Background: A well-functioning referral system is characterized by an efficient use of transportation and management of resources, and quality clinical management of referred cases. This study evaluated the referral transport services for maternal and newborn care in Ethiopian health facilities.

Methods: The study used 2016 Ethiopian Emergency Obstetric and Newborn assessment. The survey was a cross-sectional census of public and private health facilities that provided maternal and newborn health services. The final data analysis was done for 3,804 facilities.

Results: Overall, only 17% of facilities had their own dedicated functioning ambulance (motor vehicle, motorcycle, or tricycle ambulance). Among these, reports of using the ambulance for non-emergency transport were common. Use of the ambulance for transporting client’s home was reported by 48% of facilities. District Health Offices provided ambulance services for 62% of health facilities overall.

There is no relation between institutional delivery and availability of ambulance on-site (ρ=0.14). Hospitals/MCH centres had almost 5 times (95% CI: 3.16,7.12) more likely to have ambulance on-site than health centres/specialty clinics and the same for urban located facilities (aOR =2.86, 95% CI: 2.29, 3.58).

Availability of ambulance on-site in public facilities was found to be 80% and 63% less to that of private owned and private-for profit health facilities. Facilities that didn’t provide onsite obstetric surgery were also less likely to have an ambulance on-site. There was no significance difference on ambulance availability for the facilities that have referred in/out and in provision of 24/7 service for emergency obstetric and newb care.

Conclusions: Very lower percent of health facility in Ethiopia had ambulance onsite. No effect of referral transport service on institutional deliveries was noted. Ambulance is mandatory for interconnected health centres to hospital referrals. However, this needs to be backed up with adequate supply of basic and emergency obstetric care at all facilities.