title: Unaffordable or cost-effective?: introducing an emergency referral system in rural Niger.
abstract: OBJECTIVE
  An important investment was made in two health districts in Niger to organize an emergency referral system. This study estimates its impact and cost-effectiveness in relation with external determinants.
  
  
  METHODS
  After installing a solar radio network in the health centres, emergency calls and related data were monitored over 7 years and investment and recurrent costs for the system were estimated.
  
  
  RESULTS
  The number of emergency calls increased significantly in both districts. In 2003, the total yearly cost for the district amounted to US dollars 14,147, the cost per useful and successful call was US dollars 49 and the cost per inhabitant and per year was about US dollars 0.06.
  
  
  CONCLUSIONS
  The impressive and immediate impact on the health system, the relatively low recurrent cost and the minimal management requirements for the health service make the investment very worthwhile. Organizing emergency evacuation systems should be a priority for any health district in the world.
authors.affiliation: Belgian Technical Cooperation Agency (BTC), Brussels, Belgium. paul.bossyns@pandora.be
authors.forename: Paul
authors.initials: P
authors.lastname: Bossyns
authors.forename: Ranaou
authors.initials: R
authors.lastname: Abache
authors.forename: Mahaman Sani
authors.initials: MS
authors.lastname: Abdoulaye
authors.forename: Wim Van
authors.initials: WV
authors.lastname: Lerberghe
mesh_terms: D000552:Ambulances / Q000191:economics; D003151:Community Health Centers / Q000191:economics; D003362:Cost-Benefit Analysis / Q000379:methods; D004632:Emergency Medical Services / Q000191:economics* / Q000458:organization & administration; D017048:Health Care Costs; D006767:Hospitals, District / Q000191:economics; D006801:Humans; D009548:Niger; D017063:Outcome Assessment, Health Care / Q000379:methods; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D011845:Radio / Q000191:economics; D012017:Referral and Consultation / Q000191:economics*; D012423:Rural Health