leading public and private healthcare facilities were selected as key collaborators, including the University of Benin Teaching Hospital, Edo Specialist Hospital led by Prof. Darlington Obaseki the Chief Medical Director (CMD), and Lastly Lauren Parker Limited led by Uzor Zainab.

 

METHODOLOGY

The emergency medical service operates through toll-free numbers 112 (Federal) and 739 (Edo State), linked to the Command and Control Centre. Trained agents at the Control Centre receive emergency calls and dispatch nearby first responders to offer first aid manage the situation until an ambulance arrives if needed. The communication line between the Ambulances and hospitals will be kept open via the technology based platform in order to enable a smooth and efficient patient transportation.

Through a rigorous nomination and selection process, the Community-Based First Responders were selected from across each local government area within the pilot regions. They underwent a six-day comprehensive training from a specialized curriculum developed for Edo State, including practical drills and live simulations of emergency scenarios, furthermore they were equipped to promote enrollment of citizens in the Edo State Health Insurance Scheme to boost health insurance adoption in the state.

 

CHALLENGES AND SOLUTIONS

Implementing Community-Based First Response(CBFR) and Emergency Medical Services (EMS) involves several challenges and risks. A major challenge faced in the communities at the initial stage of implementation, was a wrong perception about the Ambulances. Ambulances were perceived primarily as vehicles for transporting deceased individuals to the morgue. This cultural bias made Emergency Medical Response (EMR) seem foreign due to the lack of prior service provision. As a way of curbing this challenge, Contextual promotional campaigns were carried out to create awareness and to educate the community about the benefits of EMS and reduce cultural biases. These campaigns helped to integrate EMS into the community’s perception as a valuable and life-saving service.

Other potential risk factor alongside the mitigation actions implemented includes:

• Risk of inadequate talent to implement project, data shortages, vehicle inadequacies. In order to mitigate this factor, Community-based recruitment, MOUs with stakeholders, thorough pre-project assessment and relevant capacity building were implemented.
• Risk of harm or injury to CBFRs and paramedics, social tensions, unrest and gender discrimination. Implementation of extensive training programs for CBFRs on scene safety, the use of personal protective equipment (PPE), and crowd control measures was used to control this factor.
• Risk of technology or communication failures and data transfer leading to slow/delayed response, poor technology adoption, cyber security risks. Multiple communication channels and data backups, low-data requirement channels for emergency requests, adherence to NDPR guidelines, contextual promotional campaigns was implemented.
• Risk of the abuse of EMS system by patients, extortion by CBFRs. Implementing a strong triage, closely tying the system to health insurance enrollment, appropriate financial incentives and participation disincentives for CBFRs was a strategy used to limit this factor.

READ MORE

• How Edo EMS is Setting New Standards for Emergency Medical Services in Nigeria

 

RESULTS AND IMPACT

As a result of significantly raised public awareness about Edo EMS services and the importance of health insurance, good amount of cases were being attended to, about 20-30 cases per week. Also, health screenings provided valuable insights into the community’s health, facilitating timely interventions.

Recent emergency responses, including the efficient handling of a teenager’s collapse on Siluko Road, Egor Local Government Area, and assistance provided during flooding incidents at Upper Ekewan Road, garnered praise from the residents, highlighting the efficacy of Edo EMS services even in challenging circumstances. As a result, there has been a notably significant increase in call rates, with a 36% rise observed between March 24th and May.

The project is expected to drive the enrolment of community members in the Edo Health Insurance Scheme (EDHIS) for financial sustainability. The joint efforts of EMS staff, CBFRs, and community members demonstrated a commitment to improving emergency. Edo State is committed to leading the way as the first state to implement this innovative model as a framework for unlocking access to the Emergency Medical Transport (EMT) gateway.

 

CASE STUDIES

 

Case Study: Victim and First Responder Experiences, and System Improvements

 

Case Study 1: Victim’s Experience

A teenage boy collapsed/fainted at siluko road at Egor local government Area. Upon dialing emergency services, the callers experienced a rapid response from the CBFRs, who arrived within minutes. The paramedics provided immediate care, stabilizing the patient’s condition and ensuring he was transported to the nearest health center efficiently. The by-standers and witnesses appreciated the professionalism and empathy shown by the responders, which significantly reduced their anxiety during the crisis.

 

Testimonials from Beneficiaries

• “Thank you for responding. We are grateful. We didn’t know what to do in an emergency, but now we do.”
• “The response was more than 100%. You guys really tried. I must commend the effort of the response team.”
• “We are grateful. We are grateful. I will continue calling when necessary to promote the service.”
• “Thank you very much for your help. It means a lot. My daughter is very fine, and we are happy we got the help we needed.”
• “The medic was knowledgeable. My friends and neighbors were so surprised and kept asking for your service number. I really appreciate you guys.”

 

Case study 2: First Responder’s Experience

One of the Community Based Responders on the scene highlighted the importance of clear communication and efficient resource management. He noted that the real-time traffic data provided by the dispatch center helped them navigate to the scene quickly.

 

Case study 3: Analysis of system improvements and efficiencies gained through the project.

System Improvements and Efficiencies Gained;

1. Implementation of an Advanced Dispatch System: A tech solution for dispatching and responding to cases was.  This allows emergency cases to be monitored and tracked end-to-end, providing real-time updates from the patient’s location to the hospital. The introduction of a new dispatch system that integrates traffic data allowed EMS teams to reach the scene faster and allocate resources more efficiently.
2. Improved Communication Protocols: New communication protocols were established to ensure that all responding units and agencies had access to the same real-time information via the dispatch app, facilitating better on-scene coordination.
3. Mental Health Resources for First Responders: Recognizing the stressful nature of such incidents, Edo EMS implemented additional mental health support resources like incentives for the most active CBFRs, including weekly Data allowance or movie tickets and a refresher course to handle the issues of learning decay.

These improvements have resulted in quicker response times, more efficient use of resources, and better care for victims, enhancing the overall effectiveness of Edo EMS system.

LESSONS LEARNED

 

Key insights on what worked well;

1. Efficient Communication Channels: The use of advanced communication systems, including real-time dispatch information from the Dispatch App, allows for the proper management of emergency cases. This system synchronizes the movement of paramedics, ambulances, and CBFRs with the Responder App, and handles special real-time hospital requests via the Hospital App. These integrated tools have significantly improved response times and coordination among teams.
2. Training and Preparedness: Training for the Community Based First Responders, drills and simulations for the paramedics ensured that first responders and paramedics are well-prepared and capable of handling various emergency scenarios effectively. 167 community based first responders (CBFRs) were selected from each pilot local government and trained in basic first aid.
3. Collaborative Approach: Collaboration with Edi International, University of Benin Teaching hospital, Edo specialist Hospital and Bethel Faith clinic, the Nigerian Police, and other ministries such as The Edo State Ministry of Health, Ministry of Security and public Safety, the Edo State Health Insurance Commission and the Edo State Primary Healthcare Development Agency, facilitated a hitch free transition of care and resource allocation.
4. Community Engagement: Edo EMS Awareness Walks; The Edo Medical Emergency Services (EMS) conducted strategic initiatives in May to enhance awareness and utilization of emergency services in the Egor, Ikpoba-Okha, and Oredo LGAs of Edo State. Our primary objective was to promote the use of the 112 and 739 emergency numbers. This effective measures taken by the marketing team brought about awareness and responses towards the initiative.

Areas for Improvement;

1. Data Integration and Sharing: The integration of data from different sources (e.g., hospitals, emergency services) needs improvement to streamline patient care and ensure that first responders have all necessary information.
2. Mental Health Support: There is a need for enhanced mental health support for first responders who experience high-stress situations, to prevent burnout and improve overall well-being. The initiative to tie the Community Based First Responders’ monthly stipend to three criteria (4 EDOHIC registration a month,5 community/sensitization engagements and response to at least 1 emergency case) has served as a motivation for the CBFRs to more proactive in their tasks as first responder.
3. Public Awareness and Education: While community engagement was effective, there is room to increase public awareness about the EMS system, including when and how to use emergency services appropriately.
4. Expanded Media Outreach: Spread out to more radio stations within the pilot LGAs and repeat radio engagements and awareness walks every two months.

RELATED SERVICES

• First Aid and CPR Training

 

Recommendation

The case study of the Edo EMS pilot phase reveals the critical need for emergency medical services throughout the state. It is strongly recommended that the project be extended across the entire state and eventually nationwide. Additionally, it is recommended to increase outreach efforts to include more radio stations within the pilot LGAs. Regular radio engagements and awareness walks should be conducted every two months to educate and inform the pilot LGAs about the available emergency response services.

 

CONCLUSION

The Edo EMS project has effectively leveraged technology to revolutionize emergency medical care in Edo State, setting a new standard for fast and reliable medical emergency services that save lives, particularly in underserved areas. As we continue to innovate and expand our reach, we are eager to collaborate with government entities at all levels to further enhance emergency response capabilities across Nigeria and beyond. If you’re interested in partnering with us, please reach out to us via contact@emergencyresponseafrica.com