Ensure continuity of emergency life-saving referral services in Idleb and Aleppo governorates - Envelope 1 In NWS the access to healthcare services is interrupted in many areas as a result of the unavailability of referral services and the effects of conflict produced increased burden of disease and poor health conditions, so this project aims to reduce mortality and morbidity rates among the critical cases from most vulnerable groups, by providing life-saving emergency referral services for 11 months to 12,749 beneficiaries through Sham ambulance system in Idleb and Aleppo governorates.

This project will provide emergency patient referrals and COVID-19 emergency referrals through 12 pre-existing ambulances (3 first aid amp 9 cardiac) serve the health facility and surrounding communities, each ambulance will operate 24/7 through two shifting teams, and each team consists of one paramedic with advanced first-aid experience and one driver with basic first-aid experience, within this project, the ambulances will be provided with operating/running costs including fuel, maintenance, and cleaning materials, etc.

1) Emergency patient referrals:
6 equipped ambulances with qualified staff will provide emergency referral services in Salqin (1), Dana (2), Janudiyeh (1), Bulbul (1), and Raju (1), amp transport critical cases between levels of care, cross-border, Hospitals, and other health facilities, in Salqin amp Dana sectors we'll have 2 female paramedics with one morning shift and this feature is being provided only by AHF.

2) COVID-19 emergency referrals:
The COVID19 referral system is a part of COVID19 preparedness and response plan for NW Syria and it was established to facilitate patient transportation for emergency and not urgent medical suspected, probable, and confirmed cases through ambulances and non-emergency patient transportation vehicles respectively and it is coordinated by a referral desk and supported through a referral capacity building.
The referral system links all initial stations, PoEs, referral Hospitals, CCTCs, and other HFs, it links between 9 PoE, 28 CCTCs, and 11 Isolation hospitals. 
The project activities will contribute to strengthening COVID-19 referral system by operating 6 ambulances with IPC trained staff in Salqin (2), Dana (2), Janudiyeh (1), and Afrin (1), the ambulances will transport COVID-19 cases between PoEs, referral Hospitals, CCTCs and other HFs, and the project will cover a scale-up in COVID-19 emergency referrals for the anticipated 2 months peak for COVID-19.

The ambulances will be attached to existing health facilities and parked at them in Dana, Afrin, and Raju, but in Salqin, Janudiyeh, and Bulbul the facilities work for one daily shift or have no space for the ambulance staff, so the ambulances will be parked in AHF's rented garages near the HFs, AHF uses the same communication system with the health directorates, the ambulances dispatcher receives the requests from hospitals, PHCs, CCTCs, other HFs, and communities, and dispatches the nearest available ambulance based on need/situation, the community can access the ambulances through different methods include emergency WhatsApp groups, approaching the nearest health facility in the area, the radio frequency of ambulances and health facilities using a walkie-talkie, calling a landline in the areas where landlines are still operational, and the availability of the services will be known through posters and coordination with LCs, RCCE teams in the locations.
All ambulances will register all facilitated cases, case-by-case, the data clerk receives and compiles the data of all ambulances and reports to the field coordinator, who will review and cross-check the data with ambulance registers randomly, and the referral system operations are coordinated with several partners and donors under the umbrella of the health cluster and the supervision of WHO PHC technical officers.

The referral services of this project will strongly integrate with other HFs and other referral service providers, and internally integrate with AHF HFs.