Emergency Referral Systems D-tree International

the problem

Ambulances are often unavailable to transport emergencies in low and middle income countries for a variety of reasons:

  • No fuel
  • Driver not available
  • Needs maintenance
  • On another call
  • No system to coordinate transport

the innovation

Use digital technology to organise existing community resources (private cars, taxis) in a supplementary ambulance service.

Similar to "sharing economy" insight

system components

A database of drivers, their phone numbers, and the locations they will serve

A database of routes with prices

A triaging protocol, to determine when a case should be treated as an emergency and which level facility can handle the case

Mobile Money integration, to pay driver's automatically once journeys are completed

Call center where emergency calls can be accepted and cases managed.

The system integrates tightly with a larger system designed to address the "three delays" of obstetric care - the Mobilizing Maternal Health program

Dispatchers at a call center are available 24 hours per day, accessible by a toll free number, and use a mobile app running on tablet to triage calls, organize journeys, pay drivers and conduct follow-up.

Triaging determines whether call is to be treated as an emergency, and also whether the woman's condition can be handled by a lower-level facility, or whether she needs to go directly to the referral hospital.

A ministry of health ambulance is arranged if one is available, otherwise a community driver is contacted.

Once the dispatcher has selected a driver and confirmed availability, driver gets confirmation of client contact information and location automatically by SMS

The dispatcher can review any case information and arrange ad hoc journeys when necessary.

When a client lives on an island, this poses additional challenges and perils. Our driver database also includes boat drivers and the system prompts the dispatcher to arrange a boat to the mainland (and then a taxi from mainland to hospital).


The program dashboard provides real-time updates to monitor individual emergencies as they occur and track aggregate data to monitor trends, identify over-referrals and tailor support.

Complexity on the server-side yields simplicity in the system as a whole - our system integrates with a mobile money API and the drivers are paid automatically the amount set for the route undertaken.

This happens as soon as the dispatcher confirms that the journey has been completed.

The emergency transport system supports a population of approximately 1.2 million people in Northwest Tanzania and has supported more than 6,000 life saving referrals, averaging 7 emergencies per day.

Video from the Vodafone Foundation, describing the program

D-tree International



Created with images by DFID - UK Department for International Development - "The impact of the violence" • Justin.Raycraft - "Taxi"

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