The impact of community-based transport intervention on Emergency Obstetric and Newborn Care (EmONC) access and response times in two underserved districts of Ghana

Background: Timely access to Emergency Obstetric and Newborn Care (EmONC) remains a persistent challenge in low-resource settings, where transportation barriers continue to delay care and increase maternal and neonatal mortality. In rural Ghana, districts such as Gushegu and Nkwanta South face prolonged delays in reaching health facilities. This study evaluates community-based transport interventions, focusing integration of Modified Motor-Tricycle Ambulances (MMAs) into the National Ambulance Service (NAS) and their impact on emergency response times and EmONC access. Methods: A retrospective cross-sectional quantitative design was employed, utilizing secondary data from Emergency Dispatch Centers established under the Developing Acute Care and Emergency Referral Systems project. The analysis covered 548 emergency transport cases, including 346 managed by NAS ambulances and 202 by Integrated Motor-Tricycle and NAS Ambulances (IMNAs). Independent samples t-tests were conducted to compare 5 key performance indicators: case turnaround time, response time, handling time, facility turnaround time, and vehicle engagement period. Results: IMNAs achieved faster average response times than NAS ambulances (30.9 vs. 42.9 minutes, P < 0.001) and significantly reduced facility turnaround times (12.5 vs. 28.9 minutes, P < 0.001). They also exhibited shorter vehicle engagement periods (196.4 vs. 239.4 minutes, P = 0.002), improving case throughput. NAS ambulances, however, recorded shorter crew waiting times (8.5 vs. 20.2 minutes, P = 0.004), reflecting greater dispatch coordination. Although not directly measured in this study, potential operational factors influencing IMNA performance, such as road conditions, vehicle maintenance, and fuel availability, warrant further investigation. Conclusion: Integrating MMAs into Ghana’s National Emergency Medical Services structure enhances emergency response efficiency in underserved regions. The substantial reduction in response and facility turnaround times supports their role as a valuable complement to conventional ambulances. Policy recommendations include scaling up MMA operations, strengthening dispatch coordination, and improving operator training to sustain timely access to life-saving maternal and neonatal care.