Byarugabas start first private ambulance business in

Uganda Last Updated: 03 June 2015

Byarugaba and wife Isabella beside one of the ambulances they own

It is an area everyone thought was a preserve for government or charity organisations.

Yet this is where Dr Hannington Byarugaba and wife Isabella Birungi Byarugaba found the gap

for one of the most needed services: an efficient and well-managed ambulance service in

Uganda. Their business, City Ambulances Ltd, was born after the couple saw the suffering that

the 2010 Bududa landslide victims went through.

Red Cross Society, which was the charity organisation on the ground, was overwhelmed with the

number of casualties, making it a nightmare to transport many of them to nearby hospitals. There

were not enough vehicles and neither was there any private company to call to provide an

ambulance service.

―This made me think that if there was an independent private ambulance provider, many lives

would have been saved,‖ Byarugaba says.

DIGESTING THE IDEA

―I started digesting the idea and discovered that there [was] no ambulance service, which was

independent.‖

―I got inspired to save life,‖ which has become City Ambulance motto, he added.

This is not the business one can start overnight; it was much more complicated, requiring a lot of

planning, understanding, consultations and hefty resources.

According to Byarugaba, they planned for four years – mobilizing resources, reading available

literature on how a private ambulance works, and visiting several countries such as South Africa,

India, and United Arab Emirates, which have such services.

In November 2014, City Ambulance started. It has five advanced ambulance vehicles worth Shs

100m each; 12 fulltime employees and many part-timers who are on call, including specialized

doctors, nurses, paramedics, and drivers who are also trained as first aiders.

Under City Ambulance, eight products are offered: emergency medical rescue, planned patient

transportation, events and conferences medical support, training in first aid, health and safety at

workplace, supply of first aid kits and other emergency medical equipment, medical air

evacuation, medical escorts, and emergency medical consultancy.

Emergency medical rescue is the core activity, which operates a full-time centre.

―There has never been an ambulance call centre that runs 24/7 in Uganda,‖ Byarugaba says.

City Medicals centre

The company has an ambulance toll-free line, 0800111044, which anyone with an emergency

can call, with the guarantee that help would be on the way in the shortest time possible. The

target response time is eight minutes within Kampala and 15 minutes in parts closer, but outside

Kampala – that is in the event that there is no heavy traffic along the road.

The call centre is equipped with emergency medical dispatchers (EMDs) – people trained to

categories calls – if it’s a priority call meaning someone is in real danger, they will have to send

an ambulance that has the capacity to handle such a case like a heart attack or uncontrollable

bleeding.

Most important is that first aid is offered on phone by an EMD as the ambulance is on the way to

pick the patient.

―For example, the dispatcher will tell the attendant how to hold the patient, stop the bleeding or

do a certain manoeuvre that would prevent further injury or deterioration of the patient’s

condition,‖ explains Byarugaba.

They also liaise with the hospital where they would take the patient such that by the time the

ambulance reaches the hospital, the receiving medical team is ready.

―You can promptly take the patient to Mulago but still spend an hour before the patient is

touched.‖

Choice of the hospital depends mainly on the client because many of them are insured and know

where to go.

―If the client has no preference, we use our own discretion, according to the patient’s condition,‖

he says.

City Ambulance vehicles have GPS and navigation tracking system, with live tracking from

when the vehicle is dispatched, when it reaches the scene and up to the receiving hospital.

―It helps us to know what happens during evacuation [so that] in case of anything, we dispatch

another vehicle immediately,‖ he says.

MAPPING SYSTEM The company has also done a mapping system to determine where every health centre is,

especially those with the capacity to handle an emergency. Under planned patients transfer, they

transport patients from one location to another; for instance, home to hospital or vice versa,

hospital to airport for the patients going for air evacuation, and from hospital to other facilities

that have certain services like computerised scans (CT scan).

Birungi, the wife, explains that this happens on appointment, where the company knows that at a

certain date and time, they would be transporting a particular patient.

Under this product, they have introduced a new service – discharge through ambulance – where

after a hospital discharge; the patient is usually not strong enough or medically fit (like after

surgery or in case of fractures) to move back home in a private vehicle, taxi or boda boda.

Under events and conferences medical support, any gathering with more than 300 people should

have a standby ambulance.

―We have been at sports events like the Rugby union, MTN marathon, Agha Khan convocation,

and motorsport rally,‖ Birungi says.

The company has so far done six medical air evacuations out of Uganda since they started, using

charter planes. It has also offered emergency medical consultancy to NGOs, private institutions

and government departments.

MARKET

Dr Byarugaba describes the market reception of his service as ―exciting‖ with many Ugandans

saying it is timely. The monthly average traffic for emergency service calls is about 50 to 60

calls at present, which is still less than 10 per cent of their capacity. With the current fleet, they

can handle up to 50 calls per day.

Growing demand has also been experienced in first aid training and supplies. Corporate firms,

banks, schools, and medical personnel have made a courtesy call to be trained. It costs about Shs

1.5m to train a group of 10-15 people in first aid, health and safety at the workplace. Other

training courses include: fire fighting and safety, health and safety at workplace, basic life

support, advanced life support, and advanced cardiac life support.

City Ambulance also has medical equipment and supplies such as first aid kits, wheelchairs,

stretchers, and first aid drugs, among others.

It has not been a smooth ride, though. The couple has faced challenges such as the limited

availability of start-up capital, the high cost of advertisement, and lack of public awareness.

INVESTMENT The couple say the initial investment into the business came to about Shs 1bn — with equipment,

the fleet, training, staffing and administrative structure. More than half of the investment went

into the purchase of vehicles and equipment.

At the start, insurance companies provided the clientele.

―We signed with them and took over a clientele of over 120,000 people at a go,‖ he says.

The cost of hiring City Ambulance in Kampala is about Shs 120,000. Outside Kampala, each

kilometre is charged between Shs 2,000 and Shs 3,000, depending on the terrain and the

condition of the patient.

―We have transported patients as far as Juba in South Sudan, Nimule, Gulu, Kisoro, Fort Portal,

Mbarara, and Kiboga,‖ says Dr. Byarugaba.

Byarugaba has advice for those seeking to start a business.

―Careful planning is very crucial,‖ he says. ―You may have the money, but you don’t have the

expertise.‖ For the couple, start-up capital came from savings.

While the couple shares roles as directors, the business is run as a limited company and family

issues are kept out of it.

―Family compromises decision-making and principles. When starting, we were very clear on

what we wanted,‖ says Birungi.

―Business succeeds because of the expertise of the founders. If you are schooled in an area, you

have a competitive edge. You are most likely to understand the products and marketing – that

prior knowledge is important,‖ advises Dr Byarugaba.

The couple are both medical professionals.