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Dispatchers At Work

Digitalisation of ambulance service streamlines emergency care in Kyrgyzstan

Until recently, the ambulance service in Osh struggled to provide timely, reliable emergency care. Long waits were routine, and residents lost faith in a crucial service. A new ambulance information system, developed with German support, is making the work of emergency teams more efficient.

When someone is involved in a serious accident or becomes acutely ill, every second counts. Prompt emergency care can mean the difference between life and death, between a return to health and a life-long disability. It’s no wonder, then, that residents of Osh, Kyrgyzstan’s second-largest city, were sometimes frustrated with the local ambulance service. Until recently, it could take a long time for emergency teams to arrive on the scene, especially during peak hours.  

Complaints from citizens would ultimately reach the desk of Sultanov Mirbolat, the director of the Osh City Emergency Medicine Center, which oversees ambulance services. But since September 2023, when he and his colleagues began using a digital system to manage the work of emergency teams, the number of complaints has fallen. Emergency teams are getting on the road faster – and arriving on the scene more quickly.  

‘The new system has improved the quality of services we provide to residents of Osh,’ says Sultanov Mirbolat. ‘People now have much faster access to medical help in emergencies.’

Sultanov Mirbolat
Sultanov Mirbolat

Kyrgyzstan works to modernise its ambulance services

 Ambulance services are an essential part of integrated emergency care systems. According to the World Health Organization, these encompass care provided at the scene of an accident or illness, during patient transport, and at the emergency unit of a health facility. Globally, it is estimated that more than half of deaths which occur every year in low- and middle-income countries could be prevented with effective pre-hospital and facility-based emergency care. 

As part of the national health strategy Healthy Person – Prosperous Country, the Ministry of Health of Kyrgyzstan has committed to modernise the country’s ambulance services to address gaps in the provision of emergency care.  With support from the German Federal Ministry for Economic Cooperation and Development (BMZ), the E-Health Center of Ministry of Health has overseen the development of a new ambulance information system for the city of Osh which will eventually be used to manage the work of emergency teams across Kyrgyzstan. 

‘The successful digitalisation of the Osh ambulance station is a good example for other regions of Kyrgyzstan and for other Central Asian countries as well,’ says Sadarbek Karimov, a technical advisor with the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) which implemented the measures on behalf of BMZ. 

The new ambulance information system at a glance

According to official statistics, Osh has a population of 294,000 people; unofficially the city is home to more than twice this number. On a typical day, dispatchers at the Osh City Emergency Medicine Center receive anywhere between 80 and 110 emergency calls. They coordinate the movements of 12 ‘brigades’ – teams comprising a driver, an emergency doctor and a feldsher (paramedic) – which work in 24-hour shifts, directing them to addresses and the scenes of accidents spread across a 75-square-kilometer area.

The core functions of the Osh City Emergency Medicine Center have not changed as a result of digitalisation, but the way information is received, captured and shared is now fundamentally different. Time consuming paper-based processes have been replaced by a digital interface which dispatchers, the senior physicians on duty, and members of emergency teams can access simultaneously at their computers or via their mobile phones.

The former paper-based system has been replaced by a fully digital one The former paper-based system has been replaced by a fully digital one
The former paper-based system has been replaced by a fully digital one © GIZ/Vladislav Ushakov

Dispatchers at the central ambulance station now receive incoming calls via Internet telephony, rather than over landlines. The system automatically logs the exact time and duration of incoming calls, and records them for future reference. Speaking over hands-free headsets, the dispatchers enter the details of the call into a digital record in their computers, rather than writing it down by hand on a paper form, as they previously did. This allows the senior physician on duty to monitor incoming calls from his or her own work station and to make faster decisions about which emergency team should be assigned to respond. A real-time map showing which teams are available, and where each team is located, makes it possible to assign teams strategically based on the urgency of the call. Assignments go out via electronic notifications on a mobile app, rather than over the radio, enhancing both speed and transparency. As a result of these changes, the time taken to register a call and dispatch an emergency team has dropped from an average of 11 minutes previously to just five minutes now.

Emergency doctors responding on the scene now record details about the call-out – for example, the patient’s condition, assistance or medications provided, need for follow-up – directly into an electronic record which they access through their smartphones. Thanks to built-in templates and voice recognition software, this now takes as little as 5 minutes per call-out. On average, each emergency doctor now spends up to one hour per 24-hour shift on reporting, compared to up to three hours per shift previously.

Taking an ‘agile’ approach builds ownership

The IT team which led the work used an ‘agile’ approach to the design and development of the new system. They sought feedback from the staff at the Osh City Emergency Medicine Center and officials at the E-Health Center at each critical juncture. This helped to secure buy-in from the dispatchers and emergency doctors who would eventually use the system on a daily basis, as well as from the officials at the E-Health Center who would ultimately be responsible for maintaining, updating and replicating the system elsewhere. According to Anatoly Chumakov, the Deputy Director of the E-Health Center, the process was a valuable opportunity to accompany the development of a health-related IT system from initial idea through development, piloting and roll-out.

Learning to complete the electronic call-out card
Learning to complete the electronic call-out card

 Once a demo version of the information system was ready, the IT team trained 160 doctors, feldshers (paramedics), dispatchers, drivers and administrative staff at the Osh City Emergency Medicine Center how to access and work with the system. ‘It was challenging at first to complete the electronic records, especially for the older employees,’ Sultanov Mirbolat recalls. ‘It took a lot of training and on-the-job support to build their comfort with the new system.’ Once they embraced it, however, the quality of their work improved. Thanks to built-in prompts, drop-down menus and automatic validations, the software has helped to reduce mistakes and omissions.

‘The biggest problem with the implementation of IT systems in development projects is future sustainability,’ says Felix Shapiro, the IT consultant and performance improvement expert who led the technical aspects of the work. ‘Sustainability becomes possible when an organisation takes ownership of the changes that have been introduced. It’s a big achievement that the dispatchers and doctors feel ownership for this new system,’ he continues. ‘We demonstrated to them the value of this system and they accepted it.’ 

Results to date:  A faster, more reliable ambulance service – and a data ‘gold mine’

From September 2023, when the new system went live, until the end of January 2024, the station responded to 12,193 calls. During this time, the proportion of emergency teams dispatched on time (defined as within 20 minutes of the incoming call) rose from 83 to 88 per cent. In just over half of cases, ambulances were on the road within 5 minutes of the incoming call. Faster dispatching translates into faster arrivals: over this period, the proportion of ambulances which arrived on the scene within 15 minutes climbed steadily.

The system is not only faster, but it is also more reliable. ‘Primary health care teams now know that they can count upon an ambulance to arrive in 20 to 25 minutes if a woman with a high-risk pregnancy needs to be transferred to the hospital,’ explains Damira Seksenbaeva, a technical advisor with the GIZ Promotion to Primary Healthcare project, which supported the development of referral linkages between primary health care facilities and other health institutions in Osh.

The new information system also generates a wealth of data. Standardised reports showing call-outs by date, time of day, age and sex of the patient, address, and nature of the emergency help the management of the Osh City Emergency Medicine Center provide better, more responsive services. They can see, for example, where the addition of more teams during peak hours could help to bring down waiting times, or where the creation of local ambulance hubs might better serve people in areas of the city which are difficult to reach quickly from the central station.

In addition, the diagnostic codes which emergency doctors now record in the electronic call-out cards are like a gold mine for public health experts and health system planners. The geospatial mapping of diagnostic codes, for example, can potentially reveal localised disease outbreaks. Analyses of the diagnostic codes can also reveal how other parts of the health system are working. If many calls come from people with chronic conditions, for example, it suggests a need to reconsidered how such patients can be better managed at primary health care level. 

Digitalisation as an opportunity for system strengthening 

The digital transformation of ambulance services in Osh took more than two years of careful planning, development and piloting. The aim was not simply to develop a software solution to replace the previous paper-based one, but to consider the requirements of the ambulance system as a whole and how the information which it generates could eventually be integrated with other health information systems. From the beginning, in line with the aspirations of the government’s Digital Kyrgyzstan 2019-2023 roadmap, there was a commitment to build a system flexible enough – i.e. using open source elements – that it could be adapted to the needs of other cities in Kyrgyzstan whose ambulance services might be organised differently.  

Following the successful experience in Osh, this moment has now arrived. With additional support from BMZ, the E-Health Center and Ministry of Health now plan to adapt the ambulance information system for use in the neighbouring regions of Batken and Jalalabad, where ambulances are linked to hospitals rather than managed through independent emergency medicine centers. ‘With modest resources, and using only local expertise, it has been possible to generate a big impact,’ says GIZ’s Sardarbek Karimov. Kyrgyzstan’s home-grown ambulance information system is about to take a big step forward.

Karen Birdsall
March 2024

© GIZ
© GIZ/Vladislav Ushakov
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