A Malawi News investigation into the availability of ambulances in district hospitals has shown that there is a crisis of transporting referral cases and it is one of the main causes of maternal deaths.
We telephoned 10 district hospitals across the country to give us the number of ambulances they have and the population they serve.
We matched the figures with the recommended one ambulance to 50 000 people ratio.
The 10 district hospitals that we contacted are Mzimba , Nkhata-Bay, Chitipa, Thyolo, Ntcheu, Kasungu, Dowa, Mwanza, Chiradzulu and Blantyre.
Based on the population of each district and the required standard ratio of 1:50 000 we have established that the 10 districts require 104 ambulances in total to serve 5, 236, 371 people. However, it is only 39 ambulances that are running in the 10 districts leaving a gap of 65 ambulances.
Going by the ratio, it means in the 10 districts, only 1, 950, 000 people have access to ambulances leaving out 3,250,000 without access.
We also found that 26 ambulances are grounded in the 10 district hospitals thus widening the need gap. Officials said most of the ambulances had exceeded the recommended 220 000 km distance before bonding them off.
For example, we found that Mzimba North with a population of 400 000 people has only four running ambulances and another four grounded, according to the District Medical Officer Dr. Bitiel Banda.
“We need four more. The gap is a challenge because when all the four ambulances are busy, we fail to transfer cases to one facility and so we have deaths. In some cases, we delay in taking patients. We cannot afford to operate as required in an ideal situation,” said Banda adding that the ideal situation was to operate within the recommended ratio of one ambulance to 50 000. Other DHOs also confirmed the ratio.
In Chitipa, with rough and mountainous terrain in Misiku Hills and long distances between health facilities they have three ambulances against the population of 211 441. They said they needed one more ambulance. The hospital has to refer cases to Mzuzu Central Hospital which is 365 km away.
In Nkhata-Bay, DHO Albert Mkandawire, said he needed five ambulances. The population is 269 000.
With only two ambulances running, he is saved by some motor bike and boat ambulances.
With a population of 557 433 in Ntcheu, the required number is 11 ambulances but only two are running and four non running.
Kasungu needs 16 ambulances to serve a population of 826 285 but has a total of seven ambulances of which only three are running and four grounded.
As for Dowa, with a population of 732 000, it needs 14 ambulances but only three of the seven it got are running.
Blantyre District Hospital, with an estimated population of 1.2 million people and which has 28 health centres, requires 24 ambulances in an ideal situation but has only 12 of which four are grounded and most of those running exceeded the recommended 220 000 km distance.
“Most of the ambulances are an old fleet dating back to 1991. Only two ambulances have not yet exceeded the 220 000 km distance. Maintenance costs are taking a lot of our resources because the vehicles break down frequently and when they are on the road, they hardly run for a week.
For the four grounded ones, we are just waiting for recommendation for them to be bonded off,” a senior officer at the Blantyre DHO said on Thursday, adding that they had proposed for 14 runner ambulances.
Another district in the south, Chiradzulu, which has 314 059 population, requires six ambulances by the ratio but has only four running and three non running.
According to the logistics officer, a Mr Nkata, the ambulances are an old fleet which frequently breaks down and the hospital fails to serve its 13 health centres.
As for Thyolo with a population of 622 000, it requires 12 ambulances unlike the eight it received of which only five are running.
Of all the sampled districts, it is only Mwanza that has a surplus of two ambulances because with its 104 153 population, it was supposed to have two ambulances but has four.
However, according to the public relations officer there, Dikirani Chadza, two are old.
Mwanza is lucky because it got one ambulance from Vale, a company that was constructing a rail line that passed through the district.
In some hospitals like Karonga, all sick calls are not attended whenever the district health officer has traveled because he uses the ambulance as an official vehicle.
Speaking recently when TNM handed over Katili Health Centre to Karonga district council, Karonga District Commissioner Rosemary Moyo bemoaned the shortage of ambulances in her district saying there was only one and whenever the DHO uses it, as was the case during the handover, all calls are suspended.
In that situation, some patients may die while waiting for the ambulance.
Malawi Health Equity Network (Mhen) Executive Director Martha Kwataine said there is indeed shortage of ambulances but attributed it to high disease burden and inefficiencies at the primary care level where she said many referrals are made.
“We should build capacity of health centres to handle slightly complicated cases like acute malaria requiring quinine treatment by allocating enough nurses and clinicians to handle such cases so that referrals are reduced,” said Kwataine.
She also attacked some doctors in district hospitals who are lazy as they refer any cases without making attempt to deal with them, thereby adding congestion in referral hospitals leading to loss of lives and resources.
Kwataine also advised government to consider the geographical terrain of a district when allocating ambulances and not just the catchment area.
She said ambulances operating in mountainous and rough places like Misuku Hills in Chitipa have a shorter life span.
Ministry of Health spokesperson Adrian Chikumbe was yet to respond to our questions on the crisis.
Meanwhile, UNICEF has announced a donation of 60 ambulances to the Ministry of Health.
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