Maternal and Child Health Journal

, Volume 17, Issue 6, pp 1038–1043 | Cite as

Emergency Obstetric Referral in Rural Sierra Leone: What Can Motorbike Ambulances Contribute? A Mixed-Methods Study

  • Sunil S. Bhopal
  • Stephen J. HalpinEmail author
  • Nancy Gerein


Giving birth remains a dangerous endeavour for many of the world’s women. Progress to improve this has been slow in sub-Saharan Africa. The second delay, where transport infrastructure is key in allowing a woman to reach care, has been a relatively neglected field of study. Six eRanger motorbike ambulances, specifically engineered for use on poor roads in resource-poor situations were provided in 2006 as part of an emergency referral system in rural Sierra Leone. The aim of this study was to evaluate the implementation of this referral system in terms of its use, acceptability and accessibility. Data were collected from usage records, and a series of semi-structured interviews and focus groups conducted to provide deeper understanding of the service. A total of 130 records of patients being transported to a health facility were found, 1/3 of which were for obstetric cases. The ambulance is being used regularly to transport patients to a health care facility. It is well known to the communities, is acceptable and accessible, and is valued by those it serves. District-wide traditional birth attendant training and the sensitisation activities provided a foundation for the introduction of the ambulance service, creating a high level of awareness of the service and its importance, particularly for women in labour. Motorbike ambulances are suited to remote areas and can function on poor roads inaccessible to other vehicles.


Maternal mortality Developing countries Sierra Leone Delivery of health care Transport 


Conflict of interest

The authors declare they have no conflict of interest.


  1. 1.
    Kinney, M. V., Kerber, K. J., Black, R. E., Cohen, B., Nkrumah, F., Coovadia, H., et al. (2010). Sub-Saharan Africa’s mothers, newborns, and children: Where and why do they die? PLoS Medicine, 7(6), e1000294.PubMedCrossRefGoogle Scholar
  2. 2.
    Khan, K. S., Wojdyla, D., Say, L., Gülmezoglu, A. M., & Van Look, P. F. A. (2006). WHO analysis of causes of maternal death: A systematic review. The Lancet, 367(9516), 1066–1074.CrossRefGoogle Scholar
  3. 3.
    Campbell, O. M. R., & Graham, W. J. (2006). Strategies for reducing maternal mortality: Getting on with what works. The Lancet, 368(9543), 1284–1299.CrossRefGoogle Scholar
  4. 4.
    Thaddeus, S., & Maine, D. (1994). Too far to walk: Maternal mortality in context. Social Science and Medicine, 38(8), 1091–1110.PubMedCrossRefGoogle Scholar
  5. 5.
    Hofman, J. J., Dzimadzi, C., Lungu, K., Ratsma, E. Y., & Hussein, J. (2008). Motorcycle ambulances for referral of obstetric emergencies in rural Malawi: Do they reduce delay and what do they cost? International Journal of Gynecology & Obstetrics, 102(2), 191–197.CrossRefGoogle Scholar
  6. 6.
    United Nations Department of Economic and Social Affairs Population Division: World population prospects: The 2008 Revision. New York; 2009.Google Scholar
  7. 7.
    Kambia Appeal. Call Di Lifesaver. Available at: Accessed January 2012.

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Sunil S. Bhopal
    • 1
    • 2
  • Stephen J. Halpin
    • 3
    Email author
  • Nancy Gerein
    • 4
  1. 1.Newcastle Upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
  2. 2.Institute of Health & SocietyNewcastle UniversityNewcastle Upon TyneUK
  3. 3.Leeds Teaching Hospitals NHS TrustLeedsUK
  4. 4.Nepal Health Sector Support ProgrammeMinistry of HealthKathmanduNepal

Personalised recommendations