Ziqitza Healthcare Limited through eyes our investor Acumen Fund CEO Jacqueline Novogratz

When we first invested in ZHL, the company had 9 ambulances with a purely private business model based on a sliding scale pricing structure. Over the past 7 years, partnership with government has driven the company’s growth. Scale and sustainability are possible – and so is a commitment to ethics. At the nexus of both is the constancy of moral leadership.

Before ZHL, a state like Odisha, India’s fourth poorest, provided little in the way of emergency services.  On my recent visit to Bhubaneswar, the state’s capital, I met numerous people who shared horror stories of trying to get loved ones to hospitals using rickshaws, taxis, even bullock carts. Now, by dialing 108, any person with an emergency can expect a quick pick-up and delivery to a public hospital. What is most surprising to users is that the 108 services are actually effective. Average delivery times are less than 25 minutes, despite the fact that 80% of users live in rural, underserved areas with inadequate infrastructure. Prashant, a fish farmer who lost an uncle while trying desperately to get to hospital said that this new ambulance company was like “the gods coming to help the poor people.”

If free, quality services are a surprise, so too is the absence of corruption: bribes are not tolerated.  To ensure this, a quality team is tasked with calling users regularly to inquire: 1) whether the driver has asked them to pay; 2) whether they’ve paid something, even voluntarily; and 3) how they would rate the quality and speed of service. The group also monitors daily calls, currently coming in at 10,000 a day. By year’s end, ZHL in Odisha alone will transport more than a million people to hospitals, proving the potential of a public-private venture to serve the very poor.

The company’s leaders focus vigilantly on re-enforcing its values-based culture.  Sumit Basu, Regional Head for East India, tells the story of the Emergency Medical Technician, Pratap Kumar Sethi, who noticed a wallet containing 21,000 rupees (about $350) beside a roadside accident’s unconscious victim. The driver insisted on bringing the wallet to the hospital and holding it until the man regained consciousness, not trusting doctors to be honest. ZHL ensured the local newspaper covered this act of integrity. The driver earned respect. The idea that good service is possible was reinforced. Everyone gained in dignity. If scaled and buttressed by transparency and ethics, a single company can impact an industry.

This is the idea: patient capital is vital for early-stage investing when the company must confront significant challenges to disrupt an industry. At this stage, few other than philanthropy-based patient capital will take the financial risk the company needs for experimentation. As new standards and practices are established over time, the company serves as a model for others. If all goes well, it moves to profitability and sustainability, so that the company can raise more traditional capital. The poor thus have greater access to freedom, to dignity. How this translates into lives impacted is something we are studying along with the Grameen Foundation, so stay tuned