Gaps and priorities in prehospital emergency services in Addis Ababa, Ethiopia: A mixed-methods assessment

Background Emergency Medical Services (EMS) in Addis Ababa, Ethiopia, operate across fragmented public, private, and non-governmental sectors with limited coordination, mirroring challenges faced by many urban systems in low- and middle-income countries (LMICs). This mixed-methods study evaluated stakeholder and provider perspectives to identify barriers and priorities for strengthening the prehospital care system in Addis Ababa. Methods We conducted a convergent mixed-methods needs assessment in Addis Ababa between June and July 2025. Thirteen semi-structured interviews were conducted with key EMS stakeholders from government, non-governmental organization (NGO), and private sectors, complemented by a 47-item survey distributed to 70 prehospital providers. Sixty-five complete responses were analyzed, including 46 in Amharic and 19 in English. Quantitative data were summarized descriptively, and qualitative transcripts underwent thematic analysis using a structured coding matrix, with findings integrated across major EMS system domains. Results Six overarching domains emerged: resource constraints, workforce and training challenges, dispatch and communication inefficiencies, inter-provider coordination gaps, limited public trust and awareness, and digital readiness barriers. Survey respondents cited poor road conditions, weak communication systems, ambulance maintenance issues, inadequate advanced medical equipment, and workforce turnover as major obstacles. While 86% (56/65) reported centralized dispatch systems, operations relied largely on manual phone-based coordination and paper documentation. Digital adoption was viewed favorably, with 75% (49/65) expressing strong support for national platform integration, although poor internet connectivity, limited device access, and low digital literacy were common barriers. Conclusion Addis Ababa’s prehospital EMS system faces interconnected infrastructure, workforce, coordination, and digital implementation challenges. Strengthening referral governance, standardized training, improving ambulance and communication infrastructure, and pairing digital innovation with workforce and connectivity support may improve EMS coordination and access. While survey findings primarily reflect public-sector provider perspectives, integration with stakeholder interviews across public, private, and NGO sectors offers actionable insight into priority areas for EMS strengthening in Addis Ababa.