Nairobi by Numbers: the Emergency Facts

Whether you live in Nairobi or are a fact-loving individual like us (or maybe both), you're likely wondering what the ambulance and emergency market looks like here. We've pulled together some useful stats to give you an idea of the current state of affairs and also show you what we're helping to change.

All of this information is based on several interviews and meetings with our ambulance partners in Nairobi. We've organized the facts under the most Frequently Asked Questions (FAQs) which we often get from potential investors, other entrepreneurs and individuals in the healthcare space in addition to our friends.

How do you call an ambulance today?

  • There's a short-code - 999 or 112 - that you can call. The call is routed to the main police station in Nairobi and then the officer on duty calls a St. John ambulance. There has been a long-standing agreement between St. John's and the police station. The number is not always operational and the line is unable to accept more than one call at a time.
  • Every ambulance company (the 8 we are working with at least) have 3 or more numbers to call. That means there are more than 24 different numbers across even the existing companies.
  • Every hospital also has a number that you can call to try and get help. Most hospitals in Nairobi do not operate ambulances or they operate a small fleet and therefore have to coordinate with the other private and public ambulances.
  • We estimate that there are nearly 50 different numbers to call in Nairobi for emergency help. Summary: 2 central hotlines + 24 ambulance numbers + 21 public and private hospitals + some that we haven't recorded.

Who runs the market?

  • 8 major operators; major operators are those with more than 5 ambulances within their fleet.
  • 2 of the 8 major operators also have their own health facilities and insurance programs and the remaining 6 are independent of a specific facility.
  • 1 of the major operators is a non-profit and all the other ones are for-profit.

Do ambulances actually exist in Nairobi? I never see any...

  • 100 private ambulances of which 62 are running on a daily basis. The reason that most are not operating their full fleet is that demand is low.
  • 70 ambulances are estimated to be needed in Nairobi as per the WHO recommendation where 1 ambulance is required for every 50,000 person.
  • 3.24 runs per vehicle per day on average.
  • 78K estimated total runs per year in Nairobi of which our ambulance partners estimate 80% are hospital to hospital transfers.
  • 70-90% additional and available capacity on a daily basis.
  • Note: we have not included any public ambulances within this estimate which surely are significant enough that these figures like number of ambulances and runs per year would dramatically change.

What is the response time in Nairobi? How will you deal with traffic to improve response times?

  • 2 hours is the average length of a single trip from start to finish.
  • From interviews, we find that the break down of the trip varies greatly but the main components include: 1. Calling the various ambulance companies and gaining pre-approval from insurance companies (if you have insurance), 2. Dispatching of the ambulance, 3. Waiting for the ambulance to arrive, 4. Transport to the facility, and 5. Delays in receiving and clearing the patient at the hospital.
  • With Flare, the ambulance companies will now be able to use Google Maps navigation software to improve their routing to the patient and also to the facility after picking up the patient. Today, they have no real-time traffic and mapping technology to show them the fastest and alternate routes. We believe that steps 3 and 4 of the process will be where we can save the most with the navigation software due to traffic. Other features and functionalities of the Flare platform will improve the remaining steps.

So how fast do you think ambulances will be able to respond to patients once Flare goes live?

  • 6 minutes and 10 seconds is the median response time in New York City. 9 minutes and 15 seconds is the average response time.
  • 8 minutes is the recommended international standard for response time.
  • For reference, here's the average break-down of time (9:15) in NYC: 1. Reaching 911 and connecting with someone for help - 1:05 , 2. Dispatching of an ambulance - 6:04 3.Waiting for the ambulance to arrive - 2.06 and 4. Unknown and 5. Unknown.
  • We are going to keep close track of each step during the pilot and are going to start working with our ambulance partners to set realistic goals that do not compromise the health of the patient. Our initial goal is to be able to achieve steps 1-3 in 30 minutes. Let's see how quickly we can achieve that goal!

Ambulances must be too expensive for most to use, right?

  • There are 2 types of ambulances in Nairobi: Basic Life Service (BLS) and Advanced Life Service (ALS). Within Nairobi, BLS averages about 3,500 KES while ALS averages about 8,500 KES.
  • 5,500 KES ($55 USD) is the average trip cost in Nairobi. This is based on percent of trips that are BLS and ALS.
  • 10,000 KES ($100 USD) is the average trip cost if traveling outside of Nairobi. Ambulance companies charge based on kilometers traveled outside of Nairobi.
  • For comparison sake, an ambulance ride can range from $224 to $2,204 per transport for Medicare beneficiaries according to a 2012 report by the U.S. Government Accountability Office.
  • We believe that prices need to be transparent (that's a must!) and know that there are opportunities for the prices to be reduced especially as volume picks up. We are working with our ambulance partners to ensure that they are financially sustainable and exploring ways that they can expand their service offerings to more Kenyans. Further, there are opportunities for the public ambulances to join the platform which is something we're still assessing and hope to solve before launching the consumer side of the platform (app and hotline).

References:
NYC Stats ; Median Response Time in NYC & US Ambulance Costs

Caitlin F Dolkart

Graduate from MIT Sloan School of Management (MBA) and a Legatum Fellow. Background in management consulting, impact investing and international development.

Nairobi, Kenya

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