Somalia has one of the highest lifetime risks of maternal deaths in the world, with women facing a one in the 22-lifetime risk of maternal death. Communities living in Hafun, Banderbayla, Bargaal and Qandala remote coastal towns in Puntland have been having challenges accessing specialized health care due to the bad conditions of the road which would take anything between 12 to 36 hours depending on the area and the traditional referral systems by ambulances is costly and tough for the patients for the same reasons. The shortest route from the coastal towns is by sea but the communities did not have reliable means of transport for transferring sick people to the hospital. When asked about appropriate assistance, the boat ambulance was a key innovative suggestion by the communities. In response to this life-saving demand, procurement of two boat ambulances was done by Save the Children (SC), the boats were then modified to suit referral services with shade and referral beds incorporated. The boat ambulances handed over to the government are first of its kind in the area designed specifically to address the existing challenge of access to health care services for the majority of Bari region residents. The boat ambulance is being used to transfer patients, particularly pregnant women with complications and sick children to the nearest regional hospital in Bossaso for specialized care and treatment. A boat ride to Bossaso will reduce the time to a minimum of 45 minutes instead of 12 to 36 hours. In Hafun where we have a referral health centre, the referral time between Hurdio health central and the RHC in Hafun is cut from 3hrs to 25minutes by the boat. Apart from reducing the travel time, the boats were renovated to include all the facilities of an ambulance and patients will be able to receive first aid support as they are being transferred to the nearest hospital.