Searchlight Convening Reflections: Sheila Ochugboju

Searchlight Convening in Mumbai: Reflections from Participants

An important component of the development of the Searchlight function has been an annual, in-person workshop of all the participating organizations to explore the trends that are emerging from various regions. The second such convening, organized by Intellecap with support from the Rockefeller Foundation, took place in April 2011 in the global city of Mumbai, India. Workshop attendees included representatives from the 11 Searchlight scanning organizations.

One of the goals of the workshop was to learn from the dynamic and cutting-edge activities being undertaken throughout Mumbai by way of a series of field visits that illuminated some of the forward-looking, pro-poor development and policy initiatives in India that could have relevance to other regions related to the urban poor. In addition to the field visits to key social entrepreneurship organizations, a learning journey to Dharavi was organized by an innovative civil society organization SPARC, that is working with the residents to deliver and secure affordable and high-quality housing, services, and employment opportunities.

The workshop was characterized as a collaborative and cooperative process of discussion, reflection, and strategic planning. The following section presents the personal and professional reflections from one of the Searchlight function representatives who attended the meeting. This is part one of three in the series. You can read the full report here.

Sheila Ochugboju, African Centre for Economic Transformation (ACET), Kenya

Our field visit to the Dial 1298 Ambulance in Mumbai revealed the concept of “Mission Command” first explained by Helmuth von Moltke the Elder, the great military strategist, Chief of Staff for the Prussian Army in the late 19th Century. Simply put, it illustrates the art of defining and refining good adaptable plans, a process whereby the company goals and objectives are allowed to filter way-down the lines of authority, allowing the deepest level of delegation to create an empowered workforce, able to deliver critical results in very difficult circumstances.

The original vision of the 1298 Ambulance founders is reflected in the organization’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 short time of operation (4 years), 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, Ghana, 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 as compared to the 12.5 million inhabitants of Mumbai, with a small but 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 April2009, after yet another disaster, the Minister for Health in Ghana was reported assaying, “The recent gas tanker explosion on the Winneba road, confirmed our unpreparedness to handle emergencies.” He then outlined plans for a National Ambulance Service Bill. These plans include a financing agreement for the construction of 12 district hospitals and technical training institutions. The agreement is also for the supply of two air ambulances, 50 mobile clinics, 10 educative mobile units and 200ambulance cars. The plans are still waiting to be promulgated into law in 2011 and ultimately to be tested in the field of emergency care. 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. In Ghana, where Christian culture has a huge reverence for the dead, the “living 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 specialized 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 organizations 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, (4% of the population), compared to 267 million people expected to reach that category in India by 2015. Therefore, any private sector initiatives to safeguard basic human rights like healthcare would have to be heavily subsided by the state as the markets alone could not sustain large scale pay-per-use ambulance models such as Dial 1298 for Ambulance in Mumbai. Without determined efforts to develop public-private partnerships that can subsidize 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.