Cost-Efficient Assessment of Ambulance Services for Community Critical Care Transport Needs in Machakos County, Kenya

Abstract

Throughout the world, performances of ambulance services are measured using indicators such as technical efficiency, response time, on-scene time and clients’ satisfaction. The aim of this study was to establish whether ambulance service offered by Machakos County were cost-efficient. The study also determined knowledge, attitude and practice of community towards the ambulance services; costs associated with ambulance services as well as identifying the demand and supply transport barriers. A mixed study design was conducted. Multistage sampling was carried out to recruit household’s respondents. The technical efficiency scores were computed using Data Envelopment Analysis (DEA) Programme, version 2.1 (DEAP 2.1).The results was based on two inputs (cost incurred on vehicles and medical consumables) and one output (number of kilometers covered monthly by an ambulance). The household survey results demonstrated that residents were aware of free ambulance services, 30-39 years 31.5% (95% CI=26.95-36.05) was the dominant population of which majority had 1- 3 children 66.3% (CI=61.67-70.93). It was reported by majority that the ambulance services were accessible, available and efficient to those who sought them. Between the periods starting March 2014 to May 2015, a total of 12,674 clients were transported by ambulances from the locations to various tires of hospitals, Majority 24.7% (95% CI=23.95-25.45) were in need of emergency obstetric care (EMOC). Annual operational cost was Kshs. 70,328,627; staff salaries 49% (95% CI=48.99-49.01), overheads costs 33.5%and 1.3% for space. The key demand factors were; social cultural, health seeking behaviors and political patronage while supply barriers were; transport costs, operational costs and in-efficient signage. Machakos County Government was operating at an average technical efficiency of 90.6% (95% CI=82.70-98.30). Machakos County ambulance services were operating efficiently (technically), however effort were needed to procure four wheel drive vehicles and advanced life service ambulance.