Defining our Impact

What does an optimal ambulance system look like? And what can Flare achieve in a market like Nairobi, Kenya and more broadly throughout Africa? Those are questions that have been on our mind for awhile. Those are questions that include a lot of complexity. Those are questions that we'd argue are more pervasive in these markets. But, we think that's a good thing.

An optimal ambulance system is one that is fast, high quality and affordable. Achieving those three elements is difficult without making trade-offs at different points and when a coordinated system is nearly non-existent as is the case in Kenya. So here are our initial goals at Flare:

  1. Vet the quality of ambulance providers by only allowing companies that have the right vehicles, equipment and personnel on-board to join the Flare platform. We will also make sure that there are ongoing quality reviews through patient feedback mechanisms and government checks. We will also look at how improved and more advanced training can be provided to enhance the level and specialty of services offered.
  2. Improve the coordination and dispatch of independent ambulance operators - first, private ones and then, looking at how to integrate the government fleet. In turn, we believe this will improve speed and reduce the time to care. Shorter time to care leads to improved health outcomes and reduces the number of unnecessary deaths from accidents and emergencies.
  3. Create transparent pricing for ambulance rides and next, work to standardize the prices. We would also like to reduce the prices, but this must be done in a sustainable manner. We believe that there are other means to increase access to those that cannot pay beyond lowering the price for all.
  4. Increase the number of ambulance trips per year for needed emergencies and medical care. Today, many people take alternate means of transport to health facilities like public transit, personal vehicles and motorcycles or they do not get care. We want to increase the overlap in the number of people who need an ambulance with those who use an ambulance.

The next natural question after we've defined our impact goals is likely around how these will be measured. Here are the short answers to these questions:

  • For quality of ambulances, we pre-approve all ambulances to be on the system and then will openly make their user reviews and ratings available to consumers. If at any point, we doubt the quality of service provided, we have the ability to take the ambulance company off the Flare platform.
  • For speed, we will have this documented within the platform and plan to publicly announce our response times on a regular basis. Patients can also see before requesting an ambulance the estimated time of arrival of the ambulance.
  • For pricing, each company listed on the platform, must publish their prices. A patient is able to obtain an estimated fare in advance of requesting an ambulance based on the type of services being requested and the distance.
  • Lastly, for access, we know that today around 70k ambulance rides occur per year in Nairobi. We will measure growth of rides monthly and annually. We will also look into the demographics of who we are reaching to ensure that access is distributed as equitably as possible.

The last question that seems to be on everyone's mind is the scale of our impact -- how many people will actually be able to access these services? And will you be able to improve access for everyone? It's great if we can make services speedy, high quality and more fairly priced, but this must mean that only the wealthy will still be able to afford these services, right? Achieving high quality services, low cost and speed at the same time is going to be our greatest triple challenge. Prices cannot go rock bottom or ambulance companies may not have the right incentives to act fast and provide top-notch services. Ambulance companies need to act fast but they must drive safely and provide the necessary level of care to the patient.

The way that we plan to ensure that even those who cannot pay for the services get them include the following: 1. Working with the private ambulances companies to define what percent of their rides can be for CSR (corporate social responsibility) or from a finance perspective write-offs. The private ambulance companies today in Nairobi already complete many free rides per month for patients that cannot afford their services. Now, it's a matter of better documenting these and defining what ratio allows them continue to be financially sustainable. One company in Nairobi has already defined this by indicating that 20% of ambulance rides are write-offs. 2. Working with the government to provide care for those that are unable to pay. Government ambulances exist throughout the country and within Nairobi, but patients have a difficult time accessing their services similar to their challenges to accessing the private services. Also, the government has a difficult time knowing for whom really needs their service. Flare helps the government better identify which patients they should be handling.
3. Making the system accessible to everyone phone user. Phone penetration stands at nearly 100%, but smart-phone ownership and usage of apps on a smart-phone is still growing. Estimates are all over the place, some say the nationwide estimates are somewhere around 15-19% while others say the percentage is closer to 40% in places like Nairobi. Either way, we will have an app that users can use in addition to a hotline.

At the end of the day, we believe that the number of individuals which we can impact is huge. We can ensure only quality providers are in the market. We can significantly reduce the time to care. We can reduce the price. And, we can massively grow the ambulance rides each day. However, we must do each of these carefully and in balance to not achieve one outcome while worsening another.

We also believe that the impact is more than just about the numbers. We plan to write about individual stories and share them with you. We plan to tell you about the car accident victim who is now being taken off in an ambulance versus being taken by a motorcycle or the woman going into labor who now delivers a baby in an ambulance en route to a hospital versus in her home. We also plan to write about the people who survived because of getting access to an ambulance. And we plan to write about the people who previously could not afford an ambulance but now are able to get access to the service for the very first time.

Impact is at the center of what we do. Impact is not a secondary idea to profit. We believe that making Flare financially sustainable and achieving impact go hand-in-hand.

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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