There lies the challenge for most social enterprises and a question that has been asked by many and successfully executed by a few. In a rapidly changing environment and the growing need for expansion, the urge to scale opportunities and unlock human potential is at the forefront in the mind of any social entrepreneur. Put simply, the question now is “How can we get 100x the impact with only a 2x change in the size of the organization?”
The idea of scaling impact is to be able to deploy a limited amount of resources and magnify the area of effect of those resources, without adding more. The three areas of knowledge; what, how, and why, form the essence of strategic decisions for every organization, that allow them to assess and magnify this impact. The optimum and most scalable level of impact is determined by the methodology and understanding with which these questions are answered. In recent years, social enterprises, in their pursuit of the idea of scalable impact, have created and adopted many different strategies of finding a solution to the question posed.
Replication of processes in different locations with partnerships and collaborations is one of the successful models that have proven to be effective and adopted by many. Bangladesh-based organization BRAC (Bangladesh Rural Advancement Committee) founded by Sir Fazl-e-Hasan Abed is a prime example of success in scaling through the realization, that it requires not only fidelity to core processes and programs, but also constant adjustments to local needs and resources.
After the devastating cyclone in 1970 in the island of Manpura, Bangladesh, Abed created HELP, a voluntary organization to provide relief and rehabilitation to the affected. The vision of HELP over the years, grew into the multi-dimensional BRAC, the largest non-government organization in the world. It utilized the strength of the private sector in order to maximize the sustainability of an initiative and let it run on its own. This process was replicated in different industries like dairy, banking, poultry, feed mills and more. Today, the BRAC World covers a population of 138 million, spends USD 932 million annually, and runs 45,000 schools.
Turning the focus to Pakistan, social enterprises functioning in the country have implemented several strategies to tackle the prevailing socio-economic problems. Many of these methods have failed overtime and some have succeeded in creating sustainable change for the better. The Aman Foundation’s efforts since the year 2008, have allowed it to form a blueprint of solutions to key problems of Pakistan in the verticals of Health and Education that can grow geographically through a similar replication process.
In a corner of a small, custom-built facility in Khuda Ki Basti, the first nutritious and free-meal-program under the name AmanGhar School Meal Program was inaugurated.
Aman Foundation’s vision of transforming lives began with the inception of AmanGhar in 2008. The Program initiated in Khuda Ki Basti, Karachi, where children belonging to the marginalized community were not receiving a proper education because their parents/guardians are unable to afford school fees as well as pay for their children’s meals. To facilitate their basic right to education and refuel with proper nutrition, the staff at AmanGhar cooks over 3,500 healthy free-of-cost meals, for students during their lunch break.
Henceforth began Aman’s quest for a scalable and sustainable blueprint of solutions for Pakistan’s socioeconomic problems. The organization’s vision was brought out and implemented on to the roads of Karachi in 2009 with the purchase and fabrication of 10 life-saving ambulances and the inception of the Aman Ambulance. The first three years of operations, 2009 to 2011, saw over 175,000 calls for help answered.
In 2011, Aman sought to resolve one of the most profound problems facing Pakistan; a lack of education and training for the people. The Aman Institute for Vocational Training (AIVT), also known as Aman Tech, a large facility harboring state-of-the-art training machinery and workshops, was completed. To provide an alternative to higher studies, an accredited vocational training certification in collaboration with USAID and City & Guilds was offered to the underserved youth of communities in Korangi, Orangi Town, Landhi, and Lyari with the launch of 11 different trades at AmanTech. Now Aman Tech offers 12 trades. Aman Tech keeps updating the curriculum as per the industry needs and introduces new trades.
Once the foundations for a social enterprise or program have been laid, the mechanism continues to turn and work on its own with periodical troubleshooting. What remains after such a state, is optimization of process and output i.e. sustained scaling of impact. With a pathway set up for it, AmanGhar to-date has been able to serve over 3.5 million free-of-cost, nutritious meals to school-going children in marginalized localities of Karachi.
Over the course of its existence, the AmanGhar initiative has been able to expand the impact of its limited resources through strategic alliances with likeminded organizations. A Memorandum of Understanding (MoU) with The Citizens Foundation (TCF) ensured a larger beneficiary base for the School Meal Program, filling AmanGhar’s meal-serving potential further.
Perhaps the greatest feat for the initiative is its collaboration with Saylani Welfare International Trust, which is an organization that excels in the distribution of free-of-cost food among the underserved. With AmanGhar’s excellence in processes and proficiency in nutrition and Saylani’s expertise and popularity in feeding people, the alliance has the potential of far greater impact than either one of the organizations could have achieved on its own within a specific time. Together, we can go further and faster! With a better understanding of the problem it was tackling, how to go about solving it, and why it needed to be solved, the single meal that was cooked in 2008, evolved and scaled its impact across a larger geographic landscape and beneficiary count.
Aman’s vision of implementing scalable solutions that can create a lasting positive impact is illustrated through the efforts of its Emergency Medical Services (EMS). The fleet of Aman Ambulances that started off with 10 vehicles, has grown to 80 ambulances capable of covering a vast majority of the metropolis. To-date, the Aman Ambulance has catered to over 900,000 interventions and continues to expand its reach.
The metropolis of Karachi, however, proves to be a challenge when it comes to providing timely medical care to its 21 million inhabitants. Various other services have been functioning to provide medical aid and transport to and from hospitals, in an emergency. The problem in such healthcare lies in the growing need for in-ambulance medical care during an emergency to increase the chances of a saving lives en-route to hospitals.
The Aman Ambulance fleet provides advanced medical coverage in-ambulance on-the-go, but lacks the vehicle count. From 2010 to-date, Aman Ambulance has been able to scale its efforts from 10 ambulances to 80 to extend its reach as far as possible in Karachi. The initiative reached a part of its latent potential by collaborating with the Sindh Government to launch the Sindh Peoples Ambulance Service (SPAS) in Thatta & Sajawal with the launch of 25 fully equipped life-saving ambulances in March 2017.
Today the need is to further scale the working model of Aman’s Emergency Medical Services so it may be replicated and implemented elsewhere. In the six months that the SPAS has been functioning, it has made over 9,954 interventions, out of which 31 were in-ambulance baby deliveries. This effort can be defined as a major leap towards magnifying the impact of the Aman Ambulance, as well as an opportunity to understand the prevailing problem of a lack of healthcare in the country, what can be done to improve it, and why it needs to be focused on.
In future, Aman is determined to create more beneficial partnerships to ensure that the basic necessities of healthcare and education are provided to each and every citizen of Pakistan. Aman’s vision is for Pakistan to prosper and grow together, without any individual or organizational boundaries.
Aman Health Eco-System
Aman, through its various health initiatives has developed a health eco-system which interlinks:
– Acute emergency healthcare
– Non-emergent healthcare
– Preventive healthcare
- Acute Emergency healthcare system comprises of emergency medical services, the Aman Ambulance.
- Non-emergent healthcare comprises of Aman Community Health Program (ACHP) and links to Aman Clinic and TeleHealth services under the preventive healthcare initiative.
- Combination of all services has allowed them to build an eco-system where their database keeps growing through the services they provide and a health consciousness is seen in the underserved community through their free and economical healthcare initiatives.
Aman Ambulance Service And Ems
- They have an online call triage system (Medical Priority Dispatch System) & their key points are marked in hospitals strategically where they receive maximum number of calls.
- They have introduced an emergency medical service that functions using a fleet of ambulances, placed strategically all over the city so as to cater to the maximum number of emergencies.
- Currently the number of ambulances in Karachi are able to cater to only about 35% of all emergencies.
- Each Aman ambulance performs up to 4.5 interventions daily, that is 280-300 interventions for the fleet everyday.
- Their fleet comprises of 80 life-saving ambulances but the city of Karachi needs a greater number of these on the roads so that the remaining 65% of cries for help do not go unheard.
- To-date, the service has made over 900,000 interventions.
- They have more than 200 Emergency Medical Technicians & 15 Emergency Medical Officers (Doctors).
- Their average response time to reach a patient is 12 mins and a Rapid Response Unit (RRU), which is a motorbike with a paramedic has also been introduced to be used in critical cases to avoid delays.
- It is important to understand that the building and operational cost of an ambulance is far greater than an average vehicle.
- Their ambulances carry the latest life-saving equipment that is constantly upgraded and maintained.
- Something that they are rather proud of when it comes to saving lives, is the commitment and courage of their pre-hospital care staff. They go beyond call of duty to save a life.
- The Aman Ambulance has helped deliver more than 100 babies in-vehicle.
ACHP AND SUKH
- Through their ACHP program, their community health workers go door-to-door in Ibrahim Haidri, an Aman adopted area due to it being one of the poorest communities in Karachi with an average income support between PKR 6000–12,000 per month.
- The door-to-door service provides consultancy on issues such as malnutrition, common diseases, providing EPI (Extended Program for Immunization) vaccinations for children and referring them to the Aman Clinic and TeleHealth program for future consultations and medical care/advice.
- With the success of this initiative, foreign NGOs have invested in the ACHP and initiated an extended program called the SUKH initiative which works primarily on mother and child healthcare in other areas of Karachi, Korangi, Landhi, Malir and Bin Qasim.
- Modern contraceptive rate has gone up to almost 43% as opposed to 26 percent when we started operating in these areas.
- Vaccination is upto 87% from 57% since 2012.
- The community health workers also provide follow-up services for worrisome cases.
- Their community health program, which includes a family planning and maternal health program called Sukh, covers a population of over 1.1 million.
- Over 550k interventions have been made through this initiative.
- Sukh aims to inform and bring awareness to the local communities about family planning and contraceptives.
- The initiative has been successful to an extent in penetrating the taboos in the communities they serve.
- The Aman Clinic in Ibrahim Haidri provides economical, quality healthcare – consultation charges are as low as PKR 40.
- Through the Aman Clinic, behavioral change has been brought to the community; i.e., receiving value for service.
- An average of 1500 patients are treated at the Aman Clinic per month.
- The Aman Clinic also has an outreach program in different areas of Karachi where the doctors put up camps twice a week in different areas on rotation – this allows them to refer emergent cases to the Aman Clinic or public/private hospitals accordingly or then follow-up on the next visit for non-emergent cases.
- The camps also provide advice on utilizing the TeleHealth service.
- With the addition of TeleHealth, they are able to form an overall Health Ecosystem that is Aman Health Services – 511k plus individuals served.
- TeleHealth is one of the very few services of its kind where the caller is given medical advice and assistance.
- 9123 is the short-code that transfers your call to a medical health counselor who offers medical advice.
- Aman has created partnerships with all the telecos operating in Pakistan to ensure subsidized call rates when someone dials 9123.
- This is a 24/7 helpline servicing 20,000 calls per month on an average.
- TeleHealth follows a triage system where a single medical issue on-call is transferred to a counselor or a certified doctor if needed.
- It has over 10,000 healthcare facilities mapped on its system to refer to callers.
- Over 11.4k mental health needs counseled.
- 0ver 4.7k family planning calls serviced.
- The Aman Ambulance has helped deliver more than 100 babies in-vehicle.
Urban Health Institute (UHI)
- All of their paramedics are trained at their own Urban Health Institute.
- UHI is a ISO certified training institute at Aman where their instructors provide training to Aman Ambulance paramedics in BLS, ACLS, and PALS courses.
- UHI has also taken initiatives to inform and train employees of different industries and organizations in Basic Life Support.
- Trained 27k+ individuals in BLS.
- Over 120 paramedics trained at the institute.
- Their paramedics training program is affiliated with Jinnah Sindh Medical University, DOW and American Heart Association.
- UHI’s BLS, ACLS, and PALS courses are accredited by the American Heart Association through its local body that is DOW University.
- With their AIVT program, they aim to target the youth of Karachi and provide them with a skillset that can help them become productive and integral part of society and earn a better living.
- Aman Tech offers training in 12 different trades including auto mobile, mechanical, electrical and electronics, refrigeration & air-conditioning which are the most popular ones.
- All our courses have been accredited by City & Guilds.
- Education criteria for majority of the course is Matriculate pass however 8th pass students can take admission in offset printing, fabrication & welding and plumbing.
- The age criteria is 17 and above.
- Recruitment process takes place twice a year with matriculation as the key requirement.
- The facility is equipped with state-of-the-art workshops, machinery, and tools to help students learn.
- The teaching curriculum involves vigorous practical implementation rather than just theory.
- They have partnered with the local industry to better align their curriculum according to the needs of the industry.
- A total of 8,668 students have received certifications from Aman Tech to-date.
- 67% job placement rate
- Many of their graduates go on to receive employment opportunities abroad.
- The AmanGhar initiative aims to increase school attendance in the Khuda Ki Basti area by providing children free-of-cost meals – 15% increase in school attendance to-date.
- AmanGhar kitchen has a capacity of producing over 5000 meals everyday.
- Provides daily nutritious meals to 3,000 marginalized children in Khuda ki Basti.
- 3.8 million plus meals served to-date.
- The AmanGhar kitchen as a whole, in addition to daily meals, provides employment in the area it serves, especially to women.
- Balanced diet — AmanGhar acquires up to 4,000 kgs of flour, 600 kgs of rice, 800 litres of oil, and large quantities of other ingredients like poultry, livestock, vegetables, and more.
- AmanGhar has recently been donated to Saylani Welfare Trust to extend the number of meals being served per day.