A community-based ambulance model

Lessons for emergency medical services and everyday health systems resilience from South Africa

Bibliographic Data

ID15127410
AuthorsLiam Brady (0000-0001-9571-2817, University of Cape Town, corresponding author), Lucy Gilson (0000-0002-2775-7703, University of Cape Town), Asha George (0000-0002-5968-1424, University of the Western Cape), Shaheem De Vries (0000-0003-3986-1652, Western Cape Department of Health and Wellness , Cape Town 8000), Shakira Hartley (Western Cape Department of Health and Wellness , Cape Town 8000)
Year2024
Volume39
Issue9
Pages956-969
Publication date2024-10-15
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Policy and Planning (JOURNAL)
Journal identifiersISSN: 0268-1080 • E-ISSN: 1460-2237
PublisherOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czae070
PMID39092537
OpenAlexW4401280658
LanguageEN
Citations received1
References cited37

The role of the emergency medical service (EMS) is changing globally as ambulance crews respond to a shifting burden of disease, as well as societal stressors such as violence and inequality. New ways of thinking about how to provide emergency care are required to shift EMS from a role primarily focused on clinical care and transporting patients to hospital. In this paper, we present the experience of the Philippi Project (PP), an innovative community-based model of care developed by front line ambulance crews in a low-income neighbourhood in Cape Town, South Africa. Our insights were developed through observational, interview and document review work, within an overall embedded research approach. Our analysis draws on the everyday health systems resilience (EHSR) framework, which sees resilience as an emergent process that may be stimulated through response to stress and shock. Responses take the form of absorptive, adaptive or transformative strategies and are underpinned by system capacities (cognitive, behavioural and contextual). We consider the PP as a potentially transformative resilience strategy, defined as a new way of working that offered the promise of long-term health system gains. We found that the PP’s initial development was supported by a range of system capacity attributes (such as the intentional development of relationships, a sense of collective purpose and creating spaces for constructive sense-making). However, the PP was hard to sustain over time because emergent ways of working were undermined both by other capacity attributes rooted in pre-existing organizational routines and two contextual shocks (Coronavirus and a violent incident). The paper adds a new empirical contribution to the still-small EHSR literature. In addition, the PP experience offers globally relevant lessons for developing community-based models of EMS care. It demonstrates that front line staff can develop creative solutions to their stressful daily realities, but only if space is created and protected

Community resilience · Constructive · Economic growth · Economics · Health care · Political science · Process (computing) · Psychological intervention · Psychological resilience · Public relations · Sensemaking · Sociology · Systems thinking · Transformative learning · Computer Science · Disaster Management and Resilience · Disaster Response and Management · Health Policy Implementation Science · Medicine · Nursing · Psychology · Social Psychology