Logistics is one of the greatest problems in global health. Often when a person becomes ill, the help they require is available somewhere but they are unable to access it in time. Many people die because they are simply in the wrong place at the wrong time.
My youngest sister, Busola, was 12 years-old when she died because there was no air ambulance in Nigeria at that time to enable her to get to a specialist facility quickly.
I set up my company, the Flying Doctors Nigeria, a leading pan-African air ambulance company and the first indigenous air ambulance company in Nigeria, to solve this problem.
According to the Association of Air Medical Services, almost 100 million people in the US would not be able to access emergency healthcare without air ambulances. In Africa, where there are fewer healthcare professionals, an under-developed road infrastructure, smaller healthcare budgets and often huge distances between specialist medical facilities; the number of people that cannot access emergency healthcare without an air ambulance is much higher.
Provision of specialist healthcare (building, equipping and running hospitals) is very expensive. Healthcare budgets in Africa are often lower than 0.1% of their counterparts in the developed world. Therefore, specialist care must be centralized, allowing the bulk of the budget for specialist care to be deployed into very few hospitals. This allows more efficient use of scarce resources; human capital and money.
The high volumes of complex medical cases such as congenital heart disease will allow the doctors to specialize in these procedures and also produce economies of scale with regard to equipment, expertise, research and data.
Centralization of specialist healthcare allows us not just to do more with less, but to do better with less.
The British Medical Journal states that the centralization of specialized healthcare services is typically characterized by reorganization of healthcare services into fewer specialized units serving a higher volume of patients, and aims to improve patient outcomes and efficiency.
Dr Ole Tjomsland is director of quality at the Regional Health Authority in Norway; a country that has drastically improved health outcomes through centralization. He argues that centralization is simply in the best interests of patients. He claims that it just isn’t possible to provide consistently high-quality procedures in smaller, fragmented hospitals with low volumes.
There are three types of delay that are relevant to almost every medical emergency:
– Delay in recognition of life-threatening symptoms
– Delay in transportation
– Delay in in-hospital treatment
But whilst a great deal of time, policy and investment is directed at the first and last of these, the second, logistics, is largely neglected.
Air ambulances can vastly improve a healthcare system’s response to emergencies. Increasingly air ambulances serve medically and geographically-isolated populations in new ways. This includes primary through to tertiary care without the need to build new clinics, hospitals or critical care centres.
The Flying Doctors Nigeria Air ambulance service has worked across 10 African countries for nearly 10 years, providing essential, life-saving aeromedical transportation services. Our innovative systems and processes allow us to deliver this service at as low as 10% of the cost of similar services around the world.
Conversations at the World Economic Forum for Africa 2017 centred around inclusive growth. As we deliberate, it will be important for us to bear in mind that a population’s individual and collective health status directly affects a nation’s economic development.
Governments simply must take health seriously if they wish to sustain and advance socioeconomic outcomes. Empirically, high levels of population health go hand-in-hand with high levels of growth and income.
African countries face an increasingly complex set of medical challenges. An ageing population, lifestyle diseases such as diabetes and cancer, as well as the unfinished business of infectious disease. Most of the interventions for these diseases will take place in the community, primary care centres, or in the home.
However, in emergency situations, patients will need to access specialized care swiftly and efficiently. This is where air ambulances provide an essential lifeline.
There can be no truly inclusive growth without inclusive healthcare: healthcare provided through systems that allow every citizen to access medical care in a regional/national specialist hospital with minimal delay.
Inclusive growth means ensuring that there are far fewer cases of children like my sister Busola, who died simply because she was in the wrong place at the wrong time and there was no transportation to enable her access to specialist care.
*Ola Orekunrin is Managing Director, The Flying Doctors