Motorcycle ambulances for referral of obstetric emergencies in rural Malawi: do they reduce delay and what do they cost?
OBJECTIVE
To assess whether motorcycle ambulances placed at rural health centers are a more effective method of reducing referral delay for obstetric emergencies than a car ambulance at the district hospital, and to compare investment and operating costs with those of a 4 wheel drive car ambulance at the district hospital.


METHODS
Motorcycle ambulances were placed at 3 remote rural health centers in Malawi. Data were collected over a 1-year period, from October 2001 to September 2002, using logbooks, cashbooks, referral forms, and maternity registers.


RESULTS
Depending on the site, median referral delay was reduced by 2-4.5 hours (35%-76%). Purchase price of a motorcycle ambulance was 19 times cheaper than for a car ambulance. Annual operating costs were US dollars 508, which was almost 24 times cheaper than for a car ambulance.


CONCLUSIONS
In resource-poor countries motorcycle ambulances at rural health centers are a useful means of referral for emergency obstetric care and a relatively cheap option for the health sector.
Liverpool School of Tropical Medicine, Liverpool, UK. hofmanjj@liverpool.ac.uk
Jan J
JJ
Hofman
Chris
C
Dzimadzi
Kingsley
K
Lungu
Esther Y
EY
Ratsma
Julia
J
Hussein
D000552:Ambulances / Q000191:economics*; D003365:Costs and Cost Analysis; D004632:Emergency Medical Services / Q000191:economics*; D005260:Female; D006767:Hospitals, District; D006801:Humans; D008295:Malawi; D009049:Motorcycles / Q000191:economics*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics / Q000628:therapy*; D012017:Referral and Consultation / Q000191:economics*; D019035:Rural Health Services / Q000191:economics*; D013997:Time Factors