If I call, will it really come?

I am now more than half way through my internship with the Ministry of Health (MOH) in Ghana where I am working on a research project to evaluate barriers to access of the country’s ambulance service. Since 2001, when a deadly stadium collapse killed 127 people and revealed weaknesses in the country’s medical emergency services, Ghana has invested in improving its emergency care. One of the critical programs in this area is the National Ambulance Service (NAS). The service started in 2009 to provide free emergency medical transport. Over the years the service has expanded beyond the main cities in Accra and Kumasi and into every region in the country. The number of ambulances are still woefully inadequate, but the MOH continues to plan expansions of the service. In preparation for this expansion and to understand how the service can better serve the public, the MOH is collaborating with researchers at the University of Michigan and Emory University to asses the barriers to access of the country’s ambulance service. The research seeks to do two things 1.) describe the attitudes and knowledge that the general public has toward NAS; and 2.) gauge the validity of the survey as a tool to be used in assessments of ambulance services in similar situations.

Over the past seven weeks, I have been able to explore all parts of Accra with my Advanced EMT colleague from NAS. After spending two weeks piloting the survey, we now spend late mornings and early afternoons interviewing all kinds of people. Having spent time considering health systems from afar and at a high level it is now refreshing to be hearing from members of the general public how they experience their healthcare. From these interactions, I have begun to appreciate the challenges that face any new health service.

In Ghana there is considerable mistrust of government services. Ghanaians are accustomed to government services that are inadequate and poorly resourced. A common concern voiced in the interviews is whether an ambulance will really come if it is called. If it is to be successful, NAS must focus on building trust in the service by proving to the public that it can provide quality and timely care. If the service is seen to be efficient then nearly all Ghanaians we have spoken to would be glad to access an affordable emergency care service. But until they hear examples from their friends and neighbors of lifesaving emergency care provided from the ambulance service, most will be reluctant to put their trust in the new system. This emphasizes to me the importance of brand management. Whether in relation to a health system, pharmaceutical company, or any product for that matter, whether people want to use it is equally if not more important than whether they can use it. This of course, isn’t a new insight, but does remind me that while good design and implementation are important for delivering a quality product, without proper marketing to drive demand all is for naught.

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