Center for Health Market Innovations (CHMI)

Programs

Ad-din Ambulances

last updated Apr 5, 2013

Overview

Implementing organization: 
Ad-din Hospital
Legal Status: 
Private (not-for-profit)
Year Launched: 
2008
Stage: 
Existing/expansion stage
Income Level of Target Population: 
All income levels

Funding

Primary Source of Funding: 
Out-of-pocket payments
Additional Source(s) of Funding: 
Donor, Other 3rd party (e.g. debt, equity), Revenue (e.g., interest on loans)

Technology

Technology Used: 
Phones › Voice, Global Positioning System (GPS)
Technology Purpose: 
Other
Technology Partner(s): 
Grameenphone

Scale

Personnel Employed: 
50-99
Number of Clients Served: 
93,924
Number of Facilities Operated/Networked: 
66 ambulances
Upscaling: 
In January 2008, the Ad-din Hospital purchased a fleet of 10 ambulances. Within a year, the fleet had grown to 46 vehicles, and interest in the new program increased quickly. In 2011, another 20 vehicles were added to the fleet.
Summary: 

The Ad-din Hospital established a low-cost ambulance service in 2008 after recognizing that many women in Dhaka were failing to access emergency obstetric care. Using mobile phones and a global positioning system (GPS) tracking, Ad-din manages a fleet of 66 ambulances stationed throughout the city. These ambulances serve women requiring transport for emergency obstetric care, as well as for non-emergency services such as transport home after discharge.

Program goals/rationale: 

The high cost and lack of availability of transportation can pose significant barriers to laboring women in need of skilled care around the world. In densely populated urban environments, transportation problems remain acute, despite the ubiquity of vehicles. In Dhaka, the humming capital of Bangladesh, 11.9 million people jostle for space (BBS, 2011). Women in labor can opt to travel by rickshaw or three-wheeled minivan during the day, which can be effective, although slow and uncomfortable. At night, however, drivers may refuse to transport laboring women because of security concerns. Hiring a private ambulance or car has historically proven prohibitively expensive for many. Transportation to skilled maternity care facilities provides women with the services they need to prevent obstetric fistula, which occurs when a woman is in labor too long or the delivery is obstructed and she has no access to a cesarean delivery.

Key program components: 

Each of Ad-din’s 66 ambulances is just 1.4 m wide and 3.4 m long (4 feet, 7 inches by 11 feet, 2 inches). Each ambulance is equipped with a stretcher, an oxygen tank, a mask, and two small fans. The compact design means that ambulances can navigate nearly any Dhaka road and weave more effectively through the congested traffic than larger vehicles might. To ensure efficiency and quality, each ambulance in the Ad-din network is equipped with a GPS tracking device, which allows dispatchers to quickly determine which driver can reach a given patient with greatest ease and speed. This rapid response is especially important for women who are experiencing obstetric complications and need emergency care.

The fleet is managed by an ambulance desk near the entrance of Ad-din Hospital, where a dispatcher asks callers for their name, location, contact number, and the patient’s name. The dispatcher does not discuss the patient’s health issue, as the ambulance service is available to all. Rather, the dispatcher determines which driver is closest and available, then puts the driver and requesting party in touch with one another so they can confirm how soon the ambulance will arrive and exactly how to locate the patient’s address. Patients can choose to be driven to any facility in Dhaka, unless they urgently require care, in which case the driver takes them to the nearest appropriate facility.

Since 2009, uptake of Ad-din’s ambulance service has been rapid. Although ambulance services are typically designed to assist patients in reaching emergency care, the service also provides an important transport option for patients needing to return home from the hospital; 62% of Ad-din ambulance trips in 2010 were to return discharged obstetric patients to their homes. In the same year, 82% of incoming patients using Ad-din’s ambulances chose to be delivered to a hospital other than Ad-din.

Program history: 

Ad-din Hospital in Dhaka is one of the charitable projects of the Ad-din Foundation, dedicated to serving the health needs of women and children. In January 2008, the Ad-din Hospital purchased a fleet of 10 ambulances. Within a year, the fleet had grown to 46 vehicles, and interest in the new program increased quickly. In 2011, another 20 vehicles were added to the fleet.

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