Ambulex Emergency Healthcare Solutions

Recent attention has highlighted the need to integrate emergency care into existing health care systems. Delays in management and treatment of critical illnesses and injuries due to costs and infrastructural barriers have contributed to an increased mortality mainly in informal and rural settings, yet integration into community systems has potential to reduce this by 45% and 39% of deaths and disabilities respectively (Broccoli et.al, 2015).  Globally, out of 45 million annual mortalities in (in Low and Middle Income Countries (LMICs), 54% are due to conditions that can easily be addressed by pre-hospital and emergency care. Due to the response, cost gaps and access constraints, approximately 1,023 million of disability-adjusted life years (DALYs) and 932 million years of life lost (YLL) to premature mortality have been recorded globally. (University of Washington, 2018).  

In Sub Saharan Africa, health systems have traditionally addressed the burden of infectious diseases, but now face an increasing prevalence of non-communicable diseases and injury. Kenya typifies this epidemiological transition, with a clear need for horizontally integrated emergency care systems currently unmet by the public health system. Emergency departments are typically staffed by clinical officers (mid-level providers with 3 years of clinical medicine training) who provide most of the country’s emergency care, yet lack specific training in prioritization, resuscitation and stabilization. Most acutely ill and injured patients self-present at hospitals, as the only ambulance providers operate few ambulances throughout the entire country while private ambulances are not affordable for most. 

 Consequently, Kenya does not have an organized national emergency care system, has inadequate specialized trained emergency care health personnel, and has not developed standard operational procedures and emergency operation plans. Emergency medical response services are therefore heavily privatized with fragmented market penetration which makes it extremely expensive for families living in poverty to access as the costs can go as high as $400 per emergency response, exclusive of hospitalization when there is need . Families that earn less than $3 a day may end up spending more than $1,000 in EMR services and hospitalizations; funds they will have to borrow or request from family and friends and because  more than 35% of Kenyans living in poverty are economically disadvantaged, they end up heavily indebted and not able to meet other basic needs (Nicholson et.al, 2017). 

The solution is a GPS and biometric enabled wrist-band that is distributed to families who have subscribed to Ambulex’s  services at $1 a month.

 The wristband acts as a tool to call for help in case of medical and trauma emergencies. The wristband informs Ambulex of who is in distress and requesting for help and their geo location for quick response, especially in slum areas that lack proper emergency response systems. For example, A person in distress would place a finger on the band which will send information to our central system  then an emergency medical technician (EMT) will be dispatched within that community. The technician responds with a motorbike equipped with a trauma kit and  assesses and manages the case i.e stabilization and will only call for an ambulance if there is need.

People living in poverty find it difficult to access emergency healthcare services. Even where public services such as clinics and hospitals are provided within low income communities such as the slums, the high cost effectively bars most slum dwellers from calling an ambulance.

Ambulex Health Solution serves low-income families living in low-income communities, earning approximately $3 per day. The innovative solution aims to reduce deaths and disabilities by 45% and 39% respectively (Broccoli et.al, 2015), by integrating community systems into our Emergency Medical Services (EMS) solutions. The intended impact is a sustainable and affordable access to emergency medical response and rescue services for more than 100,000 families in the next 5 years.

The Ambulex team lives and has worked with low-income communities especially in designing and implementing programmes and projects such as NPI-SHARP, DREAMS and APHIA II, which were aimed at improving their lives and giving them opportunities to live to their full potential. Together the team has more than 30 years of experience working with families in low-income settings, providing health-related services including creating demand and uptake for essential health services and commodities on malaria, HIV/AIDS. TB, etc.

 From this experiences, ASL has identified a Community Mobilization Model -hubs and spokes- which has proven to be an invaluable instrument for identifying the  bottlenecks of access to EMS (community mapping exercise); identifying low cost but high impact solutions (invest for impact); mobilizing  relevant stakeholders (mobilize for change) and institutions (engage and improve services); and a continuous learning process in order to adapt  to the new environment and challenges (learn, monitor and evaluate).

We work within community leadership structures and systems that allow for ownership of the idea. We provide job and business opportunities for community members to improve their lives by engaging them at the community level. 

Ambulex Healthcare Solution is applying to Solve for technical support to improve the technology solution- the GPS and biometric enabled wristband to not only be more efficient but also cost-effective. The current cost per unit for a wrist band is high at $180, and reducing that drastically to $3 will allow for more families to afford while ensuring a sustainable venture. The current design of the wrist-band is bulkly and conspicuous, which does not support our efforts in cases of responding to GBV where victims can place a silent call for help without the perpetrator knowing. 

 The company is also looking for financial support that will allow it to expand its hubs and spokes model, by on-boarding more EMTs to cover more communities and to additionally reduce the cost of response by ambulances from an average of $150 per trip to $45, and reducing the response time from the average of 2 hours to 15 minutes. 

The Ambulex solution is different from other existing initiatives as it seeks to provide an alternative narrative in the emergency medical response services industry.It shifts from a heavily supply-side control of EMS dynamics, to a demand-side surge of service uptake, in a fashion that is more responsive and effective, by the ignition of access and linkage engines, by combining:

1. Provision of last-mile EMR services in liaison with communities, government, financial and private health institutions under an affordable emergency care micro-insurance scheme. 

2. Complementarity of EMR services with continuous data generation, spurred by a Pan-African research approach with relevant facilities, informing national and regional policy development and pursuit of data-driven policy implementation. 

3. Catalyzing the uptake of paramedicine discipline in training institutions and providing a market for the same, including post-training/in-service career expansion.

Ambulex proposes a bold approach  with the unique innovation of the Hubs & Spokes model, which is anchored into the Kenya Community Health Strategy, by utilizing Community Units (CUs) manned by Community Health Volunteers CHVs) as the entry points and reference sites for emergencies, thereby reducing the response time to 15 minutes from the current average of 2 hours, that has been associated with majority of injury progression and even deaths, as a result of longer turnaround time (TAT) in responding to distress calls for critical care cases. This is the mainstay of Ambulex’s push for a grassroots-level critical care service package that is less ‘health-facility-dominated.’ 

 Though there are varied EMS packages to suit different audiences, the current service providers in Kenya are very expensive and services are out of reach to the common citizenry. Membership subscriptions are also web-based with over-reliance on demand-side initiation of memberships, while heavily focusing on a centralized custody of ambulatory equipment and dispatch teams. 

 Ambulex as a company has carried out an accurate market segmentation to ensure availability of a variety of products to suit different social needs and economic classes. Affordability is a key mantra for Ambulex, by providing pocket-friendly monthly subscriptions covering a whole family, as a departure from the current “corporate favored” EMS covers even for low income earners. A family-wide subscription is registered with the details of the head of family while enlisting the entire household membership, so that any member of that family benefits, regardless of who is the nominee. 

Ambulex aims to achieve the following impact goals for the next year and the next five years:

• To provide 10,000 households with affordable and timely emergency medical response and rescue services 

• To employ more than 100 young people as emergency medical technicians

• To impact 10 businesses owned by young women 

• To  provide response and evacuation services to gender-based violence victims 

 We will achieve these by vigorously working with communities to subscribe to the solution through community health volunteers and other community leadership structures such as “nyumba kumi”- a strategy designed to bring together Kenyans in clusters defined by their physical locations and common interests to create a safe, sustainable and prosperous neighborhood. The organization will also conduct community mobilization and sensitization activities that will be its marketing strategy, that will provide information and materials for the communities to make informed decisions on how they would want to access emergency healthcare. 

Ambulex will measure its progress using the following measurable indicators:

• Number of families subscribing to our services 

• Number of distress calls made from our subscribers 

• Number of calls response to and services provided 

• Revenue from subscriptions 

• Turnaround time for response to distress calls 

Two decades ago, it was predicted that 80% of all Emergency Medical Services (EMS) will be provided at home or in decentralized ambulatory centers, with physical locations, technology assistance, patient comfort, flexible hours and customer friendly providers being its critical components (Watkins & Associates, 1997). This premonition has come to pass, with the majority of EMS providers currently diversifying their services to include on-site casualty stabilization before transportation to hospitals for further management. The community is one gravely untapped resource in EMS  in Kenya, with many communities feeling morally obligated to EMS as their responsibility and to support in alleviating suffering before help comes, with desires for reduced EMS costs, improved response systems and structures including transportation and community EMS capacity enhancement (Broccoli et.al, 2015).

Ambulex Healthcare Solution potentially aims to reduce deaths and disabilities by 45% and 39% respectively (Broccoli et.al, 2015), by integrating community systems into its EMS solutions. The intended impact is a sustainable and affordable access to emergency medical response and rescue services. Therefore, as an outcome, we will efficiently design a national emergency medical response and rescue system.  Ambulex aims to achieve this by:

1. Creating  medical emergency response and rescues reference sites in communities through our innovative hubs and spokes model, working with community health volunteers for last mile delivery of EMS,

2. Enrolling families into a subscription scheme ($1 dollar a month per family) to address and enable affordability,

3. Developing digital response tools (Biometric and GPS enabled medical wristbands) that will reduce turnaround time for emergency response and rescue to 15 minutes or less, 

4. Provide effective linkage and referral system for pre-hospital care and hospitalization, to ensure that patients are attended to and not left to die or in pain at emergency or casualty rooms, and 

5. Integrate the National Health Insurance Fund in our end to end service provision, to enable universal health care access. 

Our technology-enabled solution uses a wristband for emergency response services. The wristband  has the following features:

- GPRS communication via a sim card

- Embedded with a GPS chip for geolocation services

- Has a 1000mAh lipo battery

- Has a USB charging port

- The USB charging port also functions as a diagnostics port

- Upon a button press it sends the current location to a pre-configured phone number

- The wrist band has a unique identifier.

The Ambulex leadership team is diverse in age, gender and brings together a wealth of experience in community and health systems, business development and technology. The CEO and the Board Chair are both women, while 70% of the Board consists of women. Our team is made up of professionals from different regions in Kenya, which promotes the culture of inclusivity and diversity. 

Our decision-making processes are guided by our values as well as systems, policies, and procedures, which reflect and ensure compliance with local laws, rules, regulations, industry standards and best practices, in support of the realization of our vision and mission. These are built upon a democratic system of governance which among other things, is participatory, inclusive, consensus-oriented, and aligned with other best practices in good governance. 

Our leadership team and employees make decisions that help us remain accountable and transparent, guided by the set guidelines of our organizational policies/procedures including Organizational Chart, Human Resource Management Policy, Equal Employment Opportunity and Affirmative Action Statement, Diversity, Equity, and Inclusion Policy (Gender, Disability, and others) Leadership Succession Policy and Finance and Accounting Policy among others.

As Ambulex grows, we will on-board people from across the country and encourage more young people and women to pursue paramedicine as we will open up the job market for emergency healthcare.

Ambulex as a social enterprise was founded on the basis that access to healthcare is a basic human right as is enshrined in the Kenyan Constitution, and that all  Kenyans must therefore enjoy this right and live to their full potential. We have anchored our solution on this right, by providing technology-  enabled innovation that is human-rights centered and community-driven. For the past 6 months, ASL has worked alongside communities,  ambulatory service providers and networks to respond to emergency medical calls and on-board families to subscribe to these services. We  are driven by love and humanity, knowing that these two can provide hope for families to become resilient and live to their full potential. Our solution is targeted at families that live in low-income settings who subscribe to the emergency response solution at 1 dollar a month. Should any of the family member need emergency healthcare, they either use the wristband or make a call to our call center, after which an emergency medical technician  living within that community will be dispatched who will assess and stabilize the patient before summoning an ambulance in cases where one is needed.

Ambulex solution is designed  in such a way that the community owns and drives the activities, therefore, strongly seeing this as a means to sustainability, as the organization  will not spend a lot of resources on marketing, hence a good projection on revenue from its core business as the numbers  targeted are large and its route to market provides an opportunity to scale. Beyond this, as Ambulex as a social enterprise, has put in place strategies that will also generate grant income from different development partners, with a focus on gender-based violence especially in informal settlements. The solution on GBV  is already  attracting attention from partners such as the government of Kenya, UN Women and UNFPA

 Therefore, Ambulex will be funded primarily through revenue generation from subscriptions and it  will raise investment capital to support scale and grow revenue.Ambulex also seeks grants to support the business in areas of research and service delivery improvement including capacity building for employees to deliver better health outcomes. The grants will also go into supporting the work that is already being advanced in the areas of gender based violence. 

Ambulex solution has so far received a grant of $1,500 from Vilgro Africa and $16,000   in the form of  angel investment. The Solution has also generated revenue worth $6,000 in the last 6 months.