Evaluating the Impact of a Motorcycle Ambulance Voucher Scheme on Facility-Based Delivery Uptake in the Mountainous Regions of Lesotho

Geographic inaccessibility remains a significant barrier to facility-based deliveries in the mountainous regions of Lesotho, contributing to high maternal mortality. While transport voucher schemes are a proposed intervention, robust evidence of their impact in such terrain is scarce. This study evaluated the impact of a community-based motorcycle ambulance voucher scheme on the uptake of facility-based deliveries for obstetric emergencies in Lesotho’s remote highlands. A mixed-methods, quasi-experimental design was employed. Quantitative data on delivery location were collected from health facility records in intervention and matched control areas. Qualitative data were gathered through focus group discussions with voucher users, traditional birth attendants, and healthcare workers to understand implementation and perceived value. Analysis indicates a positive association between the voucher scheme and increased facility-based delivery rates. Quantitatively, a 22% increase in the proportion of deliveries at health facilities was observed in intervention areas compared to control areas. Qualitatively, the scheme was perceived to reduce transport time and financial burden, though challenges regarding vehicle availability during extreme weather were reported. The motorcycle ambulance voucher scheme appears effective in improving geographic access to emergency obstetric care in mountainous settings by addressing key financial and logistical barriers. Programme planners should consider scaling the scheme to other remote districts, with strengthened logistical support for reliable all-weather service. Further integration with community health worker programmes is recommended for improved voucher distribution and awareness. maternal health, emergency transport, voucher scheme, geographic access, Lesotho, motorcycle ambulance, facility-based delivery This study provides novel evidence on the operational effectiveness of a motorcycle ambulance voucher system in a mountainous, low-resource African setting.