Accessing Public Perception Of The National Ambulance Service, Ghana

Abstract

Emergency Medical Services (EMS) are widely recognized as having an essential role in the prevention of preventable deaths and improved health outcomes in case of critical emergencies. In Ghana, the establishment of the National Ambulance Service (NAS) was a strategic step towards strengthening the country's healthcare delivery system, particularly through the provision of prehospital emergency care. Despite laudable progress in enhancing ambulance numbers and national coverage, there is public opinion about NAS that is controversial, based on a mix of admiration for its ability to save lives and deep skepticism about its efficiency, accessibility, and acceptability. Against this background, the present study aimed to assess public opinion towards the National Ambulance Service in an effort to understand how trust, communication, socio-cultural values, and urban–rural differences shape utilization. Qualitative research methodology was used in order to facilitate in-depth analysis of community experiences and meanings surrounding NAS. Semi-structured interviews were conducted in six purposively selected communities with differing contexts: Bongo, Salaga, and Kete Krachi as rural, and Takoradi, Madina, and Bantama as urban. This format provided a balanced comparative view for comparing both structural and cultural dimensions. Data were subjected to systematic coding, open, axial, and selective, and yielded the derivation of five broad thematic categories. The analysis was also enriched by basing the findings on viable theoretical frameworks, including Diffusion of Innovations Theory (Rogers, 2003), Health Belief Model (Rosenstock, 1974), Theory of Planned Behavior (Ajzen, 1991), Service Quality (SERVQUAL) Model (Parasuraman, Zeithaml & Berry, 1985), Social Construction of Technology (Bijker, Hughes & Pinch, 1987), Trust and Confidence Theory (Luhmann, 1979), Systems Theory (Bertalanffy, 1968), and Risk Perception Theory (Slovic, 1987). The study revealed five strong and interconnected findings. In the first, ambulances were universally needed but not trusted. In both urban and rural settings, the ambulance was described by participants as "the difference between life and death" but also expressed distrust in the form of postponement, capricious reliability, and fear of hidden costs like requesting donations of fuel. Second, the ambulance was culturally positioned both as a sign of death and a lifeline of hope. While residents from urban areas tended to give favorable reports of lives saved, rural communities tended to stigmatize ambulances as "death cars," cultivating hesitation to call NAS. Third, 112 hotline distrust and communication barriers persisted as a common problem, with city residents complaining of unanswered calls and rural residents mentioning blatant unfamiliarity with the toll-free number, compounded by weak mobile network reception. Fourth, affordability and access obstacles undermined utilization, as certain communities were asked to pay for gas and others avoided NAS due to fears of sneaky charges or slow response in congested city traffic. Finally, differential access inequities across urban and rural environments were apparent: while urban communities had public visibility of ambulances but grumbled about inefficiency, rural communities grumbled about structural exclusion, bad road conditions, and a virtual absence of stationed ambulances. Theoretically, the findings are in agreement with and extend earlier studies. The Risk Perception Theory (Slovic, 1987) explains the paradox where citizens perceive NAS as saving lives yet avoid it due to perceived inefficiency. The Health Belief Model (Rosenstock, 1974) highlights insufficient "cues to action" in rural areas where awareness of the hotline is low. Theory of Trust and Confidence (Luhmann, 1979) places the way in which repeated service failure drains fragile public trust, but single positive experiences are not enough to balance inherent inefficiencies. Social Construction of Technology (SCOT) Theory (Bijker et al., 1987) illustrates the way that cultural understandings redefine the use of ambulances as a hearse in some communities and as a life-saving technology in others. Along with this, Systems Theory (Bertalanffy, 1968) demonstrates how unevenness in road infrastructures, allocation of ambulances, and communications systems worsens the overall functioning of the EMS system. All the theories together provide an interdisciplinary lens for locating community perception of NAS in broad contexts of trust, behavior, culture, and systemic performance. The study contributes to empirical and conceptual insight. Empirically, it fills a gap in Ghanaian research by putting analysis based on the community at the forefront of NAS, going beyond service statistics and rhetoric of policy to engage in the realities of living citizens. Conceptually, it takes a step further in incorporating cultural construction, risk perception, and trust in analysis of emergency healthcare services in low- and middle-income contexts. Through a fusion of empirical data and theory, the research clarifies that an understanding of NAS is both a reflection of the effectiveness of services and co-produced by cultural stories, structural disparity, and fragile trust relationships. The research summarizes that NAS is regarded as necessary but inadequate. Urban residents hear it but doubt its quality, while rural residents hear of it but doubt its accessibility. This paradox undermines the legitimacy of the service and limits the service from being an accepted public good for all. To solve these challenges, several recommendations are offered. These are: enhancing geographic reach in rural and underserved areas; strengthening communication infrastructure and availing guaranteed 112 hotline connectivity; overcoming cultural stigmas by working with chiefs, elders, and religious leaders; enhancing transparency to address the concerns about hidden expenses; enhancing professional visibility and training of EMT staff; and integrating ambulance accessibility into overall health and transport infrastructure development. Subsequent research needs to examine mixed-methods approaches, longitudinal studies to track shifting attitudes, cross-regional comparison across Sub-Saharan Africa, and the facilitator functions of digital technologies such as GPS monitoring and telemedicine in building trust in EMS delivery. In summary, this study identifies that the Ghana National Ambulance Service is at a crossroads: while symbolically recognized as a valuable pillar of emergency medicine, it is also silently undermined by inefficiencies, cultural stigma, and institutional disparities. Closing the gap does not only need to involve operational reforms but also culturally aware communication campaigns, deliberate trust-building programs, and systemic integration within Ghana's broader healthcare and infrastructural networks. It is only at that point that NAS can transition from being needed but distrusted to widely accepted and trusted lifeline for all in Ghana.