How to get pregnant women to hospitals when ambulances can't reach them

Maternal mortality has declined globally, but the World Health Organization says it “is still a disaster in the Africa region,” where the continent accounts for more than two-thirds of maternal deaths. The latest WHO fact sheet links long distances to a health facility and lack of transport to these deaths, and other studies have shown many mothers in Africa are forced to walk to a maternity facility due to a widespread lack of transportation services. Poor transportation services for mothers in labor have been worsened by the lack of ambulances specifically assigned to maternal health care in most African countries, and cuts across urban and rural setups, according to Sinnah Lamin, a Princeton in Africa fellow at the International Rescue Committee, or IRC. “It is usually very hard to transport expectant mothers to a health facility especially in the peak moments at night when the services might not be running normally like during the day,” said Lamin. Immediate transport access and midwifery services can reduce maternal deaths, as a National Library of Medicine study found in Ethiopia. As such nonprofits are investing in innovative solutions to transport women to maternity services. WHO listed Kenya as one of the countries with a very high maternal mortality ratio in Africa, accounting for 530 deaths per 100,000 live births in 2020. A tech-supported service that offers interfacility transfers to mothers is trying to reduce these unnecessary deaths, according to Vicky Kaigai, the head of external services at the social enterprise, Rescue.co. Mama Link, as it is known locally, is a partnership with county governments and the charity, MSD for Mothers, and uses a toll-free number, through which emergency calls are placed to a central digital unit. An emergency response team is then deployed to transport patients — from their homes or health center — to a facility that can deal with pregnancy complications. “We have a dispatch center that operates 24-7-365 and an ambulance network across the country to respond to emergencies,” said Kaigai. “In Nairobi, we work with over 200+ private ambulances including incredibly advanced service providers with incubators and physicians on-board.” Kaigai said Rescue.co has provided over 25,000 lifesaving emergency dispatches, and over 15,000 dispatches to maternal and newborn cases, providing fast care at the community level and also coordinating referrals. “Across Kenya, the number one need for emergency services is maternal and newborn issues. But while most health facilities are equipped to handle normal deliveries, they are not well equipped to deal with pregnancy complications,” she said. As a social enterprise, Mama Link serves patients within urban and rural communities in the country, with a response time of 15 minutes for emergencies both at home and in facilities. Officials said they are planning to expand the service to Ghana and Uganda. “We want to make sure that no mother or child in Africa dies because there are no emergency maternity services.” --— Vicky Kaigai, head of external services at the social enterprise, Rescue.co In rural Kenya, the challenge of delivering emergency services to mothers is worsened by weather extremes. In northwest Kenya, droughts have been forcing families to migrate to distant settlements, while floods have been cutting off entire villages from accessing health care, according to Joshua Rutto, the field coordinator at IRC, Lodwar, Kenya. The region is also troubled by geopolitics because when natural disasters occur, families don't just move within Kenya, some cross borders to neighboring countries in search of relief. This makes it very difficult for humanitarian workers to reach expectant mothers, a situation that has led to maternal deaths of above 1,000 per 100,000 births in the region, he said. A motorcycle ambulance service introduced in 2022 to provide both facility and interfacility emergency transport for pregnant mothers is, however, changing this. Funded by the United Nations Population Fund, or UNFPA, the two-wheeled service is operated by local community health volunteers, who by navigating the difficult terrain, can reach mothers in urgent need of health care. Apart from transporting a patient, the motorcycle ambulance carries with it emergency medical supplies for on-site treatment, and is fitted with a stretcher to transport patients with breathing problems, Rutto said. He said the program includes an integrated outreach service where they take health services to the population in interior sites. “We do this on a biweekly basis and this is problematic because we do not reach as many women and children as we would like,” he said. Since 2022, the Turkana motorcycle ambulances have served 38 pregnant mothers and saved four others in critical danger over the last nine months. Rutto said there are plans to expand the service to Uganda. But IRC currently works with a cross-border team that provides emergency maternal services to border communities in Uganda, South Sudan, and Ethiopia. In Tanzania, m-mama — an innovative mobile and digital technology program that provides affordable emergency services for mothers and newborns and is a partnership between the government, Pathfinder International, Vodafone Foundation, Touch Foundation, and the U.S. Agency for International Development — is working to bring emergency services to women. According to Patrick Kinemo, the director of programs at Pathfinder, Tanzania, demand for emergency maternal services in the country ranges between 30% to 50%, but the existing ambulance services were not able to meet this, especially within rural communities. Through m-mama, patients are connected to community taxi drivers within their location for transportation to a health facility. The deployed drivers are then paid through the mobile money service M-PESA upon delivering a patient to a hospital. “The centralized, standardized, and automated emergency system is at each regional dispatch center located at the regional referral hospital, and ensures that emergency transport is provided from lower-level facility to a higher level one depending on the patient condition and referral protocol,” said Kinemo. He said the service has supported 41,993 emergencies, with 83% being maternal emergencies and 17% being newborn emergencies up to October this year. M-mama also supported 72 cases of mother and newborn emergencies, adding that the service is also in Botswana and Kenya. The need for emergency delivery services has been escalated by the fact that many medical services, especially those in informal settlements operate only during the day, where most facilities cite insecurity as the main reason for their closure at night. Another is because governments do not deploy ambulance services in slums, leaving mothers at the mercy of medical services provided by nonprofits, according to Nancy Njoki, a member of a Kenyan affiliate of the nonprofit Slum Dwellers International. A 2022 Atlas of African Health Statistics reported that only three African countries, Cabo Verde, Mauritius, and Seychelles, have recorded maternal deaths below the internationally agreed target of 70 per 100,000 live births. Mama Link’s Kaigai said her firm plans to expand the services to other African countries, but called for more support from governments, the private sector, and nonprofits to make this possible. “The need is everywhere. We want to make sure that no mother or child in Africa dies because there are no emergency maternity services. We are open to talks with different countries,” she said.