A needs assessment reveals that ineffective governance hinders prehospital emergency care in Hawassa, Ethiopia, leading to fragmented services that often serve merely as interfacility transport.

• Key barriers identified include unclear ownership of prehospital care, inadequate training, and limited resources like medicines and equipment.
• Strengthening services will require clearer accountability and improved infrastructure, alongside sustained workforce training.

Addressing governance gaps is essential to enhance the effectiveness of prehospital emergency care in this region.