Our manifesto begins, “it starts by standing with the poor.” Yet for good reasons, the sector has found it challenging to measure which customers are actually being served through social impact investments – getting accurate data on incomes is notoriously difficult and the logistical challenge and cost of conducting surveys in person prohibitive.
This year, with funding from the Aspen Network for Development Entrepreneurs (ANDE), we partnered with Grameen Foundation and Acumen investee Ziqitza Health Care Limited to test a more company-friendly approach to collecting customer data in India. To accomplish our survey goals, rather than send surveyors back to ambulance pick-up locations, we built on existing company operations – in this case, customer service follow-up calls Ziqitza conducts with a percentage of the over half million people who use the ambulance service each year in India. Customers were asked a short series of additional questions aimed at helping the company’s leadership better understand the profile of the people relying on the service. Each call took no more than an additional 4 to 5 minutes.
Our primary survey tool was Grameen Foundation’s Progress Out of Poverty Index® (PPI®), a simple ten-question, country-specific poverty measurement tool. Ziqitza’s call center operators completed 1,000 customer insight calls using the tool across the Indian states of Punjab and Odisha, where Ziqitza has several hundred ambulances in operation. In both states, Ziqitza operates through public-private partnerships with state governments that allow emergency medical transportation to be offered free of charge. We then validated five percent of those responses through in-person interviews to test the accuracy of the results collected by phone.
The data found that, on average, 76% of Ziqitza’s callers in Punjab and Odisha live under $2.50 a day. Upon hearing the findings, Sweta Mangal, the company’s CEO, remarked proudly that this was the first time the company had ever “known for sure” that it was meeting its social mission. The results are affirming both for Ziqitza and for the state governments that support the service. Only a few years ago, ambulances in Indian cities were often thought of as hearses due to a lack of quality standards, and were rarely available at all in rural areas. Ziqitza began with just nine ambulances at the time of our investment in 2008, and now operates more than 1,250 ambulances across India. Since then, it has served more than 3.2 million people.
The surveyed group was found to be poorer than state averages across the regions we studied except rural Odisha where the population the company is serving is about 10% less poor than the regional average. There, Ziqitza is in the process of expanding its ambulances to reach poorer districts.
Ziqitza is also having a disproportionate impact on women. In Punjab, poverty levels of female patients were higher than that of their male counterparts. In the random sample selected, of total medical complaints registered, 43 percent of cases were related to pregnancies or maternal and child health. Coordination efforts between Ziqitza and government schemes that support maternal and child health are the likely contributor to poorer women accessing Ziqitza’s services in higher numbers, demonstrating the potential for impact when successful partnerships are forged among several public and private players.
Ziqitza is intent on undertaking more of this analysis to better understand who they are serving, now possible through lower-cost, more company-friendly techniques that are still highly accurate. The report also recommends Ziqitza work even more closely with state governments to ensure that ambulance services are being marketed adequately to the poor.
These types of insights are invaluable if we are serious about building sustainable and scalable businesses that stand by the poor. At Acumen, we are excited to iterate more on these methods through our Lean Data Initiative, which will experiment with even more ways to collect impact data more efficiently using different kinds of technology. With more of these methods and insights in the market, we hope to shift from impact measurement as a burden to impact measurement as a benefit.
The full study can be found here.