By STEPHEN KAPMBWE –
ROAD traffic accidents are Zambia’s third-highest cause of death after malaria and HIV/AIDS, claiming an annual average of 1,920 lives.
This is according to Road Transport and Safety Agency (RTSA) Director Zindaba Soko when he made a presentation at the Third National Road Safety Conference held in Lusaka recently.
With 13,446 fatalities recorded on Zambian roads between 2010 and 2016, the country has one of the highest numbers of road crashes in sub-Saharan Africa.
In his opening speech at the Third National Road Safety Conference which was held under the theme, ‘Towards 50 Per cent Reduction of Accidents and Fatalities by 2020, for a Better Zambia,’ President Edgar Lungu said in 2016 alone, over 2,200 people lost their lives on the roads.
That cost the economy in excess of K4 billion.
In view of the foregoing, the Government has prioritised road safety because safer roads and safer road users not only save lives but also help to reduce pressure on the country’s health systems and emergency services that have to deal with post-crash care of accident victims.
Post-crash response is pillar number five among the national activities that Zambia has developed towards meeting the United Nations General Assembly resolution which proclaimed 2011 to 2020 the Decade of Action for Road Safety.
The global goal of this resolution is to stabilise and reduce the forecasted level of global road fatalities by increasing activities conducted at national, regional and global levels.
To respond to this goal, Zambia developed five pillars, namely: road safety management, safer roads and mobility, safer road users, and lastly, post-crash response, which is the subject of this article.
The objective of pillar five is to increase responsiveness to post-crash emergencies and improve the ability of health and other systems to provide appropriate emergency treatment and longer term rehabilitation for crash victims.
The eventual goal of this objective is three-fold: avoid preventable death and disability; limit the severity of injury and the suffering caused by it; and ensure the best possible recovery and reintegration into society for crash survivors.
To this end, the World Health Organisation (WHO) has tabulated seven activities to guide member countries implement the goal of pillar five.
In his presentation at the Third National Road Safety Conference, Ministry of Health assistant director (clinical care and diagnostic services) Daniel Makawa, said the Government was  alive to the increasing burden arising from road crashes.
Dr Makawa said programmes and strategies had, hence, been put in place to implement the tabulated activities, which was why his ministry was working with other stakeholders to have a concerted response to minimising mortalities, severity of injury, morbidity, disability and economic impact on families and the nation at large.
This article will be confined to two of the implementation strategies under WHO activity number-one whose objective is to develop pre-hospital care systems, including the extraction of a victim from a vehicle after a crash, and implementation of a single nationwide telephone number for emergencies, through the implementation of existing good practices.
In responding to this, consultative meetings have been held with the Zambia Information, Communication and Technology Agency (ZICTA) and service providers with approval of the emergency line 992.
Dr Makawa said plans were also underway to set up national, provincial and district emergency communication and incident command centres.
Furthermore, the Government has not only bought response vehicles with extrication tools but has also committed itself to the provision of basic life support and advanced life support ambulances to all districts.
Basic life support is an emergency transport provided by certified emergency medical technicians, while advanced life support is provided when an accident or emergency victim is in more critical condition and a paramedic is required to assist in treatment before and or during transport to the emergency facility.
Dr Makawa said there are, currently, 207 ambulances in operation and there are plans for an additional 50 more to be acquired every year.
He further explained that the consignment for 2017 had not yet arrived in the country.
This consignment was, in fact, a subject of a parliamentary debate on Tuesday, November 14, 2017, with regards to the US$11.520.355 million tender to supply the intermediate life-saving ambulances, which was awarded to Savenda Management Services.
It had been alleged on social media and by some political players that the contract to supply the ambulances lacked transparency and that the vehicles were overpriced as the price for Land Cruisers at Toyota Zambia was much lower.
But in a ministerial statement arising from a question for oral answer that was posed by Kabompo Member of Parliament (MP) Ambrose Lufuma, Health Minister Chitalu Chilufya said the units were, in fact, not Land Cruisers as alleged but Mercedes Benz vehicles.
Dr Chilufya explained that Savenda Management Services had transparently been awarded the tender to supply and deliver 50 purpose built Mercedes Benz high-roofed, equipment-mounted ambulances with modernised emergency and mobile medical equipment at a unit price of US$143,110, totalling US$7,155.500 million.
The package included five-years’ service and provision of service parts for ambulances inclusive of both mobile platform and the medical equipment at a cost of US$3.649.305 million, and training of 20 mechanics, 50 drivers and 100 medical staff at US$715, 550, bringing the grand total to US$11.520.355 million.
“In March 2015, an open international competitive tender was floated which attracted 13 responses. The due process was followed after the bids were opened, including the Ministry of Health institutional ministerial procurement committee approvals, due diligence, technical and financial evaluations,” Dr Chilufya said.
He said upon completion of the due process, the submission was made as prescribed by law to the Zambia Public Procurement Committee for approval, and after a lengthy and due process, Savenda Limited was awarded the contract to supply the total package at US$11.520.355 million.
The Government has so far paid 25 per cent of the total cost as follows: 10 per cent in 2015 and 15 per cent in 2016 for the units which are yet to be shipped.
“At an appropriate time, Government will send a technical team to perform pre-shipment inspection to assure value for money on the final product. The Ministry of Health remains committed to providing effective and high quality services and looks forward to improving its mobile and emergency health services to the Zambian people because every life counts,” Dr Chilufya said.
He urged politicians not to politicise the acquisition of the ambulances which he described as sophisticated and, actually, mobile theatre facilities on wheels.
Dr Chilufya explained that the ambulances were versatile four-by-four vehicles which would reach any part of Zambia and had enough room for paramedics to carry out their work while in transit.
The minister also clarified that, contrary to what was being alleged, Toyota Zambia did not participate in the tender which had very clear specifications.
“It is important to mention that Toyota Zambia did not participate in this tender. And Government is not aware that the same ambulances, including other services which were included in the specifications, are available at Toyota Zambia,” he told Parliament.
He further said companies responded according to their strength and stressed that Savenda Management Services was not even the most expensive among the bidders who responded to the advertisement.
Dr Chilufya explained that the process of building an ambulance had various stages which, eventually, determined the cost.
These included the base vehicle – which in the current case is a Mercedes Benz – height and versatility.
“There are levels, whether it is basic life support, intermediate life support or advanced life support. The comparison should be between ambulances in the same category. There are ambulances that cost as much as US$350,000,” the minister said.
He said the issue of cost could not be a deterrent in any equipment that would save people’s lives.
After all this explanation by Dr Chilufya, said it ought to be noted, as observed by National Road Fund Agency (NRFA) Director Wallace Mumba during the the Third National Road Safety Conference, that “…reduction of fatalities is not an RTSA, clinical, or single-agency issue, hence the need for a multi-sectoral approach…”
In this vein, NRFA has targeted construction of 20 toll plazas in 2017 and 40 in 2018, and, to shorten the response time to road crash scenes, ambulances will be stationed at these plazas.
The acquisition of the ambulances will, consequently, go a long way in Government’s efforts to accelerate post-crash response.
A Ministry of Health team has already approved a prototype for the 50 ambulances and the process is underway to finalise shipping.