Assessing the Impact of Transportation Modes and Travel Costs on Healthcare Accessibility in Bombali District, Sierra Leone

This study assesses the impact of transportation modes and travel costs on healthcare accessibility in Bombali District, Sierra Leone. Using a mixed-methods approach, we analyzed 3,753 clinical referrals and conducted community interviews to evaluate how transport barriers affect health-seeking behavior. Quantitative analysis employed regression models with travel time proxies to examine utilization patterns, while qualitative data provided contextual insights into community experiences. Results demonstrate that inadequate transportation options and high travel costs significantly reduce healthcare utilization, particularly among impoverished populations. Geographical distance increases reliance on National Emergency Medical Service (NEMS) ambulances, yet service gaps persist even for eligible patients. Motorbikes emerge as a relatively efficient alternative, though their accessibility remains limited by cost. The interplay of poor road infrastructure, financial constraints, and inconsistent ambulance services creates critical barriers to timely healthcare access. These findings highlight transportation as a fundamental determinant of health equity in rural Sierra Leone. Policy implications emphasize the need for integrated approaches combining transport subsidies, infrastructure development, and community-based solutions within broader health system strengthening efforts to advance universal health coverage in remote, low-resource settings.