Ethiopia

WISCONSIN-MOH ETHIOPIA EMS EVALUATION
(2009 - 2010)

Excerpt From Semi Report To Ethiopian Ministry of Health

It is our pleasure, as Stanford Emergency Medicine International (SEMI), to submit a report to the Ministry of Health (MOH) in support of their efforts to develop a comprehensive Emergency Medical Services (EMS) plan for Ethiopia. The purpose of our report is to delineate goals and provide recommendations for EMS development in Ethiopia with specific focus on Addis Ababa. We have included key recommendations and lessons learned from our experience with EMS development in other nations. Our observations may hopefully serve as an adjunct to the current technical working draft (being developed by the EMS task force), which has appropriately identified objectives for the initiation of a coordinated EMS system. We are honored to participate in this collaboration and appreciate the support from both the Ministry of Health of Ethiopia and the non-profit organization People-to-People.

A comprehensive EMS system is a critical component of national public health and safety. EMS is integral to the patient safety net, healthcare accessibility, and disaster management. In most developing nations, steady progress has been made in vital areas such as providing access to clean water and sanitation facilities, and combating infectious diseases. Unfortunately, new public health challenges have arisen, most prominently severely limited access to quality emergency medical care.

Traumatic, cardiovascular, and obstetric emergencies continue to be leading causes of morbidity and mortality in most developing nations and the impact of these diseases on the overall health of the population is rising dramatically. Well functioning EMS systems can dramatically curb the impact of these diseases. For example, traumatic injuries from road traffic accidents are a leading cause of death worldwide in individuals under the age of 45 years old. A disproportionate number of these deaths, up to 90%, occur in low-income nations. A person suffering traumatic injuries in a developing nation would have a six-fold greater chance of dying than a person with similar injuries in a developed nation.

Furthermore, the World Health Organization (WHO) highlighted the importance of obstetric emergencies by setting the reduction of maternal and neonatal mortality as one of only eight millennium goals. The WHO goes on to recommend the presence of skilled attendants at deliveries as a primary method of decreasing morbidity and mortality in this population. In 2005, an estimated 22,000 women within Ethiopia died due to causes “related to or aggravated by pregnancy or its management,” including childbirth. This accounts for 28% of deaths among females of reproductive age. EMS can greatly improve access to skilled medical providers during medical emergencies.

The current state of prehospital emergency care in Addis Ababa, Ethiopia is outlined in our report. To summarize, EMS in Ethiopia is severely limited. There is no single, well-established toll-free emergency telephone number, no centralized EMS dispatch center, only a few, scattered, ill-equipped ambulances, and no standardized training for prehospital personnel. In response to the current state, the Ministry of Health (MOH) in Ethiopia has formally identified the development of emergency medical services as a priority. By recognizing EMS as an essential service alongside Fire and Police, the MOH has taken a critical initial step in improving medical care in Ethiopia. Further efforts currently underway at reforming EMS include a national EMS technical working group and the initiation of a medical specialty in emergency medicine.