Low ambulance availability at health facilities and disparity across regions in Ethiopia: a cross-sectional health facility level assessment

Background: Lack of well-functioning referral and quality of the service are challenges for many of the developing countries health care system. This study evaluated the referral transport services for maternal and newborn care in Ethiopian health facilities. Methods: The study used 2016 Ethiopian Emergency Obstetric and Newborn care assessment data. All public and private health facilities that provided maternal and newborn health services were included in the study. The data analysis was done on a total of 3,804 facilities. Results: Overall, in this study only 17% (95% CI: 16-18) of health facilities had their dedicated functioning ambulance (motor vehicle, motorcycle, or tricycle ambulance). Among these, reports of using the ambulance for non-emergency transport were common. Use of the ambulance for transporting client’s home was reported by 48% (95% CI: 44-52) of facilities. A total of 62% health facilities provided by district health offices. Hospitals/MCH centres had almost 5 times (95% CI: 3.16, 7.12) more likely to have ambulance on-site compared with health centres/speciality clinics. The urban-based health facilities were three times (aOR =2.86, 95% CI: 2.29, 3.58) more likely to have ambulance onsite than their counter. Availability of ambulance on-site in public facilities was found to be 80% and 63% less to that of private owned and private-for-profit health facilities. Facilities that didn’t provide onsite obstetric surgery were also less likely to have an ambulance on-site. There was no significant difference in ambulance availability for the facilities that have referred in/out and in the provision of 24/7 service for emergency obstetric and newborn care. There is no relation between institutional delivery and availability of ambulance on-site (ρ=0.14). Conclusions: In this study, low ambulance availability for emergency referral for maternal and newborn cases in Ethiopian facilitates was observed. There is a disparity in the availability of Ambulance onsite by regions facility location and type of health facility. No effect of referral transport service on-site availability on institutional deliveries was noted. An ambulance is mandatory for interconnected health centers to hospital referrals. However, this needs to be backed up with an adequate supply of basic and emergency obstetric care at all facilities.