Elsevier

Resuscitation

Volume 65, Issue 1, April 2005, Pages 15-19
Resuscitation

Emergency medical services in Zimbabwe

https://doi.org/10.1016/j.resuscitation.2005.01.008Get rights and content

Abstract

Emergency medical services in Zimbabwe are of a very variable standard, and exist in many forms:

  • Reasonably well-developed urban emergency medical services systems mixed with very poorly resourced and under-developed rural services.

  • Very high patient workloads, with severely ill medical patients and a large proportion of major trauma and multiple-casualty situations (public safety is given a low priority, and public transport is poorly regulated).

  • Long emergency response times and patient transport distances.

  • Somewhat under resourced and under developed emergency departments, with large numbers of critically ill acute patients, as well as many non-emergency/chronic patients who have no other access to appropriate health care.

This paper provides a description of the development of ambulance services and acute health care in Zimbabwe, and outline the current demands on the system. Particular reference is made to the City of Harare Ambulance Service, which is considered to be the most developed of the local authority services.

Section snippets

Background

Zimbabwe is a landlocked country in Southern Africa, bordered by South Africa, Botswana, Mozambique and Zambia. The country has an estimated population of 12.9 million, of which approximately 50% live in urban or suburban areas. Harare, the capital city, is located in the north-eastern quarter of the country, and has a population of about 1.8 million. Zimbabwe is a country rich in natural and mineral resources, and much of the country's income comes from the export of tobacco, cotton,

Health and welfare

The World Health Organisation estimates the life expectancy at birth at 37.9 years; the child mortality rate (probability of dying under 5 years of age, per 1000) is 111. The very high prevalence of HIV is the most likely cause of this. In 2002, UNAIDS estimated that approximately 33% of the adult population of Zimbabwe was HIV positive. In reality, the figure is likely to be much higher, especially in the urban areas. Clinicians have estimated that in the region of 70% of persons attending

Pre-hospital care

Until recently, there was no statutory requirement for either the state or local authorities to provide any sort of emergency medical service. This said, there are essentially four models of ambulance services in Zimbabwe:

  • 1.

    Local authority services.

  • 2.

    Government, hospital or clinic based services.

  • 3.

    Private services operated by mines, large estates, etc.

  • 4.

    Private/for profit services.

Until relatively recently, the public perception of an ambulance service has been that of a means of getting people to

Regulation

A national registration system for ambulance personnel was provided for in the revision of the Health Professions Act in 2001. Under this scheme, personnel could register with the Allied Health Practitioners Council of Zimbabwe. In the past, there was no legislation covering grades of training and protecting titles. This was used to great advantage by private services, which publicised that they employed ‘paramedics’. A three-tier system was developed, based largely upon the South African

Access to emergency medical services

A national emergency number (‘999’) has been in operation since the 1970s. This is free from fixed telephones and in urban areas is answered either in the regional telephone exchange by untrained operators, who transfer the call through to the appropriate services (police, fire or local authority ambulance). In rural areas the call goes through to the nearest police station; the police then have the responsibility of passing the call through to other services or coordinating a response to any

Dispatcher training and call prioritisation

This is very variable. In places where there are very few resources, there are no dispatchers. In busier and more developed services, dispatchers are trained in-house. Brand-name systems such as Advanced Medical Priority Dispatch System (AMPDS) are too expensive to use fully in Zimbabwe, so services develop their own priorities and pre-arrival instructions (if any). This is clearly an area that needs to be developed and improved in the future.

Response times

There are no national targets for response to emergency calls—services generally set their own. The City of Harare Ambulance Service requires that an ambulance (if available) is dispatched within 2 min of the receipt of an emergency call.

Ambulances often have to travel long distances – The City of Harare has four stations covering a population of approximately 2 million people, but calls outside the City Limits are very common – it is not unusual for ambulances to respond to calls within a 100

Clinical

There are a great many clinical problems that ambulance personnel in Zimbabwe have to face that would be considered extreme in any ‘developed’ country. Ambulance crews in the advanced services – such as The City of Harare and MARS, and to a lesser extent in the other local authority services – are trained and equipped and have the necessary experience to handle these specific problems. These include:

Hospital services

Rural, district and small urban hospitals have no dedicated accident and emergency department—patients are seen in either the wards or the outpatients clinic when they arrive, and are more often than not treated and either discharged or admitted by nursing staff. It is rare for one of these centres to have more than one doctor available around the clock, and in many instances, patients will only be seen by a doctor the following day. Seriously ill or injured patients will be discharged as soon

The future

Despite the rather dismal picture described above, the majority of people in the ambulance services—state, local authority and private are eager to see the profession develop, with a unified sense of purpose and a desire to meet acceptable international standards. However, in a collapsing economy, this is not always easy—availability of basic resources such as fuel have to be redressed before issues of equipment and drugs and disposables can be dealt with. There has been a great deal of talk in

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