Wheels for life

Every 2 minutes a mother in Kenya dies in child birth, many others suffer pregnancy related complications. This can be prevented by women gaining quality health care at the right time and a component of that is actually reaching the hospital facility in time. 

Wheels for life seeks to have women reach out via mobile phone through a toll free number to reach a doctor, who triages, and then dispatches a vehicle either a taxi or ambulance using a mobile application. The patient is then picked from home and transported to the hospital in under 30 minutes. 

This solution could see the reduction in time taken for a decision to be made to reach hospital and the time taken to actually access a facility thereby reducing first and second delay in accessing health care. This would thus significantly reduce maternal morbidity and mortality and help attain universal health care.

Maternal mortality is one of the biggest challenges in maternal health care. World Health Organization by 2017 estimated that approximately 819 women die daily during delivery. Kenya stands at 362 deaths per 100,000 live births. Maternal deaths could be prevented if the three-delay model outlined by Thaddeus and Maine were addressed. These delays have been identified as delays in (i) decision to access care, (ii) the identification of- and transport to- a medical facility, delay in receiving quality healthcare.

Another model that has been shown to improve pregnancy outcomes is the provision of delivery under a skilled health personnel which reduces risk of complications. 

While Kenya has ensured free antenatal and delivery service in public hospitals, minimal measures have been outlined  to reduce the second delay which is the access to health care. Many women currently rely on public transport to hospitals in case of obstetrics emergency or labour. COVID-19 pandemic and the measures put in place to prevent spread  in the country including curfew revealed the severity of this problem. Pregnant women were crippled with anxiety and lack of transport especially at night resulted in a significant rise in home delivery, neonatal death and maternal morbidity and even death.

Wheels for life presents as a solution to this problem by providing prompt triage and possible diagnosis through telemedicine and fast dispatch of emergency transport either by taxi or ambulance dependent on urgency by use of a mobile application. 

The patients access the intervention through a toll free number, 1196, known to public (through social media and community health workers) and are immediately transferred to the doctor on call.

The doctor then will triage the patient and give either advice or dispatch a vehicle dependent on urgency. The taxi service uses a mobile application which the doctor inputs the location of the patient and the contacts and both the driver and patient get details of each other as text message. The driver then picks the patient from home and takes them to the nearest hospital or hospital of choice.

The ambulance also uses a system that identifies the nearest ambulance to the patient and dispatches it which then transfers to the hospital that can that level of emergency (based on triage).

A report is given to the doctor once the patient is admitted at a facility. 

Our solution serves all women across the country who are pregnant and in need of consultation especially during curfew hours. It fills the gap filled by lack of access to hospital and ensures that women can still gain medical advice and reach hospital in case of need of specialised care. 

Of key interest are women of low social economic status who even without curfew are unable to reach hospital due to financial constraints or vulnerability in the community (single mothers alone in labour) and long distances to hospitals. 

We seek to ensure that access to hospital is not an additional stress factor to women in labour or undergoing any emergency.  That using their mobile phones they can easily gain not on medical care but also be taken from home to hospitals and at little or no cost.

Women who receive the service are called in under 2 weeks for a qualitative review that then shapes the intervention and causes it to evolve to meet women's needs at various capacities.  The feedback mechanism has enabled us to increase vehicles in more target areas, improve communication,  increase driver remuneration to ensure women gain quality access and feel safer in the process.

Wheels for life as a solution aligns with the challenge as it directly impacts maternal and newborn health care and seeks to ensure that  women have timely access to quality health care.

Through telemedicine, it ensures a woman has medical and emotional support by calling the toll free number and gaining free access to doctors for advice.

It is a technology based solution as it uses a mobile application to gain access to the taxi drivers and connect them with the hospitals.  The ambulance also uses flyer technology to identify the nearest ambulance and track it to the hospital.

Wheels for life as a solution is unique in that no other platform in the country has been able to solve the issue of medical transport of pregnant women as promptly as it does. 

While "m-access" had been piloted in Homa Bay county in 2019, it required that the lady had been chosen as part of a cohort that received messages throughout pregnancy and required the women pay the motorcycles that would get them to hospitals. These motorcycles were community based and thus also blocked from use by the nationwide curfew. 

Our platform can be called at any point of a woman's journey in the pregnancy even at the point of emergency and triage done and a driver selected from a pool of over 5000 drivers on the road. This ensures that at any time a cab can be dispatched within 10 minutes and the woman taken to hospital. The provision of the service for free ensures that the woman need not worry about transportation cost and therefore can focus on the labour or emergency at hand. 

The access to doctors ensures that the patient is taken to the appropriate level of care from level 3 to level 6 to prevent many inter hospital transfers and thus delay. The constant communication with the hospitals ensures that any facility issues are known beforehand and patients thus transferred elsewhere.

Our ambulances have trained EMT that can easily deliver in dire cases and begin resuscitation measures ensuring safety even on the journey.

The core technology that drives Wheels for life is the use of user friendly mobile applications to provide access to prompt health care. Provided a pregnant woman has access to a mobile phone whether it is internet enabled or not they can call the toll free number which removes the need for low income setting women to have internet enabled phones. 

Once the call is directed to the doctor, the doctor is able to quickly triage and use a taxi hailing system that allows them to be able to order multiples rides at a time and connect drivers with patients. The system searches for the closest driver to the patient's location to reduce waiting time to reach the patient.

A similar system is used for ambulances where different ambulances have been enrolled and put on  a system that allows the ambulance company to locate the closest ambulance and dispatch in under 10 minutes. 

This ensures prompt knowledge of situation at hand and response by the team for better access and consequently health care delivery.

The initiative has been in motion since April 28th and in the 6 weeks of existence in Nairobi county we have had as of 8th June 4733 calls with 559 women who had been transferred to doctors who either advised or dispatched vehicles.  We have seen a total of 285 trips by taxis and 74 ambulance pick ups with an average distance of 13 kilometres covered per trip. 

The general response received from women is that of gratitude for the programme stating how much the anxiety they had has been allayed and that of blessings for the bouncing babies held in their hands at the moment. Those who suffered complications have recovered and are doing much better and at home currently.

The consultation with doctors has ensured that more women are gaining back the confidence in the health care system and therefore preferring delivery in hospitals visavee home deliveries. This ensures that women are delivering under skilled health personnel. The net outcome is Reduction of maternal complications such as obstructed labours and fistula therefore safe mothers and babies and shorter in hospital stay post delivery with better outcomes.

The consultation has also ensured that women resume their antenatal clinics that they had stopped due to Covid 19. This ensures that obstetrics checks are done and high risk mothers identified. They are also reminded on danger signs and health seeking behaviour.  This results in reduced delay in calling for help in case of emergency and women can gain hospital care in prompt time. The outcome is therefore reduction in pregnancy related complications and better maternal and newborn outcomes.

The dispatch of vehicles during curfew hours ensures that women have a reduced or shorter time to get to hospital and are able to access care in good time.  This prevents complications such as those of bleeding and death therefore reducing the maternal mortality rate. If propelled forward even beyond curfew it means that women in remote areas who have to cover distances of 10-30km to hospitals can be easily located using the application and taken to hospitals from their homes to hospitals. This would mean that all mothers would gain quality health care at the right time. 

The initiative has brought together transdiplinary approach to healthcare, this will bring about change of policy in ensuring health care delivery. An example is that because of need for women to get to hospital, taxi services were allowed permits that would allow them to travel even during curfew hours. Going forward it would mean that the community would be sensitized on the danger signs of pregnancy through various corporate and individual levels, there would be increased social, public, corporate and political goodwill towards maternal health care ensuring that maternal health is well taken care of, well funded and at the heart of everyone. 

Wheels for life currently serves Nairobi Metropolitan Area, an area of 696 square kilometres with a population of approximately 4,397,073  of whom  47% is women of between the ages of 15-49. All pregnant women in that population serve as our target population in case of any need or emergency. It is estimated that between the months of April - June last year and approximate 15,000 women delivered in the region  and approximately 90 women would deliver every night in the region. 

Currently, our project focuses on giving service from 7pm to 5am in the morning based on the original curfew hours imposed on the government.  We have since April 28th received over 4000 calls of people interested or engaged in the program and managed to advice about 550 of them and dispatch over 380 vehicles. 

In the next phase of the project we spread wings to Machakos, Kiambu and Kajiado county. The 3 counties have a population of over 4,764,000 in total with women accounting for half of that population and 80% within the ages of 15-49. 

The vision is then to scale up beyond the 4 counties and cover all 47 counties of Kenya and then extend to East Africa through trans-dimensional partnership to ensure that all women in Kenya and in East Africa are safe and secure in child birth. 

In the next year we seek to have more extensive coverage of the country. Starting with phasing to nearby counties Kiambu and Machakos and Kajiado county then scaling up to the entire country.

In 2014 KDHS, only 62% of women were attended by a skilled health personnel (SHP) in the country with only 22.8% of women in Turkana, 63.4 % in Machakos, and 92.6% in Kiambu assisted by a SHP. The survey also found that lack of money (37.1%), Distance to health facilities (23%), not wanting to go alone (11%) and lack of permission (6%) were the greatest barriers to seeking health care by women. 

Wheels for life by offering low or no cost transportation to the health facilities seeks to ensure that at least 90% of the population is attended by a skilled health personnel in the region. While realising that this will involve community teaching, partner engagement and empowerment in order to increase uptake of the project, the effort will reduce issues such as permission and funds creating a more robust population. It will reduce pregnancy related complications and ensure that women gain exposure to hospitals including access to delivery, post natal care and family planning. 

In the next five years, we seek to be a solution not just for Kenya but for East and Central Africa. By creating and expanding with similar models we aim to ensure all pregnant women receive the service and as a region be a solution in achieving universal health care.

Likely barriers for impact include 

i) Financial

In order to start, different partners have contributed extensively during the COVID-19 period. 500 free taxi rides were offered each at approximately 500Kes (5$) and ambulances discounted and then given for free up to a total of 160 ambulances each costing 175$. As well as time given by medical team in service. In 6 weeks we have utilised almost 60% of both taxis and ambulances.  While we notice very good feedback in the society, once the free rides run out we will require aid in ensuring continuity of the no cost service to the needy women. 

Funding will also be required to renumerate different cadres of workers eg  doctors and ensure that publicity especially while encroaching other areas is sustained for maximum impact.

Technical

1. Limited phone coverage in rural areas as well as areas with no electricity coverage. 

2. Reduced number of taxis and ambulances in regions away from urban cities. 

3. Poor Geomapping in some areas, therefore a longer time to access patients. 

Legal

1. Lack of policy document that includes pregnant or sick people as emergencies.  Caregivers are still being subjected to police harassment on the road due to imposed curfew as they are non essential service providers.

Market 

1. Offering taxi service at a cheaper cost than that in the existing market will meet resistance from other taxi providers. 

Cultural 

1. Some communities believe firmly in home deliveries under traditional birth assistants and view caesarean section as a weakness.

Financial impediments will be handled by institutionalising the project to ensure continuity and looking for funding through forums such as MIT Solve to gain support and financial aid. 

The funding will be instrumental in upscaling the project to serve Kenya as a country and other regions.

Thoughts continue in making the programme a social enterprise that offers low cost service to the community and logistics are ongoing. 

Geo-mapping will be really essential in order to locate the patient as well as local health centres in a particular region. A team will be required to physically travel ensuring that most areas are in maps in order for ease of access. Hospitals will be included in this process to ensure visibility.  Community owned taxis will be utilised to enhance a sense of safety and to improve road familiarity 

In some areas, a repository of transportation services will be created to ensure that in areas where taxis are limited they can still have other models of safe travel offered
 

Community based forums will be held to improve on community uptake with men being involved in the introduction and the process.

We have a dedicated team of 38 team members.

Full term staff include:

15 think tank members across the different sectors ie health strengtheninng platform, telecommunication, transport, ambulance, health facilities.

8 Resident doctors in OBGYN

1 OBSGYNAE consultant for difficut case review.

2 content devolopers 

2 community health coordinators

Contractors 

The Creative team : marketing content 

A pool of over 5000 drivers paid per trip on distance basis

A pool of over 8o ambulances paid per trip on per dispatch basis

Call Centre: manned 24 hours by 2-3 people for calls enquiry and transfer on rota basis

Wheels for life begun from the eyes of a single doctor who saw the gap in provision of health care during the COVID-19 pandemic and the devastation it caused the family and immediately moved into action. She begun helping women as a stand alone but found that she needed help in order for it to become sustainable.  

The idea brought together a dynamic team of people from various sectors including Health, NGO, Corporate and Government to create a system that would be the solution. This trans-sectoral approach ensures that different views in the project are easily identified and acted upon.  It also pulls the community so they can own the project as their own.

In only 6 weeks, the lives of 555 women have been directly impacted by the programme. This is on a background that the service has only been offered at night in only Nairobi county. More than 500 live babies have been born with reduced hospital stay which indicates reduction of complications. 

Despite financial challenges, the team has made tremendous sacrifice with most services offered  pro-bono to ensure women get the help required. The willingness to serve, the dedicated minds and efforts shown in such a dynamic team is what defines the team behind wheels for life. A fast acting,  decisive and synergistic team that is out to see work done with clear quantifiable results. 

If enabled, this team will have tremendous impact in Society touching the lives of many and upscaling to many regions.

Kenya Health Federation- an umbrella body that provides technical support to the project and is responsible for outsourcing of funding and expertise. 

AMREF - provides health system strengthening with community health worker training who walk door to door to ensure public is made aware.

Rescue Ambulances: provide ambulance services to the programme. 

Bolt: Provides a platform to reach 5000 taxis at any time, and offered first free rides for the project. 

Telesky: Provide the call centre through which calls are diverted to Doctors and enquiries responded to 24hours/7 days.

University of Nairobi, Department of Obstetrics and Gynaecology- provide residents in the department who are on call on a rota basis. (We currently have a team of 8 permanent doctors) 

Nairobi Metropolitan Services - represent Nairobi County Government,  they provide the hospitals that we transfer patients to, also ensure that information is disseminated to the health facilities and back to the team for an efficient referral system

KEPSA: Umbrella body that governs all private sector association and the link between us and other corporates. It provides connections and protection against malware to the project. 

Our Key resources: wheels for life platform, taxi drivers, ready ambulances, doctors, funding key stakeholders: Kenya Health Federation, Emergency medical providers, Taxi industry, health sector- doctors and facilities

key activities: creating access to health care through (i) tele-medicine (ii) Prompt transportation to hospital (iii) in- ambulance medical service

Type of intervention : Tele-medicine and emergency transport

Channels: community health workers, marketing through radio, tv, newspapers, and social media

Beneficiary: Pregnant women across the country 

Value proposition : Prompt diagnosis, medical and emotional support and acccess to hospital

Impact measures: reduced home deliveries, reduced pregnancy related complications, reduced time to access hospitals, prompt dispatch

Customers: NGO's, Governments, Private hospital, medical insurance companies, NHIF

Customer value: Ensure the reduction of maternal morbidity and mortality therefore furthering the agenda of universal health care. It also ensures that we meet the SDG number 3. Private hospital and medical insurance companies can include the service as part of their package and smaller clinics as their referral system.

Initial path to financial sustainability include :

bolEmbarking on Funding from different companies  as a CSR, NGO'S and platorms such as UNFPA, WHO, USAID, foreign governments and universities.

Long term  :

a)Sustained funding from NGO's

use of social enterprise model such as :

b)Provision of market linkage to technology based companies interested in health as a platform between medical team and patients.

c) provision of free service to those in low income areas while surchaging low cost transport to middle and high income population using willingness of client as criteria

Wheels for life is applying to solve in hopes that in addition to the funding w can gain the technical support that MIT Solve and Solve members bring to the table. 

As a novel initiative, we anticipate to meet different women from various cultures and sociodemographic backgrounds whom we need to give quality service to. 

The training gained through the nine month programme will enable us to set up a sustainable business model, learn how to source fund from different organisations, improve our ideas and advance our innovation with a final goal of scaling up to increase the programme's impact to a wider global society.

wheels for life is responsible for the lives of many different women across the country Kenya, and that of their children. This includes those who can afford but want the convenience of the service and those who require it as a necessity to gain health access.

This requires a business model that can cater t both populations and still remains sustainable as an entity. Progression into the more rural areas also dictates challenges with cultural beliefs and longer distances with fewer vehicles available. Mentoring on service distribution, funding and revenue models as well as the legal implications involved is highly needed.

impact assessment and consequent exposure to media is also key in ensuring visibility of the project.

Wheels for life is willing and ready to partner with organisations across the world that are pro maternal and new born health. We know that attaining universal health care in maternal and child health is an entity that can only be achieved through the global community and as such are willing to work to ensure it happens. 

We would love to work with different organisations such as UNFPA, UNDP, WHO, UNHCR, foreign and local governments, as well as universities to further this agenda

Wheels for life is an initiative born from women and for women. As a brainchild of a female doctor in the field of obstetrics feeling the pain of women and supported by a fellow Senior female doctor to give it wings, wheels for life is at the heart of serving women. 

It utilises mobile technology to connect women to doctors and health care facilities by use of mobile friendly applications. For calls requesting medical assistance the call is transferred to one of the doctors on standby. The caller consults with the doctor who after the consultation determines the next course of action. Which may be advice or hospital dispatch through a cab/ambulance. For cases requiring hospital dispatch.The doctor through a mobile app dispatches the cab or ambulance to the patients home/location. The cab/ambulance then picks up the patient and delivers them to the hospital designated by the Doctor.The hospital receives the patient, attends to them medically. 

The team will use the prize money to ensure continuity of the project and to increase community visibility with keen messages to improve knowledge on pregnancy danger signs across the community and thus more prevention.

Wheels for life is qualified for the Health workforce innovation prize as it increases the pool of doctors available to patients at any single time through use of telemedicine. Women can easily consult over the phone and gain medical advise as well as support from whatever locality even in those with very few obstetricians in the locality. 

We are currently only providing the service at night as doctors are working on volunteer basis and subject to availability. With the prize money, we seek to create a permanent platform that can be available 24 hours a day reducing need o patient travel time unless for more specialised care as advised by our doctors.

As the project relies heavily on tele-health and good history taking skills, telehealth specialists will be brought on board for training purposes and medical-legal support. Protocols will also be established to ensure that patients get the best service available.

The Bill & Melinda Gates Foundation is open to solutions that improve maternal and new born health such as wheels for life in low and medium countries such as Kenya. 

The Kenyan Government has provided free antenatal and delivery service through the "linda mama" programme. Yet, even despite this only 62% of Kenyan Pregnant women are able to have in hospital delivery under a skilled health personnel due to lack of access to hospitals. The reduced access has been attributed to either lack of finances and or long distances to hospitals. Wheels for life seeks to bridge this gap and ensure we can contribute in attaining less than 70,000 maternal deaths a year.

Our pilot project in the last 7 weeks while working only in Nairobi between 7pm -5am is helping approximately 15 mothers every night to each hospitals. will greatly improve maternal and newborn outcome in the cohort.

With the funds awarded by the foundation, we seek to ensure the programme is available 24 hours a day and that it can spread to other counties in Kenya in need of the same support.