Jacaranda Health; An Ambitious Plan to Transform Maternal Health Care in East Africa
For a year now, Nick Pearson has been preparing the launch of his first model, mobile maternal health clinic in the slums of Nairobi, Kenya, where 100,000 women give birth each year. Most deliver at home with an unskilled birth attendant or go to a public facility where conditions are often appalling.
“Our ambition is to change the way maternity care is provided for the more than one million poor women giving birth each year in urban East Africa,” said Pearson, the founder of Jacaranda Health. “We aim to become the largest provider of affordable maternity care in the region, and more importantly raise the standard of care among other private and public providers.”
Jacaranda Health seeks to fight the injustice of maternal mortality and ensure that its approach to high-quality care can be replicated by other private and public health providers. Pearson is tackling this challenge with the tenacity and rigor of an experienced and hardened businessman.
His enthusiasm is contagious as he talks about researching how to build an effective health care system, including electronic medical records and inventories, robust supply chains, improved human resources, and training standardization for clinical staff. For Pearson, it is not the medical technology itself that will be the main factor in saving African women’s lives, but putting efficient systems in place to provide safe, accessible, respectful, and affordable maternal and antenatal care.
Jacaranda health has been selected as a winner in the Healthy Mothers, Strong World: The Next Generation of Ideas for Maternal Health competition.
Slums are the fastest growing population centers in Africa. Most women there deliver at home with an unskilled birth attendant or go to a public facility where conditions are often appalling. Women giving birth frequently encounter shared labor beds, delivery on the floor, understaffing, or under-equipped public facilities without basic lifesaving supplies. As a result, as many as one in 40 women die during childbirth and many more experience life-threatening complications.
In search of a solution to these tragic statistics, Pearson, alongside a team of 15 women with public health backgrounds, conducted focus groups in eight parts of Nairobi to substantiate some of the assumptions about why a variety of women delivered at home and what they thought of public health facilities. “The saddest thing about the anecdotes we collected is that women tell these stories and then the group of their peers laughs about them," he said.
"Not maliciously, but because they can all relate, they've all been through something like that. They all recognize it as unfair and inhumane, but accept it as their lot as poor, lower-class women. And that's really unacceptable to us.”
Zainabu, a young mother of three, living in the slum of Korogocho, is one typical example. She had her first child was when she was sixteen. The father moved away to avoid taking responsibility and provided no financial support. She was giving birth in the middle of the night, a dangerous time in the slums, and had to walk through the settlement to a small private clinic.
Zainabu exhibited some signs of preeclampsia, a life-threatening condition, and the clinic turned her away at the door, fearing that she might die. She walked to a second clinic, and was turned away and told they did not have the right equipment. Finally she was directed to a third and delivered there, hours later. The experience of being refused service and walking through the night in labor to find a safe place to give birth was so traumatic that she took the risk of delivering her next child at home with a neighbor in attendance.
The staff has no reason to be nice to the patient, which diminishes the likelihood that a woman will seek care in a safe environment. Women often will deliver at home because traditional birth attendants are kind to them. To address this issue, Jacaranda Health plans is to incorporate best practices in training and incentives for clinical staff to provide service-oriented, compassionate care at their clinics.
The idea for Jacaranda Health came when Pearson’s fiancé, an obstetrician working in Western Kenya, described her friend’s death during childbirth in Kisumu. It was postpartum hemorrhage that could have been easily avoided with better care. Pearson, who was in Kenya and working for the Acumen Fund, spent the next year working with his fiancé to understand obstetric needs and challenges for low-income women.
Now, only a few months away from the September 2010 launch of the first mobile clinic, Pearson believes that the unique way Jacaranda Health combines business expertise with clinical excellence will be the key to providing sustainable services. Pearson is still grappling with some of the details, such as whether Jacaranda Health will be a non-profit or for-profit institution, and how much the services will cost.
Because of the current inefficiencies in the market, projected costs are currently very high, and it is still unknown what women will to pay for high quality services. “The way I’m trying to build Jacaranda Health now is to put the systems in place and pilot the first mobile unit, then make the call as to whether we are able to grow as a non-profit or for-profit,” Pearson said.
“In these kinds of settings it has to be a pragmatic decision about where can you access funds to scale, and that depends on the sector and their willingness and ability to finance an organization like Jacaranda Health.”
At capacity, Pearson anticipates that each Jacaranda clinic will conduct 1,440 deliveries per year, or an average of four per day. In the next four years, Jacaranda Health hopes to grow to 30 mobile units and clinics in providing 30-40,000 safe deliveries per year, in addition to serving over 300,000 women with antenatal care, prevention of mother-to-child transmission of HIV, and family planning.
Changemakers will follow the progress of Jacaranda Health, and give the Changemakers community an update when Jacaranda Health launches its first mobile clinic in September.
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