Sweta Mangal, Co Founder and CEO, Dial 1298

They say that life is unpredictable and all we can do is prepare for the worst and hope for the best. However if we need emergency medical service what do we do especially in India? Many of us know of at least one such case where timely medical aid could have saved someone's life. Sooner or later even if we are not involved in an accident we will need some medical assistance. If you are ever in a situation where you need urgent medical attention, pray that you are either in Mumbai or in Kerela because there you can "Dial 1298 for Ambulance".

"Dial 1298 for Ambulance" is an initiative to provide a network of Fully Equipped Advanced and Basic Life Support Ambulances 24 hours x 7 days a week.

The service has been setup with technical and managerial assistance from the London Ambulance Service and New York Presbyterian EMS, two of the world's largest and best metropolitan Ambulance Services. In case of a medical emergency, dial 1298 from any phone for accessing a fully equipped Advanced Life Support (ALS) or Basic Life Support (BLS) Ambulance within the shortest possible time. "Dial 1298 for Ambulance" service currently covers Greater Mumbai with 51 Ambulances and seven districts in Kerala State with 30 Ambulances.

However the hypochondriac within us need not fret, as they plan to expand to at least 8 other metros of India in the next 5 years.

"Dial 1298 for Ambulance" was set up by a group of young Indian professionals (Shaffi Mather, Sweta Mangal, Naresh Jain, Manish Sacheti and Ravi Krishna) who were all educated in the US and decided to return to pursue independent careers at various corporate firms. It was a series of unfortunate events that lead to the conceptualization of the "Dial 1298 for Ambulance" service.

Sweta Mangal (Chief Executive Officer) told Yourstory of how the" Dial 1298 for Ambulance" service came to be… Shaffi Mather had a personal experience in which his mother choked in her sleep at midnight. Unsure of how to relieve her or what number to call for help so late in the night, Shaffi felt helpless. Although Shaffi's mother survived, this experience left a lasting impression on him. A week later, Ravi Krishna's close friend died in a road traffic accident because timely medical attention was not available.

 These events made them realize the acute need for an organized and networked Ambulance service in India for saving lives which may have been lost only for want of timely medical attention. Shaffi and Ravi, who were childhood friends thought of starting an ambulance service to help people. They both discussed this idea with Sweta, Manish and Naresh, who found the thought very compelling and decided to be a part of the initiative.

The idea was to start a world class ambulance service in India, modeled around the 911 caller service of US and 999 of UK. The idea was floated in 2003, and following that the whole of 2004 was spent researching all the failed & successful models across the world, so as to arrive at a model that would work in India. During this period Shaffi won one of the most coveted scholarships around as the Gurukul Chevening Scholar at London School of Economics (LSE). During his time at LSE, he had the opportunity to work closely with London Ambulance Service and managed to build a relationship wherein they agreed to help in launching the service in India. This was big step in the incubation of the "Dial 1298 for Ambulance" service.

On his return, an Ambulance was purchased and fully equipped as per LAS standards and started on a pilot basis. As for the charges it was decided that people would be given the option to pay if they could afford. Within the first month the payment logic had to be revised, since in India no matter how wealthy an individual is, if the option is presented, most likely the person will not pay.

While the team was evaluating various options on how the charges could be levied, the team met with Dr. Sam Pitroda and he guided the team, saying that for any social project to be successful in India, it needs to be self sustainable, emphasizing on the importance of using a cross subsidy model which will ensure revenues and at the same time universal access. His advice helped the team and finally after some trail and error, the cross subsidy model was adopted which has worked effectively in the Indian Scenario.

The service is also one that reaches across economic divides for us Indians. Dial 1298 looks at providing "World Class Quality Emergency Medical Service" which can be accessed 24X7 irrespective of the user's ability to pay.

Ambulances have been available in India but the Ambulance scenario has been highly fragmented, or dominated by a single Ambulance Owner. There is no concept of Life Support, either Basic or Advanced and no networking among Ambulance Operators where the caller has to make multiple calls. Most of the Ambulance services available are not available 24/7 and the response time can be very long. In short, a Quality Life Saving Ambulance (Emergency Service) is still lacking even though our healthcare industry has progressed in leaps and bounds over the last 20 years. The organization seeks to fill this vacuum in Emergency Medical Service / Transportation in the Indian Healthcare Delivery Channels.

The following table shows the no of calls the service has completed as of March 2008.

So what makes this ambulance service different from the others that are there?

The answers are simple. The uniqueness of the service business model is its Self Sustainability (from its own revenues) and Universal Access (provision of service irrespective of the ability / capability to pay using cross subsidized pricing regime).

The differentiator is its multi-level Differential Pricing Strategy. Working on the principle of cross subsidy where the high income population pays higher, the economically underprivileged pays lower and the BPL (Below Poverty Line) population getting the service free of charge in life threatening medical emergencies. To enable easier and corruption free administration of this differential pricing model, the hospitals are divided into different levels based on the prices / tariffs charged by the hospital and the user fees are levied accordingly based on the originating / destination hospital of the patient.

The project has demonstrated the self sustainability of the model over the last three years as the costs are met by the user charges collected from the higher income clients.

This revenue is further augmented by sponsorship revenue generated out of marketing activity carried with various corporates and by placing advertisements on the Ambulances. The model has achieved cash positive results for the last two financial years showcasing its scalability and replication feasibility. The Ambulance Control Room in the Mumbai for the "Dial 1298 for Ambulance" is well equipped and can manage upto 500 Ambulances at any given time without any further Capital Expenditure.

Thus with a model that can be replicated all over India and a vision to expand to at least 8 other metros of India in the next 5 years. The group now plans to grow with all speed. The entire project is managed and run on a day to day basis by M/s. Ziqitza Healthcare Limited (Operating SPV). The organization is a professionally structured and staffed organization with outstanding managerial talent and committed staff passionate about EMS and saving lives.

Functioning under the strict control and supervision of the Ambulance Access for All Foundation, this working structure enables running the

"Dial 1298 for Ambulance" service with the efficiencies of the private sector while maintaining the universal service response required by an Ambulance in life threatening situations. All this happens with the cherry on top, of assured service irrespective of the ability to pay for the service by the patient / victim or their families.

This structure has also helped attract funding for scaling up the project along with structured debt / equity for Capital Expenditure beyond the limited but growing philanthropic / grant based funds available. Leading Social Enterprise Venture Fund Acumen Fund (www.acumenfund.org) has invested USD 1.5 Million in the project helping a faster scale up of the service in Mumbai and Kerala.The group is on a road show for a second round of funding which will enable them to scale up across India.

With so much success did the service ever have to face any hurdles in their functioning?

Undoubtedly they had to face a few, as is the case with any venture. Sweta Mangal detailed some of the trials they faced

1. Corruption in the Indian System:

"The first step taken to start the ambulance service was to apply for an easy to remember four digit number, for which we approached the Telecom Minister who allotted the number 1299, however the bureaucrats under him asked for a huge sum for assigning the number, which we refused, therefore just to trouble us, the number 1298 was given, but since "beggars cannot be choosers" we took the number. This is just one of the examples, as at every step we found people asking for bribes and favors which we objected to, and therefore we faced a lot of problems in getting the service off the ground."

2. Capital to start the project:

"Once we thought of the project we approached various banks to finance the ambulances, all the banks appreciated the project but refused to give a concession on the rates. We therefore decided to put in our own savings as seed capital to start with 10 Ambulances."

3. Trained Manpower:

"We decided to operate the Ambulances; and we started looking for doctors who would work on the Ambulances. We found that a MBBS or a doctor in alternate medicine did not find it attractive to work in an ambulance. We had to pay higher than market rates to attract doctors to work for us."

Despite the problems they faced the group never gave up. They had more than their share of troubles because as newcomers to the scene there were a few hard earned lessons in store for them. Sweta Mangal relates "The biggest mistake we made was that we trusted a software company, which we paid in advance for the product, they did install the product but did not provide any support, eventually we had to scrap the product which was worth 25 lakhs because without any support the software is no good and we had to get a new one. The mistake was to trust a vendor and pay in full before the product was installed."

From just 2 ambulances in 2004 to the 81 ambulance units that they run today "Dial 1298 for Ambulance" has been able to achieve a bit of success, however Sweta says their biggest achievement was "the total number of calls (over 70,000) completed over the last 4 years of operation, around 10% of calls were emergency calls, wherein a person's life was. Also over 18%of the calls completed have been either free or subsidized, thereby making the service available to the needy irrespective of their ability to pay.

 "During the recent Mumbai terror attacks in December, the 1298 Ambulances were first on the scene at the Taj Hotel & Leopold's Café even before the police or media reached the incident sites. 1298 helped rescue a number of victims including foreigners & Indians, policemen and NSG Commandos. A total number of 125 victims were transferred during the three days. 1298 had 90 Ambulance crew members working on the field at the incident sites 24 X 7, ready to assist in rescue victims over the three days of the terror attack."

With all the good work they have achieved there have been times when even they contemplated pulling the plug on their operations. After bearing witness to the amount of corruption which existed in the name of saving lives and running ambulances, the group decided to combat the corrupt system. Sweta says "It was then we realized how difficult it is to fight the system and the corruption. Finally, our patience, our persistence paid off, but during those times I did feel like giving up sometimes and finding a regular job"

The Recognitions and Awards for "Dial 1298 for Ambulance" Project have some in steadily, following are some of the major awards and accolades which has come by for them

Godfrey Philips National Bravery Award for Social Act of Courage 2007

Times of India / Times Foundation Recognition Award for Life Saving Service in Mumbai 2006

Oxford University, Said School of Business Case Study

Harvard University Business School Case Study

1 of 20 Social Entrepreneurship Projects from around the World selected for Global Social Benefit Incubator Program

In response to all the recognition and glowing accolades, Sweta says "Saving a life is one of the most rewarding experiences a person can undergo in his/her life. The feeling of creating something new, something which will not only make money but also benefit the society at large is what keeps me going. I receive letters and phone calls from people thanking me when 1298 plays a part in saving someone's life, which keeps me going."

The plan for the future is to scale up the "Dial 1298 for Ambulance" service to top eight cities (Delhi, Calcutta, Jaipur, Pune, Hyderabad, Chennai, Bangalore, Ahmedabad) and to cover the entire state of Kerala in the next five years.

Sweta and "Dial 1298 for Ambulance" also had a few words for any entrepreneur looking for such success…

"You need to be persistent and have loads of patience, research the industry in which you would like to operate. Have your vision and objectives clearly defined, once your pilot is successful, scale up fast." On a lighter note they also advise "Do not reinvent the wheel, rely on partnerships and tie ups ". So with that said Yourstory wishes the visionaries at "Dial 1298 for Ambulance" much success and Godspeed in their mission to aid their fellowman.