The “crawling Ambulance”: An opportunity for Public-Private Partnerships to reduce ambulance anxieties for pregnant women during labor

Whenever public-private partnerships (PPP) are mentioned in the health sector, what easily comes to mind is health financing or pharmaceuticals. However, there are many other possible ways of improving health, especially maternal and child health, by investing in prompt referral through PPP. It is widely accepted that, there is a relationship between mobility, power and wellbeing.

Earlier this year, the government of Ghana procured and distributed ambulances to deprived districts that lacked appropriate referral transportation systems. The transport intervention gave priority to maternal and child health cases where these patients were transported at no cost. Before long, these ambulances remained barely used, ‘slowly crawling’ on the dusty roads.  Funding for fuel was scarce and vehicle maintenance rare. This strategy was clearly not sustainable, causing health workers and patients to continue to worry about the future of healthcare referral.

Every day, approximately 800 women die from preventable causes related to childbirth and pregnancy (WHO). Although there have been increasing interventions to reduce the incidence, these figures are still unacceptably high. Many reasons account for the increasing number of deaths, including the role of transportation for emergency referral. A medical model suggested that there are three main delays that affect maternal mortality: delays in decision making to seek help, delays in transportation to health institutions and delays of care within health facilities. (Turner)

Transportation for referral is usually unavailable in most communities due to poor management, inadequate resources and other factors enable for this languid ambulance system.

The majority of women still deliver at home, with rising numbers for communities without access to health posts. And when patients decide to seek care, the only available means of transportation are often walking or using bicycles, causing only further delays (Turner).  Could partnering with the private sector make transport faster?

It is uncommon to find big companies managing private means of transportation in Ghana and most developing countries. Taxis and mini vans used for short-to-medium commuting are owned by individuals. A partnership with these private vehicle owners can greatly improve referral in various ways:

  1. Faster referrals: Private vehicle owners who live in communities are familiar with routes and have the right type of vehicles for the terrain to transport patients on time.
  2. Reliability: Private drivers are more likely to respond to emergency calls once there is a direct economic return for them.
  3. Affordability: Depending on the number of clients referred at a given time, health facilities can negotiate for cheaper transportation cost than the prevailing market price.
  4. Enhanced financial transparency and management with the transportation system will occur due to the more efficient nature of private sector operations.
  5. Sustainability: Once both parties (health facilities and transport owners) maintain their promises, PPP for referral would be ideal to reducing the delay in accessing care and thus, improve maternal and child health.


[i] Jeff Turner; Maternal Health and Transport- a need for action

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