New York City Department of Health and Mental Hygiene, New York, NY, USA.
University of Basel, Swiss Tropical and Public Health Institute, and Ghana Health Service, Accra, Ghana.
Glob Health Sci Pract. 2016 Dec 28;4(4):552-567. doi: 10.9745/GHSP-D-16-00253. Print 2016 Dec 23.
Although Ghana has a well-organized primary health care system, it lacks policies and guidelines for developing or providing emergency referral services. In 2012, an emergency referral pilot-the Sustainable Emergency Referral Care (SERC) initiative-was launched by the Ghana Health Service in collaboration with community stakeholders and health workers in one subdistrict of the Upper East Region where approximately 20,000 people reside. The pilot program was scaled up in 2013 to a 3-district (12-subdistrict) plausibility trial that served a population of approximately 184,000 over 2 years from 2013 to 2015. The SERC initiative was fielded as a component of a 6-year health systems strengthening and capacity-building project known as the Ghana Essential Health Intervention Program. Implementation research using mixed methods, including quantitative analysis of key process and health indicators over time in the 12 intervention subdistricts compared with comparison districts, a survey of health workers, and qualitative systems appraisal with community members, provided data on effectiveness of the system as well as operational challenges and potential solutions. Monitoring data show that community exposure to SERC was associated with an increased volume of emergency referrals, diminished reliance on primary care facilities not staffed or equipped to provide surgical care, and increased caseloads at facilities capable of providing appropriate acute care (i.e., district hospitals). Community members strongly endorsed the program and expressed appreciation for the service. Low rates of adherence to some care protocols were noted: referring facilities often failed to alert receiving facilities of incoming patients, not all patients transported were accompanied by a health worker, and receiving facilities commonly failed to provide patient outcome feedback to the referring facility. Yet in areas where SERC worked to bypass substandard points of care, overall facility-based maternal mortality as well as accident-related deaths decreased relative to levels observed in facilities located in comparison areas.
尽管加纳拥有组织完善的初级卫生保健系统，但缺乏制定或提供紧急转诊服务的政策和指导方针。2012 年，加纳卫生局与社区利益攸关方和卫生工作者合作，在上东部地区的一个分区启动了一个紧急转诊试点项目——可持续紧急转诊护理（SERC）倡议，该倡议为大约 20000 人提供服务。该试点项目于 2013 年扩大到一个 3 个区（12 个分区）的可行性试验，该试验在 2013 年至 2015 年期间为大约 184000 人提供了为期 2 年的服务。SERC 倡议是作为加纳基本卫生干预项目这一为期 6 年的卫生系统加强和能力建设项目的一个组成部分实施的。使用混合方法进行实施研究，包括对 12 个干预分区的关键过程和卫生指标进行随时间的定量分析，并与对照区进行比较，对卫生工作者进行调查，以及对社区成员进行系统定性评估，提供了有关该系统有效性的资料以及运营方面的挑战和潜在解决方案。监测数据显示，社区接触 SERC 与紧急转诊量的增加、对未配备或未配备手术护理能力的初级保健设施的依赖减少以及能够提供适当急性护理的设施的病例量增加有关（即区医院）。社区成员强烈支持该计划，并对该服务表示赞赏。还注意到一些护理协议的遵守率较低：转诊机构经常未能向接收机构通报输入患者，并非所有转运的患者都有卫生工作者陪同，而接收机构通常未能向转诊机构提供患者结果反馈。然而，在 SERC 努力绕过服务标准较低的地方，与位于对照区的设施相比，整体基于设施的产妇死亡率和与事故相关的死亡率都有所下降。
