Recommendations for policy

Transport interventions must be implemented alongside other initiatives to increase the demand for services.

Transport is a single component in the complexity of issues surrounding the accessibility of prenatal and emergency obstetric care. The use of transport to access services differs by ethnicity, caste, economic status and gender (Molesworth, 2002). Other factors such as the perceived quality of care, the cost of services, and the ability to recognise complications are also important factors that affect the demand for transport and utilisation of health services.

Governments, donors and non-governmental organisations need to work directly with communities to identify obstacles to transport and the most appropriate ways of overcoming these.

When communities are involved in planning for emergencies, including the preparation of delivery plans, mobilising resources, and strengthening the referral chain, they are less likely to delay the decision to seek care. The participation of communities also means that transport arrangements are appropriate and socially acceptable.

The factors that affect women’s decision and ability to use transport to access maternal health services are context specific. This means that scaling up or replicating successful interventions may not work unless these complex social and cultural factors are taken into consideration.

Transport should be affordable and financially sustainable

Community saving schemes have been useful ways of sharing the costs of transportation during emergencies, although problems have occurred when funds are depleted. Some women may be excluded from these schemes if they cannot afford to contribute towards them.

It is important to ensure that policies and interventions reduce, rather that perpetuate existing inequities in access to services. It is the responsibility of local and national governments to target interventions such as providing free emergency transportation for the poorest people.

Interventions should be planned as part of a long-term integrated health and transport strategy

Maternal health and transportation systems are interdependent and must by planned and implemented together, along with communication systems to connect all levels of care. Strengthening transportation and referral systems may be rendered useless if health facilities cannot provide appropriate high quality care or supplies are not available.

Governments should build on and improve existing transport and health networks

Governments should consider upgrading strategically located and established primary health care centres to provide EmOC services. This reduces the distance and makes it easier for women to identify services, and is more cost effective than building new clinics. Using existing transport networks has been a successful strategy in increasing access to transportation in areas where there is no public transportation.

Better evaluation of the effects of transport interventions and improved transportation systems on access to preventative and emergency maternal health services is required

Building up an evidence base about the impact of transport interventions on maternal health makes it easier to demonstrate the link between transport and maternal health and convince governments, donors and international organisations to invest in this sector. It also enables successful interventions to be replicated or scaled up providing that they are suitably adapted to local contexts.