A business model around private ambulance services

A business model around private ambulance services

The golden hour is critical for providing emergency care to accident victims and in case of certain medical conditions. Ziqitza operates ambulance services to ensure that care is available on call



You watch a near one suddenly struggle to breathe and call for ambulance but find that you can reach the patient to the hospital faster in your car than the ambulance can reach you. This inefficiency will always become the topic of discussion between friends and graduate to the falling quality of service all around. However, very few will take a constructive step and actually find a way to address this severe pain point in the society. And sometimes, a life is lost because emergency care in what is called the ‘golden hour’ and ‘platinum minutes’ is not available. An ambulance is fitted with emergency equipment to revive and keep the patient functioning. A car is just a medium of transport.

Sweta Mangal, CEO, Ziqitza Healthcare, Mumbai, remembers how one of her close friends faced such a situation – his mother choked suddenly and he had to rush her to the hospital in his car. This shook him up, but it also got five friends together to see what they could do to make a change. Though the five had their own careers to pursue, (Mangal herself working for Zee TV at that time) they decided that the quality of ambulance service needed improving and that they could make a difference. Ziqitza Healthcare (Ziqitza ) was formed with this vision in 2003 and today operates over 800 ambulances across 17 states.

Getting the Model Right

“All five of us had returned after completing our studies and working abroad. We were pursuing our careers here, so we decided to start an ambulance service under an NGO model,” reminisces Mangal.  But, even in the pilot phase, which they tested in Mumbai, the model did not seem sustainable. At that time, the founders met Sam Pitroda, their mentor, who told them that to become sustainable, they should become a social venture.

In the course of running the pilot phase, the team observed that only those seeking admission in government hospitals could not afford to pay for the services. The rest, who preferred private hospitals, could pay and so a cross-subsidy model was evolved and the number 1298 was designated for private ambulance service in 2005.

“In 2007, different states started to float tenders for ambulance service and we won 7 out of 11 tenders,” says Mangal. With that, they started operating in Punjab, Bihar, Kerala and Odisha, among others, using the number 108.

Gearing Up

Since the core group did not have the necessary background, they decided to partner with existing experts instead of reinventing the wheel. The London Ambulance Service and New York – Presbyterian Hospitals are its two knowledge partners. Apart from sharing technical and medical protocol, they have also extended their support in launching Lifesupporters Institute of Health Sciences (LIHS), the training institute.

The prime focus remains ambulance service and the Mobile Medical Units, which have been started in Kerala, Jammu and Kashmir and Jharkhand, again by bidding for and winning tenders.

The company also received funding to the tune of US $1.58 million in the first round in 2007 from Mumbai-based Acumen Fund, which helped it scale up operations in Mumbai and Kerala. In 2010, the company raised another round of US $3.26 million from Acumen, Emergency Medical Services Corporation (EMSC), a leading provider of emergency medical services in the US; HDFC Bank, Infrastructure Development Finance Company Limited (IDFC) and India Value Fund Advisors (IVFA). This was used to scale up operations from 10 ambulances to 800. This includes vehicles for both the private sector and government (under the Private – Public Partnership scheme) hospitals.

The prime focus remains ambulance service and the Mobile Medical Units, which have been started in Kerala, Jammu and Kashmir and Jharkhand, again by bidding for and winning tenders.

Becoming tech-savvy

Mangal says with justifiable pride that Ziqitza ambulances are the first ones to have a GPS in them and all the services managed by a professional team from call-centre. When someone dials either of the numbers, it reaches the call centre, which then locates the closest ambulance to the caller through the GPS and directs them to the patient.

“There are no branded players in the private ambulance segment,” says Mangal. None of them have as many fleets or such a large operation. There are many ambulance service providers in the PPP model, but the technology and experience add an advantage for Ziqitza.

The call centre service has also enabled Ziqitza to extend helpline services for women and senior citizens. “When two women were molested in front of a five star hotel in Mumbai in 2008, the then Sheriff had talked of establishing a helpline. Since we had the infrastructure, we offered to take liaison with NGOs through the centre,” says Mangal. Since crimes against senior citizens are also increasing, it was just a natural extension to offer services for them too.

But the prime focus remains ambulance service and the Mobile Medical Units, which have been started in Kerala, Jammu and Kashmir and Jharkhand, again by bidding for and winning tenders. It also has fitted the ambulance with mobile data terminals. Mobile Data Terminals provide real time communication between the ambulance and its control centre, which is the nerve centre for scheduling.

Touching Lives

From the original five, only three are involved full time in the operations as the initial vision of starting a venture that provides emergency services has been met. Now it is all about growing from here to reach out to more.

Ziqitza does face challenges in the form of attrition. “Drivers are not a problem, but paramedical staffs that provide emergency services are,” says Mangal. Other ambulance service providers and government hospitals are always in need and the staff trained by Ziqitza fit the bill well.

The second challenge, just as is the case with most businesses is financial. Since 90 percent of the revenues come from the government there are payment delays as well.

Despite all these, the venture believes in the work it does and is looking for ways to reach out to more regions and touch many more lives. It has professionals heading all the divisions and people with experience in the domain running the show. Ziqitza has touched two million lives since it started its services in 2005 and employs four thousand people. From its Rs. 1 crore revenue in the first year of operations, it touched Rs. 103 crore last year and reported a PBT margin of 5 per cent. In three years, Ziqitza aims to grow to 3000 well-equipped ambulance vehicles across the country and will seek further funding (if required) at a later date. It expects to touch a turnover Rs. 500 crore by then. But most importantly, it is reaching out to the people during emergencies, which remains Ziqitza’s primary focus.

Concept in brief: 

The name ZIQITZA is derived from the Sanskrit word ‘chikitsa’, meaning medical treatment, and Jigyasa, meaning quest for knowledge. This social venture provides emergency medical services through the ambulance service it runs. The private service for paying patients cross subsidises services for the poor who cannot pay for these well-equipped and properly manned ambulance ensuring right treatment in the golden hour and platinum minutes. Since starting services in 2005, Ziqitza has touched two million lives and employs four thousand people. It also runs a training institute for training paramedical staff.  


Venture: Ziqitza

Founded by: Sweta Mangal, CEO

Founded in: 2003

Funded by: Acumen Fund, Emergency Medical Services Corporation (EMSC), HDFC Bank, Infrastructure Development Finance Company Limited (IDFC) and India Value Fund Advisors (IVFA)

Core focus: Ambulance Service

Knowledge Partner:

Altacit Global is a boutique legal firm specialising in Intellectual Property and Corporate Legal Matters. Altacit Global has partnered with The Smart CEO, to present a series of articles on Impact Ventures. Please visit www.altacit.com for more details.

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