A Systematic Review of Motorcycle Ambulance Voucher Schemes and Their Impact on Facility-Based Delivery Rates for Obstetric Emergencies in the Mountainous Regions of Lesotho

Geographical barriers in Lesotho’s mountainous regions hinder timely access to emergency obstetric care, contributing to high maternal mortality. Motorcycle ambulance voucher schemes have been implemented as a community-based transport intervention to address this problem. This systematic review aimed to synthesise evidence on the impact of motorcycle ambulance voucher schemes on facility-based delivery rates for obstetric emergencies in the mountainous regions of Lesotho. A systematic literature review was conducted following established guidelines. Multiple electronic databases were searched for relevant peer-reviewed and grey literature. Studies were screened against pre-defined inclusion and exclusion criteria. Data were extracted, study quality was appraised, and a narrative synthesis was performed due to heterogeneity in study designs and outcomes. The search yielded a limited number of studies. The available evidence, while not robust, suggests a positive association between the voucher scheme and increased facility-based deliveries. One programme evaluation indicated the scheme was perceived to reduce financial and logistical barriers and fostered greater community trust in the referral system. Motorcycle ambulance voucher schemes show potential as a feasible intervention to improve access to emergency obstetric care in remote, mountainous settings. However, the current evidence base is insufficient to draw definitive conclusions regarding their impact on facility-based delivery rates. Further high-quality, mixed-methods research is required to rigorously evaluate the impact of such schemes. Programme implementers should integrate robust monitoring and evaluation frameworks from the outset to strengthen the evidence base for policy and practice. maternal health, emergency obstetric care, transport voucher, motorcycle ambulance, access to healthcare, Lesotho, systematic review This review consolidates fragmented evidence on a critical intervention for maternal health in hard-to-reach areas, highlighting evidence gaps and informing future research and programme design.