Challenges and effectiveness of emergency transportation systems in improving access to maternal health service: a systematic review.

Project Description This research project is a systematic review titled “Challenges and effectiveness of emergency transportation systems in improving access to maternal health service: a systematic review.” Purpose Maternal mortality remains a critical public health challenge in sub‑Saharan Africa, with Ghana continuing to face significant barriers to timely access to emergency obstetric care. Weak emergency transportation systems contribute to delays in reaching health facilities, increasing the risk of preventable maternal deaths. The purpose of this review is to synthesize evidence on the types of emergency transportation systems used in Ghana, the challenges they face, and the innovations that have improved maternal referral outcomes. Methods The review follows PRISMA guidelines and uses the Three Delays Model as a conceptual framework. A comprehensive search was conducted across PubMed, CINAHL, JSTOR, Scopus, EMBASE, and supplementary sources such as Google Scholar and WHO Library. Eligible studies include those published between January 2010 and December 2024 that report on emergency maternal transport in Ghana. Quality appraisal was conducted using Joanna Briggs Institute (JBI) tools and the Mixed Methods Appraisal Tool (MMAT). Data extraction focused on study design, population, referral means, barriers, facilitators, and effectiveness. Expected Outcomes Evidence synthesis: A consolidated overview of Ghana’s emergency maternal transport systems, including formal ambulance services and community‑based initiatives. Identification of barriers: Documentation of infrastructural, logistical, financial, and governance challenges that hinder effective emergency referrals. Highlighting innovations: Analysis of enabling factors such as community tricycle ambulances, Sustainable Emergency Referral Care (SERC), Community Emergency Transport System (CETS), and digital communication platforms like WhatsApp‑based referral systems. Policy relevance: Recommendations for scaling effective interventions, integrating digital tools, and strengthening community engagement. -Global contribution: Insights that inform maternal health system strengthening efforts across sub‑Saharan Africa and support progress toward the sustainable Development Goal 3.1—reducing global maternal mortality to fewer than 70 deaths per 100,000 live births by 2030. Significance By systematically analyzing the challenges and effectiveness of emergency transportation systems, this project will provide actionable evidence for policymakers, health administrators, and researchers. The findings will guide strategies to improve maternal survival, reduce referral delays, and strengthen Ghana’s emergency obstetric care framework.