Cost-efficient evaluation of ambulance services for community critical care transport needs in Machakos County, Kenya

Abstract

Background: Machakos County is one of the 47 counties in Kenya. In the current study performance of ambulance services were measured using indicators such as response time, on-scene time, clients’ satisfaction and cost-efficiency (technical). Objectives: To determine the cost-efficient ambulance services appropriate for community critical care transport needs in Machakos County. Design: Descriptive cross sectional study. Setting: Machakos County (Emergencies Services Department) Subjects: Publically financed ambulances Results: Machakos has seventy Basic Life Support (BLS) ambulances distributed among the 69 administrative locations (wards). A total of 12,674 victims were transported to different tares of hospital and referrals between March 2014 to May 2015. Victims requiring emergency obstetric care (EMOC) accounted for 24.7% of victims transported, road traffic accidents victims10.3% and the least were rape victims at 0.03%. The annual operational cost was Kshs. 70,328,627 (USD 717,639.05). Expenditure profiles indicated that staff wages accounted for 49% of total operational cost,overheads costs accounted for 33.5%, while office rent accounted for 1.36%. The mean unit cost per kilometer was Kshs. 30.9 (USD 0.32) and cost per victim transported by an ambulance was Kshs. 6,504 (USD 66.37). Key demand factors were social cultural and health seeking behaviours of residents. The supply barriers were transport costs, operational costs and in-efficient signage on roads for direction. The mean cost-efficiency (technical) of Machakos ambulance transport services was 90.6% (C.I 82.7% - 98.2%). Conclusion: Machakos County Government ambulance services was technically efficient operating.