The right care at the right time: strengthening emergency care in Sierra Leone

Of the approximately 45 million deaths in low- and middle-income countries each year, an estimated 54% of mortality could be addressed by the development of the emergency care system (ECS).¹ This includes the response to life threats such as trauma, serious illness due to infectious disease, exacerbations of chronic disease and other urgent presentations that may not be life-threatening, but nonetheless require time-dependent intervention. 

The World Health Organization has defined a series of essential functions for an ECS that span from prehospital care and transport, through to facility-based emergency unit care, to early operative and critical care. The Government of Sierra Leone established the country’s first emergency referral system in 2017. Between 2017 and 2021, KGHP supported the development of this emergency referral system, enabling over 73,000 patients to access timely, appropriate, life-saving care. The majority of these patients are women and children.

In 2021, the referral system was integrated into the National Emergency Medical Service (NEMS): one of few structured, fully equipped, and free-of-charge prehospital services on the African continent - and is now fully managed and funded by the Government of Sierra Leone.

Sorie Samura, previously the Referral System Coordinator for KGHP – and now managing the system directly for the government of Sierra Leone – explains its evolution:

"I’ve been working with KGHP in Sierra Leone since the Ebola outbreak there in 2014. First as a student nurse and volunteer at Connaught hospital. As a survivor of Ebola myself I was especially motivated to support other survivors to access health care services they needed, as well as supporting hospital management, looking at the broader system.

Then from 2017 the emergency referral system was established, and I started working in this team with KGHP to support its set-up. I was selected as a mentor – to pass on my knowledge and train and support deployment and hospital engagement.

Whilst working as a mentor I also completed my degree in medical laboratory in 2018. Then I became leader of the team – Referral Coordinator Manager. It was really helpful getting input from different international KGHP volunteers – all with different experiences and expertise.

Before this emergency referral system, each hospital had a different way of working. We worked with hospital management over the long-term to make them aware of the emergency referral work and understand the new system and its potential impact. It was so useful to have the data to show what a difference the system was making and who we were reaching.

The referral system supports every patient in need of referral. However, it is clear that those who benefit the most are women and children. It has a huge impact! 

Our ultimate goal was to have an established, sustainable and robust system. We have done this! We demonstrated impact and got buy-in and integrated it into the Ministry of Health – it is now fully funded by them. It is fantastic that we achieved this. The Referral Coordinator position is now a permanent post with a government contract and official cadre within the Ministry of Health and Sanitation (MoHS).

The next steps are to try and establish a referral coordinator unit in all hospitals – with formal government recognition – and the staff to have official MoH cadre.

I see the key factors that led to the successful development of this system and integration into the MoH system as both the flexibility of KGHP and the decision to select someone like myself from Sierra Leone to lead the project team. It has also been so helpful to work alongside volunteer staff with experience from other places. And the fact it is part of a long-term partnership has been really important in transforming the partnership initiative into a government system!"

¹Reynolds, T. A., H. Sawe, A. M. Rubiano, S. D. Shin, L. Wallis and C. N. Mock (2017). Strengthening Health Systems to Provide Emergency Care. Disease Control Priorities: Improving Health and Reducing Poverty. rd, D. T. Jamison, H. Gelband et al. Washington (DC).