Feasibility and Acceptability of Modified Motor Tricycles as Rural Ambulances for Maternal and Child Referral Transport in Northern Ghana

Abstract

Background: In Ghana, maternal mortality still ranks as a major public health concern. The obstacles to obtain emergency obstetric care add greatly to maternal mortality.
Objective: This paper studies the acceptance, feasibility, and impact of community-managed tricycle ambulances in three districts in North East Region of Ghana districts.
Methods: A mixed-methods design was employed, with 200 community members surveyed, 40 health workers interviewed, 25 local leaders, and 15 tricycle drivers. This was complemented by focus group discussions. Quantitative data were analyzed using descriptive statistics, cross-tabulation analyses, chi-square tests and t-tests Quantitative data were obtained using using document review and analyzed via descriptive statistics, cross-tabulations, chi-square tests, and t-tests, while qualitative data were transcribed, coded and thematically analyzed.
Results: Tricycle ambulances were acceptable and more affordable than conventional ambulances. Affordability perceptions were strongly associated with household income (χ² = 12.4, p < 0.01;). Willingness to use modified motor-tricycles ambulances (MMTAs) for maternal emergencies was high, with 68 percent of households saying they would do so, and with 74 percent feeling that MMTAs were culturally appropriate; education level associated significantly with willingness (χ² = 9.8, p < 0.05). Referral travel time dropped from 90 minutes to 40 minutes--a 55.6% decline that was statistically significant (t = 8.7, p < 0.001). Qualitative accounts of dignity, confidentiality, and felt community ownership were major promoters of uptake.
Conclusion: Community-managed tricycle ambulances are feasible, culturally acceptable, and effective in shortening maternal health
referral lags. Policy integration and sustainability strategies are recommended to scale this innovation nationally.