Mumbai and Kerala's Dial 1298 for Ambulance is a model for developing cities worldwide
Visiting its operations in Mumbai, Accra-based Sheila Ochugboju sees much to admire in Dial 1298 for Ambulance, a private company using a cross-subsidy model to provide ambulance services for residents rich and poor, but fears the middle class is too small in her own city for the model to be replicable there.
Dial 1298 for Ambulance is a private ambulance company, the first in India catering to all residents in its service areas regardless of income, and one of just three organised operators in the country. In 2007 the company had ten ambulances in Mumbai. It now has more than 280 ambulances across Mumbai, Kerala, Bihar, Rajasthan and Punjab, and its call centres have answered more than 100,000 emergency calls. It operates on a cross-subsidy model, charging premiums to middle-class users seeking private hospital care to support more basic services for the poor.
The founders' original vision is reflected in the organisation's commitment to meeting international quality standards in emergency medical services and extending the availability of emergency transportation and care to lower-income populations. And during its seven short years of operation it has very quickly changed its plans repeatedly as it met new challenges, adapting to the vagaries of an arbitrary, inefficient patchwork of healthcare delivery across Mumbai and the Kerala State, evolving structures and procedures which have helped to save over 70,000 lives.
In Accra where I live, the provision of emergency services for the urban poor is still at an abysmal state. This is a city with a population of just 3 million, compared to the 12.5 million inhabitants of th City of Mumbai, with a small albeit growing middle class, so the opportunities for private sector involvement in emergency services delivery are not as economically feasible as they are in Mumbai. The burden of care, therefore, lies squarely in the hands of the public sector for now.
In April 2009 after yet another disaster the Minister for Health in Ghana was reported as saying, 'the recent gas tanker explosion on the Winneba road confirmed our unpreparedness to handle emergencies.' The most obvious casualties from such a poor ambulance service in West Africa come from road accidents and maternal deaths due to hemorrhages during crude transportation such as donkey carts and bicycles.
The Minister later outlined plans for a National Ambulance Service Bill. These plans include a financing agreement for the construction of 12 district hospitals and technical training instiutions. The agreement is also for the supply of two air ambulances, 50 mobile clinics, ten educative mobile units and 200 ambulance cars.
In Ghana, where Christian culture has a huge reverence for the dead, the living who find themselves in emergency situations get scant attention while refrigerated ambulances are mostly hired to carry corpses, and large amounts of money are spent to preserve bodies for funerals that take place months after death.
A major private sector initiative comparable to the Dial 1298 model in West Africa is the West Africa Rescue Association (WARA). They provide a very effective service to corporations, businesses and rich individuals. This trend is likely to grow as more specialised operators such as the Global Air Ambulance service are starting up to provide coverage for companies entering the region to exploit the new discoveries of oil and gas.
The high concentration of international organisations and NGOs in cities such as Accra skews the picture even more, as they are serving a very small elite. The trickle-down effect of economic growth in the region may not directly benefit the urban poor in the short term, because even if Africa continues to grow at the most optimistic rates quoted by the World Bank, by 2030 the total number of people defined as middle class would only be 43 million compared to 267 million middle class people expected in India by 2015.
Therefore any private sector initiatives to safeguard basic human rights like healthcare would have to be heavily subsidised by the state as the markets alone could not sustain large-scale pay-per-use ambulance models such as Dial 1298.
Without determined efforts to develop public-private partnerships that can subsidise the cost of provision to poor people, whatever plans the governments of West Africa have to reduce mortalities due to poor emergency services will not survive first contact with that old enemy called poverty still claiming lives in West African cities.