Pre hospital emergency medical services in Maharashtra: primary survey and analysis of response times, care provisioning, user experience and expectations from the PPP project

Background: Pre-hospital emergency medical services (PHEMS), have a positive impact, the health outcomes of trauma and accident cases, but, can be relatively inefficient and wasteful. PHEMS are generally operated on a public private partnership (PPP) basis and the inherent inefficiencies can be attributed to the structural arrangement. Objectives: This paper examines the efficacy - response times, service provisioning and user experience, of PHEMS in Maharashtra (108 MEMS) to provide recommendations to improve sustainability. Methods: A primary survey covering 230 respondents across six locations in Maharashtra, India, was undertaken. Official project data across sample months was also analyzed. Results: Response time were inconsistent and exceeded 30 minutes in 25% of the emergencies. The service provider, was however, in compliance to the service level expectations, due to the defined computation methodology in the contract. The quality of services and the behavior of the staff were rated satisfactorily; by the respondents, however the ambulance infrastructure, maintenance and timeliness of services were rated below satisfactory. Findings also suggested ‘potential misuse’ of PHEMS for primary care and basic maternal transportation needs, with no ‘corrective action’ from the service provider to optimize usage. Conclusion: PHEMS PPP projects are constrained due to inflexible contract and predefined set service levels, leading to inherent inefficiencies and risk of moral hazards. Contracts should allow private provider to innovate, develop strategies to perk up response times and minimize ‘potential misuse’. Further options to operationally integrate similar schemes like 108 and 102 ambulance services, can be considered to make projects sustainable