The Okoa Ambulance Trailer

Over 1 billion people worldwide lack access to healthcare because clinics are too far and safe transportation is not available. Traditional ambulances are too expensive and cannot access communities due to road conditions or traffic congestion. In the best case scenario, patients must survive long, painful journey to clinics on the back of a motorcycle with only the driver to help during roadside births or other health complications. Given these realities, many people in developing countries choose not to go to the hospital.

The Okoa Project is a nonprofit focused on increasing access to healthcare for vulnerable populations. We have developed a motorcycle ambulance trailer that can transport a patient, medical supplies and one other person to the hospital. Our locally made trailer can attach to any motorcycle and be integrated into existing taxi norms, making it a realistic and affordable solution.

In many communities in Tanzania and around the world, medical facilities are too far or too difficult for much of the population to reach, which prevents patients from receiving the care they need and contributes to high maternal mortality rates (MMR). Pregnant women often choose to give birth at home, rather than risk giving birth on the side of the road while painfully walking or riding on a motorcycle to a clinic. 

The World Health Organization (WHO) estimates 303,000 women die annually due to preventable pregnancy complications—99% occurring in developing countries. Additionally, the World Bank reported that 37% of Tanzanian women did not go to the hospital because they did not want to make the journey alone and 50% because they did not have transportation. 

For the past 3 years, OKOA has been working in the villages surrounding Madundas, Tanzania, a community of 6000 people whose nearest health facility is 10 miles away.  When The Okoa Project was created, the community members rarely sought medical treatment due to financial or geographical barriers. Public transportation between Madundas and the only fully operational hospital is unreliable, consisting of motorcycle taxis, bikes, and foot travellers.  Individual cars and taxis are basically non-existent, and taking a motorcycle results in risky complications for a sick or pregnant patient. As a result, people often choose not to go to the hospital, and easily treatable diseases go unchecked. 

With a focus on women’s pre- and post-natal care, the Okoa team and these communities began working on a viable solution. With the help of their partner, The Olive Branch for Children (a Tanzanian Grassroot NGO), the Okoa team conducted over 300 interviews with patients, drivers, and medical workers before finalizing the product.  Combining the team’s technical MIT background with the experience and deep contextual knowledge of the community leaders on the ground, Okoa was able to weigh many variables to come up with a tailored solution. Purchasing new ambulance vehicles was not financially feasible for many communities, , due to upfront costs and ongoing maintenance costs. To add to the design constraints, it was important that the solution fit into existing infrastructures, such as the common use of motorcycle taxis and the wide availability of local metal worker fix up shops. 

Leveraging the convenience and cost effectiveness of motorcycles, it was determined that the idea of a trailer attachment to the existing motorcycles would be most effective. The Okoa Project was not the first to introduce this idea. Yet issues beyond transporting patients, such as ongoing maintenance costs of the trailer, use during down time, and the wear and tear on the motorcycle were all factors that contributed to the failure of other solutions. 

Thus, the OKOA solution addresses these issues with tailored solutions:  

• All parts to the trailer are locally sourced making replacement parts readily available;

• The trailer is lightweight so that it can be attached to existing motorcycles without causing excessive wear to the motorcycle. 

• The trailer attachment is large enough to fit two people, so that women do not need to travel alone.

• The trailer integrates easily into existing motorcycle taxi norms - the dynamic attachment allows it to fit onto the back of any existing motorcycle. This increases interest in being a ambulance driver, and reduces barriers to adopting the ambulance into communities.

• The interior of the trailer is adaptable to carry not only people, but medical supplies. Therefore, the trailer can transport medical supplies to various health care outposts.

From the very start we have made sure that local Tanzanian minds were part of the design process. We have worked closely with our partner, Tanzanian innovation centers and community members, emphasizing capacity building through the process. Over the course of 3 trips to the country, our team has conducted over 240 interviews, to get input from patients, drivers, and medical workers. These conversations are what drove our design criteria. We heard stories about the pain that pregnant mothers experienced while riding on the back of a motorcycle, so have an extensively tested suspension system. We were told of babies delivered on the side of the road without any medical equipment, so added birthing kits in case of emergencies. And we heard the fear of going to the hospital alone, so added an additional seat in the trailer for a family member. We’re not the first to try this. Where other products have failed is understanding the local problems that goes past than the patient. With that in mind we created our trailer from completely locally sourced parts and included a warranty, for easy maintenance. We also have a removable interior, so that the driver can make money transporting medical supplies, in the down time. And we’re offering this trailer for half the cost of these alternative options, making our trailer much more accessible and capable of impact. 

We have made a low cost ambulance trailer that can attach to the back of any existing motorcycle. To provide accessible transport to those who need it the most. Our trailer has room for a patient and an additional passenger, as well as medical kits and a spare parts kit. Our design has been approved by the Tanzanian Engineering Mechancical, Electronics Services Agency. 

With 100% local materials and manufacturing, our ambulances create jobs and ensure local maintenance ability. We train local technicians to build our ambulances and train local drivers to become ambulance drivers. Our ambulances are lightweight, and attach onto existing vehicles in the area. They are made by, run by, and serve the communities that we work in. 

Over 1 billion people around the world do not have access to healthcare. The world bank found that transportation was one of the top 2 reasons people could not get to the hospital. In East Africa alone, 2 billion has been spent on improving emergency transportation, but the existing solutions are expensive and do not address the needs of their vulnerable areas.

Our ambulance trailer provides an accessible solution to this lack of emergency healthcare. By integrating into existing transportation structures, we provide an alternative for motorcycle taxi drivers to supplement their income. The local manufacturing, motorcycle suspension,  and simple design ensures that any mechanic can fix our ambulance - eliminating the common problem of failure by maintenance. 

In the Mbeya of Tanzania we are currently serving a population of 5000 people, that are being helped by our first ambulance service.  We take malaria patients, pregnant women, children, and critical trauma patients to the hospital. By the end of 2019 we will be serving 15,000 people in the Mbeya region by putting in five more motorcycle ambulance services. In five years we will be implementing 250 more ambulances through the Okoa Project. Assuming that we can serve 3000 to 5000 people per ambulance,  we will serve between 750,000 and 1,250,000 over the next 5 years.

Our team on the ground is operating our ambulance service in Tanzania in a self-sustaining capacity. We have orders for 15 more ambulances from a well established Tanzanian NGO - The Tanzanian Rural Health Movement-with plans to move forward with them in serving their catchment areas in 4 regions of Tanzania. Our Tanzanian team will grow organically as this partnership, and others in country, progress. In Ghana, we are excited to be launching a pilot with the Virtue Foundation this summer. With the manufacturing infrastructure of Suame Magazine, Entrepreneurial Resources from Universities in Kumasi and Accra, and the healthcare experience of Virtue, we are confident in the expansion into Ghana. Over the next 5 years, we will build a production facility in Ghana and have plans to make over 250 ambulances to serve regions in Ghana and Tanzania.  Our business plan is selling our ambulances to NGO’s in the healthcare space, who are already familiar with their communities and relevant implementation strategies. We are also exploring micro-financing strategies to provide a more accessible option for local entrepreneurs who are interested in buying the product as a means of personal income generation. If we are successful, the combined impact of Ghana and Tanzania will result in over 1,000,000 people having access to safe, context specific transportation.  

Over our time in Tanzania, we have been able to identify large challenges that we need to expect as we bring The Okoa Project to more parts of Tanzania as well as Ghana. The government and political climate are some of the largest challenges we have faced. We spent over 8 months trying to get our standards approved for our ambulance trailer in Tanzania and are looking out for the same challenge in Ghana. 

Getting word out in the rural areas and assimilating into existing cultural contexts also was a large challenge for us - specifically related to rural advertising, community acceptance of the product, and community leader buy in. We were lucky to be able to work so closely with our partners who had established relationships with the communities for over 16 years.

For working through the governmental and political challenges, we have spent 3 years working trough the Tanzanian contexts. Through connections with the government developed through MIT and local sources, we have been able to tackle the issues with government involvement. For Ghana, our partner the Virtue Foundation has connections high in the Supreme Court, and we have a deep understanding of the political climate and how to leverage it from our Ghanain team member Ekoe.

For community relationships we have made sure to select our partners based on their relationships with the community is in the trust that the communities hold related to their organizations.  We make sure that hundreds of interviews are conducted before final implementation and design are finalized. For rural advertising and getting the word out, we have switched to cartoon distributions that explain what services we are providing. By working with two partners that are very close to the communities they serve, and hiring local Tanzanians and Ghanaians for the implementation teams - we are confident that we will be able to distribute information and ramp up interest in our services as we spread.  

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Full Time Staff: 4 (between US and Tanzania)

Contract Staff: 2 (US based)

Part Time Staff: 3 (between US and Tanzania)

Volunteer: 8 (US based)

Students: 29 over the course of 3 years, 3 current (US and Tanzania based)

 We are a group of MIT engineers, local innovators and entrepreneurs, and community leaders that understand the contacts and designs that need to happen to change this healthcare problem. Our engineering team is able to engage with hundreds of stakeholders in the local communities to ensure that our design is specifically solving the problems that they need solved. Our team that is working on program development are Peace Core or local to the country they are designing for.  We know that we are not designing for these areas, we are designing with these areas -  using our technical and program development knowledge to build up local ideas and resources. Our strength as a team lies in the emphasis on creating a sustainable program that not only provides better emergency transportation, but also strengthens the healthcare system, creates jobs, and rises up the communities. 

The Olive Branch for Children - Tanzania. 

The Olive Branch For Children was the first partner for the Okoa project. We were introduced through a D lab class and they presented the problem of getting pregnant women to the hospital. Since then they have helped us work with the communities and provided all local resources and connections to make the Okoa project happen. Our ambulances are currently serving the community is that they oversee, and who helped us create this design . 

The Tanzanian Rural Health Movement - Tanzania.  

The Tanzanian Rural Health Movement has an order for eight ambulances to serve the four regions that they oversee. They have an app and text based emergency response system to serve their communities, with motorcycle first responders going out to the scene first. Our ambulances will complement the motorcycle first responder aspect of their program. 

The Virtue Foundation - Ghana.

The Virtue Foundation approached The Okoa project asking for ambulances and a chance to pilot a new manufacturing site for the Okoa program. Their connections to the government, medical system, and communities make them a perfect partner to bring Okoa to a new country. 

We will first sell the Okoa ambulances for a price at $1200 to network and grassroot Tanzanian NGOs that focus on community development, mobile health clinics and clinics in developing countries. These organizations already have community relations and understand the local culture, making it easier to integrate the ambulance into existing infrastructures. We aim to make an impact on a regional level to prove Okoa’s effectiveness, and then will lobby for larger government and international NGO contracts to help other communities in serious need. We have been contacted by over 20 organziations representing 10 countries who hope to integrate ambulances into their transport programs or explore microfinancing options to sell direct to drivers - creating entrepreneurial opportunites for members of these rural communities.

Our ambulance costs $490 to make including all material and labor expenses. Other expense drivers include product development and human resources. Our primary income comes from grants and our price markup, but also the revenue from driver training ceritifications, and the extended warranty on the ambulance.

Our organization is a nonprofit, but operates as a for purpose driven organization that will not constantly be giving money to communities. We want to make sure that the communities that we working do not become dependent on the overall project, but are rather empowered by the Okoa project. To make this happen we are starting from a donor base fundraising system as well as applying for grants and family foundation funds. In the longer-term our revenue streams will be able to cover our operating expenses by the three years from now. The way to the O'Connor project works, is that we hope set up small production facilities in country. All of them are our materials are local, and we trained technicians to make our product-the O'Connor ambulance. Vehicle ambulance is sold for $1200, to NGOs or communities that are interested in better emergency transport. We are exploring micro financing strategies for the communities so that a village can pitch in to buy their own and don'ts with a lease to own program.By selling her ambulances and having all of the local materials available in the area, our model is sustainable and will not disappear when external funding does.

The Okoa Project was conceived out of an MITClass, D-lab Design. Over the next 3 1/2 years we were able to use the principles that were taught through MIT to design our product with communities to solve the needs of pregnant women with the help of the communities that they live in. Now that we are an operating organization that has proved our concept with working ambulance services in Tanzania, we are looking to scale. We are looking to dive back in the mentorship and inspiration of the MIT spirit.We have a goal of bringing thousands of ambulances to vulnerable communities,And MIT solve would allow us to make the partnerships as well as tailor our scaling strategy to make that dream a reality. Having seen MIT solve cohorts go through the process,The tailored guidance and mentorship is exactly what we need at this critical point of our organization. We have interest from 25 organizations in 10 different countries, and constantly get requests from communities to bring more ambulances. We know we have the product that can save lives in these areas,We are looking for helping distributing and scaling so that we can continue saving lives, one ride at a time. 

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Being able to partner with larger international organizations with heavy emergency related infrastructure would allow Okoa to get to the next level in scaling. The maternal health and emergency transport organizations that we have begun conversations with that would be incredible launch pads:

Amref, JHPIEGO, Last Mile Health, JSI, VSO. 

We also have looked into partnering with ridesharing motorcycle companies in several countries. We think that being able to utilize the infrastructure combined with having an emergency transportation option like flare in Kenya would allow us to reach thousands more and provide reliable tracking options for the patients that we are picking up. Great partners would be:

MAX Nigeria, Gojek Indonesia, RapidoDelivery Ghana

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The Okoa Project began as an initiative to help pregnant women get to the hospital in vulnerable communities. Throughout the lifetime of our organization we have prioritized getting pregnant women safely to the hospital in areas where they are health and safety is not a priority. We also make sure that we employ women to be part of the process and involve them and every design decision that is made in the creation of our product. If we receive the innovation for women prize we would be able to make sure that we were able to employ more women to be part of the solution to get pregnant women to the hospital. We would also be able to tailor our product even more towards means of women in these communities.

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The a core project is an all female staff team, That focuses on bringing pregnant women to the hospital in vulnerable areas.This has been a challenge as a teamInA technology focused organization,Especially as mechanical engineers in an in a male dominated field.Applying for the UN women she inundates prize for gender responsive innovation not only is a way for us to bring our solution to more women that need our product, but also a way to show the power of an all female team and a discipline that is often overrun by men. With the UN women she innovates prize for gender responsive innovation, we would be able to not only bring more ambulances to communities that need better maternal care, but also be able to employ more women locally and provide more skill building opportunities for women in these areas. Our ambulances are built to save lives, but beyond that provide jobs skill development and strengthen healthcare systems. We hope that this prize can help us continue our mission and involve as many women as possible.