Effectiveness of a village emergency care model: a pilot intervention in rural Tanzania

Emergency services are essential to comprehensive primary healthcare (PHC) and resilient health systems. Prior to December 2021, such services were largely unavailable at the PHC level in Tanzania. To address this gap, we designed and piloted the village emergency care (VEC) model in a rural Tanzanian village. This study evaluates the VEC model's effectiveness 1 year after implementation.

A before-and-after sequential mixed-methods design was used. A community survey assessed changes in emergency care access among 191 participants at baseline and 270 postinterventions. Quantitative data were analysed using descriptive statistics and Pearson's χ² tests to assess preintervention and postintervention differences at a 5% significance level. Qualitative insights were obtained through three interviews with village leaders and healthcare providers, and one focus group with 10 community members, including members of the village health committee, at each phase. The primary outcome was perceived change in access, encompassing availability, acceptability, accommodation, affordability and physical accessibility. Secondary outcomes included awareness, satisfaction and perceived barriers. Qualitative data were analysed thematically.

Availability of emergency services increased from 61.0% to 84.4% (χ²=22.47, p<0.001), satisfaction from 12.0% to 88.5% (χ²=187.6, p<0.001) and awareness from 90.1% to 97.0% (χ²=9.03, p=0.003). Cultural barriers declined from 17.3% to 5.2% (χ²=18.56, p<0.001). Perceived affordability rose from 9.0% to 51.1% (χ²=56.91, p<0.001), however, cost remained a barrier, rising from 16.0% to 35.5% (χ²=4.81, p=0.028). Qualitative findings underscored greater awareness and trust in services but identified persistent financial barriers, particularly for high-cost treatments like antivenom. Health insurance coverage remained limited, with many relying on out-of-pocket payments.

The VEC model significantly improved awareness, satisfaction and access to emergency care in a rural PHC setting. Expanding insurance literacy and coverage, alongside cost transparency and future cost-effectiveness analyses, is recommended to support equitable national scale-up.