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Incorporated in 2015, City Ambulance Ltd has a fleet of over 200 ambulances with offices in Uganda and Tanzania; and strategic partners in Kenya, Rwanda, Burundi, DRC and South Sudan serving a broad clientele across East Africa.
Dr. Hannington Byarugaba is the Founder and Chief Executive Officer of City Ambulance Limited, the fastest growing Emergency and Pre-hospital Service Provider in East Africa. He shares with True Golfer Plus his entrepreneurial story right from his personal background, idea inception, financing, management, growth, Covid-19 effect and future plans.
Who is Dr. Hannington Byarugaba?
I was born in Kitabi village, Igara, Bushenyi District to a humble family of Augustine Byarugaba and Leodia Byarugaba in 1979. I am the seventh in the family of nine children. My father worked hard to see us in school. He was a tea grower, shop operator and used to sell clothes in village markets to ensure his children attain education that he treasured so much. My mother was just a house wife like any other.
I must say that I went to the best schools. I had my primary education at Bushanga Preparatory Seminary and scored Aggregate Five in Primary Leaving Examinations, the best score in the school that year. I went to Kitabi Seminary in Bushenyi for my O’Level and scored Aggregate 11 in 8 subjects in 1996. I was admitted to St. Henry’s College Kitovu in Masaka to study a combination of Physics, Chemistry and Biology (PCB). I scored 18 points out of 20. I joined Makerere University for Bachelor of Medicine and Bachelor of Surgery (MBChB) in 1999 on government scholarship and completed in 2004.
With those scores, definitely you were a very bright chap in school. What was the motivation?
My father. I was motivated by my father’s education motto: If I give you the best education, I would have opened the whole world to you. You can get anything you want in life through that exposure. So, I had to open up the world of opportunities for myself through education.
So, after university, you went straight to business…
No. Shortly after graduation, I got a job with Ministry of Health as a Field Medical Officer. This was the time when government was phasing out Health Centre IIs and upgrading Health Centre IIIs to Health Centre IVs. My task was to assess the capacity of Health Centre IIIs before they would be upgraded. I traversed all rural and remote places of Uganda and got exposed to realities of appalling conditions that health centres in rural areas face.
Two years later, in 2006, I got another job with Médecins Sans Frontières/Doctors Without Borders (MSF) as Emergency Doctor where I was deployed in remote locations of Kotido, Pader and Patongo at the time when Kony War was at its worst. The emergencies here were more critical than those at his former employment.
My work with MSF exposed me to real emergencies. We would board a four-seater aircraft at Kajjansi and fly to remote places of Northern Uganda, South Sudan and Democratic Republic of Congo (DRC) where emergencies were needed. I learnt how to manage critical cases without equipment. I was at the war frontline where I would find and treat victims whose limbs have been broken by Kony rebels. You find blood gashing out and you have to make an instant decision of whether you should tie a leaf around the wound to stop bleeding or something else. It was terrible.
Was exposure and management of critical cases of Kony victims your turning point? Was it reason for starting City Ambulance as a pre-hospital service provider?
This and more. My childhood dream of wanting to be my own boss would not keep me in employment for long. I took employment to gain experience and raise capital to build a clinic.
However, my biggest motivation to venture into health emergency came during the 2010 Bududa landslides that claimed over one thousand lives and property worth millions. There was only Uganda Red Cross Society on site to evacuate thousands of landslide victims in Bududa. It was overwhelming. This made me think that if there was an independent private ambulance provider, many lives would have been saved.
I started digesting the idea and discovered that there was no exclusive ambulance service. My passion for health emergency came alive. I got inspired to save life, which has become City Ambulance motto.
The idea of Ambulance Service business came out strong. How did you move from here?
This was not the business one would start overnight. It was much more complicated, requiring a lot of planning, understanding, consultations and hefty resources. We planned for five years – mobilizing resources, reading available literature on how a private ambulance works and visiting several countries such as South Africa, India, and United Arab Emirates, which have such services.
In 2008, I enrolled for a Masters in Emergency and Resuscitation Medicine of University of London. Later I did a PostGraduate Diploma in Remote and Offshore Medicine from Royal College of Surgeons of Edinburgh, Scotland.
Equipped with Emergency and Pre-Hospital competencies, coupled with work experiences at Ministry of Health and MSF, I was ready to take on my health emergency business. I was getting into the niche that was believed to be a preserve for government and international charitable organizations.
In 2015, with five well equipped ambulances and twelve fulltime staff and many part-timers on call, including specialized doctors, nurses, paramedics and drivers who are also trained as first aiders, City Ambulance Limited was born.
Being one of the only five emergency and pre-hospital specialists in Uganda at the time, I had the opportunity to exploit the niche without competition.
Financing – where did you get money to start City Ambulance? Did you hit a jackpot somewhere?
The preparatory phase took us five good years. We decided to save from our salaries towards our dream business. Using my savings from MSF, and that of my wife, we would buy one ambulance and keep, buy another and keep; just like that until we made five. It was a great sacrifice. When we bought the fifth ambulance, we got convinced we were ready to start.
What is the business of City Ambulance?
City Ambulance Limited is as an Exclusive Specialist Ambulance Service Provider offering emergency medical rescue, planned patient transportation, events and conferences medical support, training in first aid, health and safety at workplace, supply of first aid kits and other emergency medical equipment, medical air evacuation, medical escorts, and emergency medical consultancy.
Our ambulances have GPS and navigation tracking system, with live tracking from when the vehicle is dispatched, when it reaches the scene and up to the receiving hospital. GPS helps us to know what happens during evacuation so that in case of anything, we dispatch another ambulance immediately.
How do you describe the market reception and growth trends for City Ambulance?
I can describe the market reception as exciting with many customers saying it was timely. We serve a big clientele base ranging from government, hospitals, insurance, schools, companies, International Agencies, NGOs and individuals. Insurance sector alone gives us over 100, 000 customers. We also work with hospitals that now see us as a partner and not a competitor.
There is also growing demand in first aid training and supplies. Corporate firms, banks, schools, and medical personnel have made a courtesy call to be trained. Training courses include fire-fighting and safety, health and safety at workplace, basic life support, advanced life support, and advanced cardiac life support.
We have grown exponentially. Buying the first five ambulances was harder than when we bought fifteen; buying fifteen was harder than buying thirty; buying thirty was harder than buying sixty… Today, it is much easier for us to acquire any business asset because of this kind of growth.
Coronavirus had devastating effects on most businesses. How did the pandemic affected City Ambulance?
Contrary to what most businesses would testify about the 2020 Covid-19, to City Ambulance the effect was very positive. To be honest with you, 2020 was the busiest year since City Ambulance started. We handled critical Covid-19 cases for government and private sector. Our capacity was overstretched. Our ambulances were used to full capacity. We would work upto midnight and by 5:00am, we were up for work. We are not complaining.
How has City Ambulance grown over the past five years?
The company has grown exponentially and spread to neighbouring countries of Tanzania, Kenya, Rwanda, DRC and South Sudan. We have a fleet of over 2oo ambulances operating in Uganda and Tanzania. We have partnered with Amref for operations in Kenya, Rwanda, DRC and South Sudan. City Ambulance is now the biggest ambulance service provider in East Africa.
We have invested significantly in human resource to manage the continuing growth. We employ over 300 people on both full time and part time.
How do you explain the fast success of City Ambulance?
I attribute City Ambulance success to my good business idea, expertise and dedication. I believe it is the good idea and not money that makes one a successful entrepreneur. The innovativeness, passion and integrity are attributes that have made City Ambulance a great enterprise.
Apart from City Ambulance, what other business interests are you into?
For your information, we have City Medicals, a sister company to City Ambulance that handles specialized projects such as vaccination, immunization, testing and medical supplies. City Medicals currently do Covid-19 Testing and DNA Testing and provide results in the shortest possible time.
Where do we see City Ambulance in the next 10 years?
We plan to start a specialized hospital to handle in-hospital emergencies and critical cases in the next five years.
Any advice to startup entrepreneurs?
For the budding entrepreneurs, it is better to invest in areas you are schooled or experienced in. Business succeeds because of the expertise of the founders. If you are schooled in an area, you have a competitive edge. You are most likely to understand the products and marketing – that prior knowledge is important.
Stay focused on your idea but have an open mind because along the way, unexpected obstacles might pop up. These however might turn out to be opportunities.
Have passion and enjoy what you do because then, hard work becomes no work when you love what you do. The start is not always about having money. Have the idea first; like I knew that I wanted a clinic first and then everything else will fall in line. Have commitment and work hard. For example, I wake up by 5:00am. Uganda has many entrepreneurial opportunities. We just need to be creative and innovative.
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