Ambulances for All

Motorcycle ambulance trailers and an emergency hotline to provide ambulance services to underserved areas of Uganda

# Problem

People in Uganda do not have access to ambulance services. If a woman goes into labor or needs a transfer to get a C-section, her only option is often to jump on the back of a motorcycle taxi. That is true of anyone in need of emergency treatment. There are some ambulances available in the country, but they are often in disrepair, unavailable, or inaccessible because of the expense of fuel, which most people and local governments cannot afford to pay. Currently, there is not an “on-call” system in place, so there are not clear roles and protocols in cases of emergency.

# Solution

The goal of our Ambulances for All program is to provide affordable, accessible ambulance services in Uganda. We do that through four main interventions:

1) MOTORCYCLE AMBULANCE TRAILERS: We purchase motorcycle ambulance trailers for ~$1,000 from Pulse Uganda. These trailers can be attached to any motorcycle taxi, which are ubiquitous in Uganda. The motorcycle ambulance trailers will be parked at the health facility, and we will train 4-5 local motorcycle taxi drivers how to drive the ambulance trailer and transport patients. We currently have 4.

2) 911-STYLE EMERGENCY HOTLINE: We will establish an emergency hotline that people can call in the case of an emergency. Using interactive voice response software (IVR) this line can direct people to an operator that works in their area. The operator will take down the patient’s information, location, and condition and then use the dispatch hotline to contact the correct responders. Operators are health workers who are currently on staff at the major district health facilities and take on this additional duty in shifts.

3) DISPATCH HOTLINE: The operator then calls a dispatch hotline and goes through IVR prompts to contact the responders (motorcycle ambulance drivers and/or health workers) who work in the area. The IVR software allows the operator to choose the location and type of responder (e.g. “Press 1 for ambulance driver”) and then it simultaneously calls all the phone numbers of responders that meet those criteria, and the first one who picks up takes the call and is given the necessary information.

4) EMERGENCY PROTOCOL: In order for the emergency response to be successful, there must be clear roles and guidelines for operators, health workers, ambulance drivers, and callers. We will conduct rapid prototyping and role-playing to develop those systems in collaboration with all parties involved.

# Change the World

1) We will save lives in the areas where HAC operates in Uganda, and we will incorporate this program into our core package so that when we start in a new district, we work with administrators to make these services available. Among other indicators, we expect to see an increase in the rate of births given at health facilities and declines in infant mortality.

2) We will develop an open-source template for expanding accessible, affordable ambulance transportation to various different parts of the world.

We are applying existing technologies (motorcycle ambulance trailers and interactive voice response (IVR) systems) in a unique way to provide accessible, affordable ambulance transportation. Our core innovations are 1) that we are addressing a widespread global health problem that few other organizations are working on, and 2) that we are doing so in a low-cost, scalable way that can be replicated in many contexts.

Most ambulance service solutions fail because they are poorly designed and too expensive. Using IVR software and other communication tools allows our design to tap into the experience of organizations that have used these technologies to operate call centers that better serve customers. Additionally, these IT tools can help with the administrative components of directing the calls to administrative units that can respond to them and limiting the costs of setting up and maintaining a centralized call center.

We will pilot the Ambulances for All in Kalangala District with 4 health facilities and motorcycle trailers, making ambulance services available to 30,000+ people. By the end of the year we will have provided emergency transportation to at least 500 patients and will have a documented model with clear documentation. After one year, we will expand to other districts where HAC is operating: Masaka, Rakai, and Kyotera, with a total population of 800,000+ people.

Like HAC’s Medicycles program, Ambulances for All is designed to be modular and implemented in cooperation with district leadership. Over the next 5 years, we will continue to expand to new districts bringing both programs to make services available to over one million people.

# Reach

How do you implement a 911-style emergency response system in an area that has never had one? We will bring the trailer and informational flyers on a village-to-village tour to explain how the program works and let patients jump in an try it out.

# Retain

We will record and analyze calls, as well as conduct customer surveys of patients who have used the service to solicit feedback and make sure the program is serving their needs.

We want to pilot Ambulances for All, so we are not serving anyone yet. We currently help health workers serve 884+ patients/month (10,608+ patients/year) in 17 villages. We will reach at least 35 villages with monthly mobile clinics by the end of 2018. Just as Ambulances for All, under HAC’s Medicycles program government health workers do the patient care, and HAC coordinates logistics.

In Year 1 we will provide access to ambulance services to 30,000+ people in Kalangala District, Uganda. These are areas with serious transportation challenges in which a majority of residents live over 5km from the nearest health facility.

By Year 3 we will be working in at least 6 districts along Lake Victoria providing the same access to over one million residents.

Among other impacts, we expect to see a higher rate of births at health facilities and declines in infant and child mortality. The lack of transportation is a major barrier to women accessing health facilities during labor.

[Resource needed: Team skills/experience]

1) Commitment of government health officials: HAC has worked with national and district governments since 2014. The design of this program was made in direct collaboration with government health workers and administrators.

2) Design and iteration of response systems: The HAC team has 4+ years of experience designing, piloting, implementing, iterating, and growing our Medicycles program. InSTEDD will help with rapid prototyping and IT development.

3) Funding: The HAC team has attracted over $100,000 to our programs. Collaborating with InSTEDD allows us to tap into organizations interested in funding novel applications of IT.

Our service model is a hybrid in which government health facilities provide medical care and staffing, and HAC provides coordination, M&E, motorcycle ambulance trailers, communication tools, and stipends for operators. Our revenue model in the next 3-to-5 years is to receive grants from family foundations and other grantmaking institutions as we iterate our service model and show proof of concept. In the long-term we will work to advocate for the Ugandan government to either adopt the model into the national emergency response plan or contract HAC to establish and coordinate ambulance services throughout the country.

We need help with program design, prototyping, technology mentorship, and strategic networking. Ambulances for all has the potential of saving many lives and establishing a globally adaptable template for setting up emergency ambulance services, but it will only work if we design the program well, respond to the challenges, and find partners that can ensure the program’s success. Solve can connect us with business, global health, research, and IT experts who can elevate HAC’s capacity to prototype and grow Ambulances for All.

[Barrier: Solve’s help]

1) Poor program design: We have developed the program in a way that serves the unique needs of patients and health workers in Uganda. However, we need some help iterating our design to serve stakeholders.

2) Breakdown of communication systems: The most complicated component of our program is making sure time-sensitive information gets to the right people.

3) Lack of funding: We need at least $6,000 to pilot the program in one district. We also need to identify grantmakers who will help us grow and scale the program, and Solve’s networks will help us identify.