In response to the serious challenges associated with emergency referral, the Ghana Essential Health Intervention Programme (GEHIP), launched a new program know as Sustainable Emergency Referral Care (SERC) initiative. SERC, a health systems strengthening project, seeked to implement a comprehensive emergency referral and transportation program designed to address financial, logistical, and cultural barriers to care. SERC was implemented in three of the most remote and impoverished districts in the Upper East Region of Ghana.
The initiative was scaled up from one pilot sub-district to 12 sub-districts, serving a total population of approximately 123,750. Much of the population is isolated from raods or transportation systems, electricity, or other development amenities. Poor road conditions, environmental challenges, and extreme poverty complicated efforts to improve health and contributed to delays in reaching care in these intervention areas.
SERC tested the hypothesis that a contextually adapted approach to strengthening emergency referral systems at the community and sub-district levels would improve access to care and rewduce risk in rural, impoverished communities. Recognizing the importance of community engagement and partnerships with local organizations, the SERC model promoted close collaboration with all stakeholders throughout the various phases of the planning, implementation, and evaluation processes.
A 5-month pilot test of the emergency referral program was conducted in March 2012 in one sub-district of Bongo district. Lessons learned from a qualitative appraisal of the pilot informed the scale up strategy for SERC, which was officially launched in three districts in July 2013.