Wheels for Life Initiative

An initiative that provides prompt access to hospital care to pregnant women through telemedicine and emergency medical transport

Dr. Jemimah Kariuki. Founder and CEO, Wheels for life org

Pandemics cripple societies but also serve to show the gaps that are present. COVID-19 has led to the institution of country lock downs and curfews with travel restrictions to curb its spread which has had secondary effects such as increase in maternal morbidities and mortalities as women will still deliver despite restrictions. In Kenya, the 2014 KDHS, recorded an estimate 362 deaths per 100,000 live births. WHO encourages hospital delivery for all pregnant women under trained hands to prevent and reduce maternal deaths.

 A newspaper article in the Standard newspaper dated 7th April 2020 showed women across the country either having to deliver at home or walk miles to the nearest health facilities due to unavailability of public transport. A survey by KNBS on socio-economic impact of Covid19 pandemic shows an overall increase in cost by 51.7 % of transport on most frequent routes in Kenya with 32% walking. Access to skilled delivery is a big challenge, even before Covid-19 as majority of women live below 5GDP a day. They cannot afford to pay for an ambulance or a taxi to hospital. With provision of access, delivery under skilled care will increase, which will significantly reduce maternal mortality in Kenya.

Our target is  all pregnant women across the 47 counties of Kenya with attention to those who may not afford their own means to get to facilities as studies indicate that despite the free maternal service (Linda Mama) offered by the Government many are still unable to access hospitals. Cited reasons include long hospital distances and lack of funds to pay for boda boda (motorcycles), taxis or public transport. The bulk of this group is found in the rural areas or in urban slums. The curfew has further restricted movements as now they are unable to walk and night travel is limited.

Many women in the vulnerable and marginalised groups rely on their partners to make decisions or have no partners and no money to get them to hospital. They resort to walking or traditional birth attendants when time comes for delivery 

We seek to empower them through the teleconsultation to promote faster decision making to go to hospital and on safe pregnancy practices. Free Emergency transport ensures that they reach hospital safely where they can now use Linda Mama.

 Patient call-backs and processes eg lean testing at community level allows us to understand their needs better for process modification. 

Wheels for life solves the problem of increased  pregnancy related complications including death due to delay in accessing hospitals. 

This is by allowing free service to patients from making the call to free transport of the patient to hospital. Free Obstetrician consultation also ensures that no pregnant woman has to work their pregnnacy journey alone.

From the awareness and teleconsultation, we hope to achieve earlier and increased anc visits, delivery under skilled health personnels with post natal visits thanks to patient follow up. 

This will promote reduced maternal mortality in the country.

Wheels for Life has been tested and proven valuable to pregnant women and their families, by overcoming financial and physical barriers to accessing care, especially in emergencies and during the curfew hours instituted during to the COVID-19 pandemic.
Since its launch, we have served over 106,000 women across 11 counties in Kenya.With a 98% survival rate of pregnant women utilizing the service, and the safe delivery of dozens of babies, Wheels for Life has already made a difference in the lives of pregnant women and their families across Kenya.

Some Testimonies

● Mutiso Praxedes Says, *Trust that my email finds you well. Wish to express my gratitude for the 1196 nitiative. I had a pregnancy emergency, got excellent assistance and subsequent safe delivery after dialing 1196. Wish to recommend a certain Dr. Maina who attended my call on 1st May 2020,around 2.30am. His advice and recommendation changed my situation in a positive way. Kudosbfor the initiative and May God bless you all for this noble service to Kenyans*

● A mother says *I delivered on the road. Rescue team guided the process. The ambulance foundme before placenta was expelled and they later took me to hospital*

We intend to scale up to provide the service to all pregnant women across 47 counties in the country.  This involves multi-level partnerships to be able to penetrate into the communities through  Government, private sector and donor support. 

In the next three years, we intend to work with National hospital insurance fund through the ministry of health at National and County Government level. This service can be paid on a reimbursement model for the public by the Government through the ‘Linda mama’ program after scale for sustainability purposes. Advocacy and discussions on this will be driven by data collected during scale up and test fit stage. The private sector will be engaged at a corporate level for a higher reimbursement on use of the emergency maternal services at the limits of their insurance covers as a component of their maternity package. 

Maternal care in the country  is mostly catered for through the free maternal service Linda mama but many still dont use this as they cant reach hospital. Integration will ensure no one is left behind as we create a lasting health change by reaching the vulnerable pregnant mothers countrywide including marginalized communities and later scaling to the region 

We monitor and evaluate impact based on the following parameters to determine uptake in the community as well as utilisation of the initiative by pregnant women. Our call centre receives many calls including enquiries and prank calls but the volume is a direct indicator of the populations need and awareness of the programme. About 13-15% of the calls translates to pregnant mothers requiring medical help in form of teleconsulation. From the clinical team we monitor the teleconsultations done and the direct effects of the transfer such as safe delivery, number of emergencies averted and number of vehicles dispatched. 

Activities Outcomes (As of 5th April 2021)
Total number of calls 106,249
Total number of mothers assisted by the doctors 8,710
Total number of dispatched cabs 991
Total number of dispatched ambulances 784
Average calls each night 120
Average taxis dispatched each night 5
Average ambulances dispatched each night 6
Average number of mothers saved each night 15
98% of women have survived

95% Live babies born safely

We face geographical barriers such as long distance from the households to main roads or the nearest town and facility especially in rural areas. This translates to long hour pick ups at a high cost. Some areas are inaccessible via cars and force us to use motorcycles to transport the ladies which may not necessarily be safe especially in the rainy season.

The cost of provision of the service is shouldered by the initiative and the supporters as the cost of saving one woman especially by ambulance is 18200 KES. We serve very vulnerable and marginalised women who cannot afford health care and are forced to walk long distances to facilities due to cost. Translating the cost to them may not be applicable. We are currently working to build a sustainable model that can aid with that.

Some communities are nomadic and thus proven roads are not applicable to them. Our channels of communication such as community health workers thus cannot be employed. Use of mass media marketing and working with county hospitals to gain access to their registries will make it easier to overcome this challenge.

Wheels for life CBO

AMREF

Kenya Healthcare Federation

Telesky

Bolt

Rescue.co

Nairobi Metropolitan Service

KEPSA (Kenya Private Sector Alliance)

University of Nairobi

Funds gained from the Trinity challenge will ensure that we have continuity of service in the community savimg upto 5,200 women in dire emergency including severe bleeding post delivery to attain care, additionally it would allow over 100,000 women receive antenatal and post natal consultation translating to 100,000 women attending their antenatal clinics. This will mean early identification of issues such as hypertension in pregnancy, diabetes, infections and prevent premature labours and  help reduce the annual rate of 35000 still births. All these measures will promote the attainment of the SDG 3 goal of reducing maternal mortality rate to less than 70.

It will also help us achieve our goal to create a sustainable business model through training and peer to peer learning from others also participating in the challenge. 

The networking opportunities are immense and we can meet possible other companies that can benefit from Wheels for life in a B2B model for their employees. 

Publicity gained from the challenge will be beneficial in scaling to other regions beyond East Africa that may want to replicate the model in their countries ensuring many women across the world have access to maternal health care when needed.

Uber, Little Cab, Meru Cabs and other taxi hailing companies. We can partner with them to increase our pool of taxis on the road and tailor and train specific cabs for the use in Wheels for Life transport of women as medical taxis.

Facebook- we can use their database to reach more pregnant women and create awareness on pregnancy safety and protection measures especially during the pandemic. 

Universities such as University of Cambridge- we can partner with them to conduct research on our work and learn from similar research conducted by them. 

Charities- Those who connect with our plight can fund even a single woman to reach hospital. Their dontaion in resources and kind would go a long way in attaining zero preventable maternal deaths.