Worldwide Motorcycle Ambulances: (6) Malawi: They have been used in remote rural areas in Malawi as a means to improve access to obstetric health care facilities for women in labor or needing prenatal care. Lightweight off-road motorcycles, equipped with a sidecar holding a stretcher for the patient, have been found to be an efficient supplement, but not replacement for, 4-wheel drive SUV ambulances. Purchase prices and operating costs have been found to be a fraction of a four-wheeled vehicle, and the sidecar rigs have been found to be less likely to be misused by diverting them for non-healthcare purposes. The lighter sidecar rigs are better able to cope with poor roads and areas that become impassible to heavier cars and trucks during the rainy season. Disadvantages include the reluctance of drivers to travel at night in some cases, and the inability to carry more than one patient at a time. The report concluded that: Motorcycle ambulances reduce the delay in referring women with obstetric complications from remote rural health centers to the district hospital, particularly under circumstances where health centers have no access to other transport or means of communication to call for an ambulance. They are also a relatively cheap and effective option for referral of patients in developing countries, particularly in rural areas with little or no public transport. Nineteen motorcycle ambulances can be bought for the price of one Toyota land cruiser car ambulance. Operating costs compare in a similar way. Motorcycle ambulances also potentially help reduce costs for women and their families to access EmOC, although this was not the subject of this study