Jacaranda Health: Sustainable maternity clinics in urban slums

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Jacaranda Health: Sustainable maternity clinics in urban slums

Kenya
Organization type: 
nonprofit/ngo/citizen sector
Project Stage:
Scaling
Budget: 
$10,000 - $50,000
Website:
http://jacarandahealth.org/
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Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Jacaranda Health is a social venture that aims to set a new a new standard for maternity care in East Africa. We are combining business and clinical innovations to create a fully self-sustaining and scalable chain of clinics that provide reproductive health services to poor urban women. Our model is a combination of two tightly-integrated services (a) mobile vans that create a direct link with our patients, generate demand and healthy outcomes through antenatal care and birth preparedness; and (b) Jacaranda Clinics near the slums where women can go for respectful obstetric care, safe delivery, family planning, and postnatal care. The mobile outreach vans are equal parts social marketing and clinical innovation – they provide antenatal care and serve as emergency vehicles, but also help build our brand and overcome the barriers that prevent many women from reaching facilities. The Jacaranda Clinics themselves include top-notch medical care to address most causes of maternal mortality – but at the same time include process innovations to keep prices low enough that most of our target market can afford them.

Our ambition is to change the way maternity care is provided for the 1M+ poor women giving birth each year in urban East Africa. 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. Researchers and clinicians have proven that low-cost interventions to reduce mortality are feasible and effective (evidence-based clinical protocols, low-cost obstetric equipment, and cheap drugs like misoprosotol) – Jacaranda's goal is to package these innovations into the region's first truly sustainable and scalable service delivery organization.

We are piloting the model in Nairobi with a single clinic and mobile unit, then once we have demonstrated that the model works, scale up to 30 clinics in cities across East Africa over the next five years.

WHAT IF - Inspiration: Write one sentence that describes a way that your project dares to ask, "WHAT IF?"

What if childbirth was no longer a risk to your life or an unreasonable expense, but rather an accessible, dignified experience characterized by
About Project

Problem: What problem is this project trying to address?

In Nairobi 150,000 women give birth each year, and two-thirds of them live in slums. Most deliver at home with an unskilled birth attendant or go to a public facility where conditions are often appalling – shared labor beds, delivering on the floor, understaffed or under-equipped with basic lifesaving supplies. As a result as many as one in 40 women die during childbirth and many more experience life-threatening complications. Urban slums are the fastest growing population centers in Africa. Anyone reading this knows the global statistics. In East Africa, rates of maternal mortality are over a hundred times higher than they are in Europe. Every year, over 1 million babies die in childbirth. Besides the statistics, what makes this such a pressing issue is that we know what needs to be done: Mortality can be cut 75% by improving access to RH services and ensuring that childbirth happens with skilled providers. And despite that knowledge, in the last 20 years, rates of maternal mortality have barely improved in East Africa, and most facilities are no better than they were in the 1970s. Clearly, there is a need for a fresh approach to solving this problem.

Solution: What is the proposed solution? Please be specific!

Jacaranda Health is a social venture that aims to set a new standard for maternity care in East Africa. We combine business and clinical innovations to create a scalable network of hospitals. We offer top-notch yet affordable, respectful and patient-centered reproductive health services to poor women in peri-urban areas. Our goal is to set a new standard for maternal and newborn health care in resource-constrained settings. We aim to become the largest provider of affordable maternity care in East Africa and create a blueprint for scale in other regions. We have piloted our model at a single hospital in Ruiru and will open two more facilities in the next six months. We will scale to up to 25 hospitals across East Africa by 2018.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

Our impact started when low-income expectant mothers and experienced nurses worked to design their dream health care experience and our first hospital. They outlined the friendly, respectful, affordable, quality care they wanted. Very busy with work and family, they asked us to respect their time and to help them learn more about baby care and parenting. Now health educators greet them in the waiting room, and answer questions while they wait. Mothers asked us to involve fathers, since they often decide about paying for a hospital delivery. Now we market an innovation to both men and women to help families save ahead. In our first year over 3,000 women sought out this model of care for their maternal and reproductive health needs.

Impact: What is the impact of the work to date? Also describe the projected future impact for the coming years.

We measure impact on three levels. (1) Patients served: At our first hospital in Ruiru, we provided care to over 3,000 women. We are opening two additional hospitals in the peri-urban Nairobi area in the next six months, and when we scale to 25 hospitals by 2015, we will safely deliver over 22,000 babies yearly. (2) Health outcomes: In a year, the percentage of clients doing follow-up antenatal care visits increased by 15%. Additionally, the number of antenatal clients eligible for normal delivery who elect to give birth at our hospital rose by 10%. (3) Regional health systems: We aim to set a new regional standard for maternal health care care through the development of evidence-based quality management and human resource systems. These systems are geared towards replication by both private and public providers.
Sustainability

Financial Sustainability Plan: What is this solution’s plan to ensure financial sustainability?

Our model earns revenue by attracting women to our compelling standard of maternity care. We leverage philanthropic capital to build and equip facilities. Our sustainability derives from growing revenue and impact by building rapport and trust with our target customers, reaching out to them through innovative marketing, and offering incentives designed for them, such as options for pre-payment, package pricing, and "complication insurance".

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

Very few health providers deliver truly cost-effective, high-quality, and patient-centered health care. Women often say they would rather deliver at home, than be chided for having another child, subjected to HIV tests without consent, give birth in an understaffed public hospital, or go into debt to get quality care at a private facility. While we partner with service providers who have innovations in the quality improvement and, human resource space, given the status quo and existing options, we are filling a clear gap in the marketplace.
Team

Founding Story

Three years ago, my wife, an ob-gyn on the faculty at UCSF working in Western Kenya, described a friend’s maternal death due to postpartum hemorrhage in Kisumu, Kenya that could have been avoided with better care. At the same time, a friend and colleague at the Acumen Fund was wondering why there were no maternity care ventures at scale in East Africa. Despite the glaring need, no one had been tackling this issue in a creative and sustainable way. I have worked in global health for years, and I had been in Kenya in 2010 looking for investments in businesses serving low income populations. This issue is more compelling than any I’ve worked on, and seeing it through my wife’s eyes has made it especially personal.
About You
Organization:
Jacaranda Health
Section 1: About You
First Name

Nicholas

Last Name

Pearson

Website
Organization

Jacaranda Health

Country

Kenya

Are you an individual between the ages of 18 and 35 who would like to apply for a nine month Young Champions Program mentored by an Ashoka Fellow?

No

Section 2: About Your Organization
Organization Name

Jacaranda Health

Organization Phone

+254 (0) 716 534 294

Organization Address

Nairobi, Kenya

Organization Country

Kenya

The information you provide here will be used to fill in any parts of your profile that have been left blank, such as interests, organization information, and website. No contact information will be made public. Please uncheck here if you do not want this to happen..

Your idea
Country your work focuses on

Kenya, NA

Website URL
Innovation
What makes your idea unique?

Our principal innovation at Jacaranda Health is a model of high-quality maternity care that is financially sustainable and scalable. There are two reasons we will succeed: (1) We have a single specialization – maternity care – which we know intimately and which women are accustomed to paying for in East Africa; and (2) we have a “package” of innovations that dramatically improve clinical quality while keeping costs affordable for the poor.

Achieving our goal of sustainability requires four types of constituent innovations:

1. Clinical innovations: better algorithms for identifying complications in these settings and new low-cost technologies (e.g. low-cost mobile ultrasounds, neonatal resuscitators). We are working with UCSF to develop and vet a set of evidence-based clinical protocols that are best suited to our context.

2. Outreach innovations: mobile vans bring services into the slums and increase awareness among our target population via creative marketing and ubiquitous mobile phones. This is critical for reaching women who would otherwise deliver at home, building a reputation among our target patients, and driving traffic to the deliver safely in our facilities.

3. Health systems innovations: Health systems are not sexy, but they are vitally important. We are working to build a robust supply chain, design facilities for better patient flow, data management through electronic medical records and inventories, and incorporate best practices in training and incentives for clinical staff.

4. Business model innovations: We are working to secure partnerships on both the cost and revenue side, including health equipment providers such as GE, tie-ins with microinsurance programs to reduce out of pocket costs for women who cannot afford the cost of delivery, work with local programmers and mobile banking (Safaricom’s mPesa platform) to develop options for flexible billing, payment in installments, etc.

Do you have a patent for this idea?

Impact
What impact have you had?

We will measure Jacaranda Health's impact on three levels: increase in patients served, improvement in health outcomes, and influence on other public and private providers.

1. Increase in patients served: At capacity, each Jacaranda Clinic will do 1440 deliveries per year (4 per day). When we scale to 30 clinics in 4 years, Jacaranda will be providing 30-40,000 safe deliveries a year. At scale, we will be providing over 300,000 women with antenatal care, family planning, and PMTCT services through our mobile units and clinics.

2. Health outcomes: We will compare rates of maternal and perinatal mortality within our facilities to comparable baseline rates in the areas we operate. Jacaranda’s midwives will be trained and equipped to address over 70% of the complications that currently result in mortality in East Africa (postpartum hemorrhage, sepsis, abortion complications, and indirect causes like anemia, malaria, and HIV). Our referral partnerships with tertiary care facilities will enable women to get rapid care for the complications such as pre-eclampsia and obstructed labor.

3. Our long term theory of change is to raise the standard for maternity care in the region. Our ambition is that private providers will replicate our models because they improve the bottom line and boost customer satisfaction. Public facilities will incorporate our innovations because they are cheaper, deliver better health outcomes, and are publicly accessible (not proprietary).

Actions

We are piloting our model in Nairobi with a single clinic and mobile unit, then once we have demonstrated that the model works, scale up to 30 clinics in cities across East Africa over the next five years.

To date, we have completed market surveys, developed the model, built partnerships, and engaged volunteers and advisors. In fall 2009, we did an extensive market surveys: focus groups with young mothers in eight slums and peri-urban areas around Nairobi, and data collection to overlay facilities and population data to identify areas that are poorly served. Meanwhile, we have worked with partners and advisors (see response on partnerships below) to flesh out a detailed business model and financials. As we raise funds for our pilot, we have a growing team of volunteers in Kenya and the US who are helping with operations and research.

Results

See "impact" above.

What will it take for your project to be successful over the next three years? Please address each year separately, if possible.

2010
--Purchase and equip first mobile unit
--Develop protocols for mobile antenatal care and outreach, hire and train staff for mobile unit
--Complete protocols and internal systems for clinic (first iteration of electronic management, referral protocols, HR, evidence based obstetric care, etc)
--Hire and train staff for first clinic; lease first site in eastern Nairobi; setup equipment and space.

2011
-First clinic opens doors in early 2011.
-Begin monitoring impact and fine-tuning of operations and clinical and internal protocols.
-Experiment and adapt marketing and outreach
-By late-2011 evaluate success of pilot and secure funds for expansion.

2012: Scale up
--Expand core team to include finance, marketing, and permanent medical officer.
--Secure sites and establish first 5 clinics in Nairobi.
--Begin assessing second towns for expansion outside of Nairobi (Mombasa, Kisumu, Meru, Nakuru)
--Systematize staff training and community outreach to keep pace with expansion.

What would prevent your project from being a success?

The risks in our model are around pricing and volume of patients that we are able to generate. To provide an appropriately high level of service, we have a certain amount of fixed costs and running costs, for which we already have a detailed understanding. To be fully sustainable we have to achieve a certain volume of deliveries at a certain price. We can make a very well-educated guess about the volumes of patients we see at the prices we charge, the percentage of antenatal patients that convert to deliveries, etc, based on our survey of other maternity facilities -- but ultimately it is a guess that we have to be borne out in our first clinics.

The other challenge is ensuring that payments are made. If a woman comes to our clinic in labor, we cannot refuse treatment. So have to ensure that there is a way of recovering the cost of the delivery. We are working to mitigate those risks by: (a) providing financial training during our antenatal care, (b) options for advanced payment in installments (flexibly, to correspond with women's irregular income in these settings); (c) working with micro-insurance agencies and the National Health Insurance Fund to defray out of pocket costs for women.

How many people will your project serve annually?

More than 10,000

What is the average monthly household income in your target community, in US Dollars?

Less than $50

Does your project seek to have an impact on public policy?

Sustainability
What stage is your project in?

Operating for less than a year

Is your initiative connected to an established organization?

If yes, provide organization name.
How long has this organization been operating?

Less than a year

Does your organization have a Board of Directors or an Advisory Board?

Yes

Does your organization have a non-monetary partnerships with NGOs?

Yes

Does your organization have a non-monetary partnerships with businesses?

Yes

Does your organization have a non-monetary partnerships with government?

Please tell us more about how these partnerships are critical to the success of your innovation.

A comprehensive maternal health initiative has many moving parts. Wherever possible, we do not want to reinvent the wheel, but rather work with the organizations who are at the cutting edge of each service and element of our model. For example, on the clinical side, we have partnered with UCSF for clinical protocols. We will partner with organizations such as IPAS for post abortion care, MSI on family planning, tertiary hospitals like Kenyatta or St. Mary’s for referral for operative deliveries, etc. On the business side, we are partnering with micro-health insurance agencies like Microfinance Jamii Bora (which has 250,000 insured borrowers), organizations like Dimagi and Datadyne who are looking at mobile platforms for medical records, decision support and patient outreach. Kenya’s top architects at Planning House have been advising us on design, along with the San Francisco design firm IDEO.

These are not partnerships for the sake of partnerships, but rather connections that help us deliver our services more effectively and affordably.

What are the three most important actions needed to grow your initiative or organization?

The three most important actions to achieve scale with Jacaranda Health

1. Hiring, training, and retaining clinical staff. Maternity care is a service business and reputation is important. Ultimately our success building a reputation and expanding will depend on the quality of our nurses and midwives. There is a good pool of nurses and midwives in Kenya, and we need to find the best ones as we scale, and also train them on a set of clinical protocols that are standardized from facility to facility (just like Starbucks), and also instill a deep culture of respect for our patients that is lacking from many public facilities (this lack of respect is well documented in the Kenya Federation of Women Lawyers' “Failure to Deliver”, and was raised repeatedly in our focus groups.)

2. Funding. We will run the pilot clinic and mobile unit in Nairobi for a period of 12 months to test whether our clinical and health systems innovations are successful, and whether our assumptions about volume and pricing hold true. Once we have demonstrated that the model works, we will need to raise approximately $1.5M expansion funds to take Jacaranda Health from 1 to 30 clinics. If the model is successful, this will not be a challenge.

3. Outreach. Successful growth will depend on our ability to reach our target population -- who often lack information about reproductive health options --and make a compelling case that our clinics are a better alternative to delivering at home or in a sub-standard public facility. Our mobile units and outreach officers will need to ensure that the mobile antenatal clinics are well-attended (through close connections with community groups in the slums, microfinance institutions, churches, and employers), and that the process of antenatal care results in facility delivery. Part of what drives that decision is building a rapport with our patients so that they are comfortable with our clinicians and service; part of it providing incentives that help encourage behavior change. These can be financial incentives, like options for pre-payment, education about National Health Insurance, package pricing. and "complication insurance". They can be service incentives, like better integration of family planning and PMTCT options, availability of point of care testing and mobile ultrasound in field clinics.

The Story
What was the defining moment that you led to this innovation?

Eight months ago my partner, an ob-gyn on the faculty at UCSF 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.

At about the same time a friend and colleague at the Acumen Fund, who sits on the board of India’s largest chain of maternity hospitals, was wondering why there were no maternity care ventures at scale in East Africa. The more we looked into it in Nairobi, it became clear that despite the glaring public health need, no one was tackling this issue creatively.

I have worked on global health issues for years, and I have been in Kenya this last year looking for investments in businesses serving low income populations. This issue is more compelling than any other I’ve worked on, and seeing it through the eyes of my partner in Kisumu has made it particularly personal.

From that moment of inspiration nine months ago, Jacaranda Health has evolved from an idea to a well-prepared venture in the process of launching its pilot. We have spent the last six months assessing the market, developing a new model for care, and initiating the partnerships to make it a success. In the autumn, we invested in a thorough market assessment, and I left Acumen three months ago to devote myself full time to getting Jacaranda Health up and running.

Tell us about the social innovator behind this idea.

I quit my job with the Acumen Fund in Kenya to make this leap not simply because I am excited about the potential impact, but because I’m confident about making it work. Two qualities serve me well for this role: (a) deep functional experience in this setting, and (b) local and international support networks.

I am from the US but spent most of my childhood overseas. In the last few years, I worked in the slums of Bombay, on drug supply chains in Vietnam, and more relevantly, I spent the last year working with East African businesses serving the urban poor. I know our target clientele well.

I spent the last six months working with my partner (an obstetrician on the faculty at UCSF) to understand obstetric needs and challenges for low-income women, and I know East Africa’s maternity landscape well. In the fall, I led a team of 15 Kenyan women through Jacaranda’s market assessment – trained facilitators, coordinators, local liaisons, translators, and a team of young videographers.

An innovative health venture has many moving parts: clinical, logistical, marketing, HR. My biggest take-away from my work with Acumen Fund is that successful social entrepreneurs must know how to run a business, but above all, must have the resourcefulness and humility to delegate expertise to team-members, consultants, volunteers, and partners.

I know how to run a small businesses in Kenya, I understand what it takes to run a good team and make a model like this sustainable. In this respect my MBA from Berkeley is less valuable than the practical experiences and networks I have built on the ground. I am not a doctor or technologist, but I am bringing together the best expertise to help us with these elements of the business model.

How did you first hear about Changemakers?

Friend or family member

If through another, please provide the name of the organization or company

Comments

Naveen Shakir's picture

On April 15, 2010 the judges reviewed the entries for the Changemakers "Healthy Mothers, Strong World" competition and would like to pass on the following feedback (listed below) for your entry. Thank you for applying and for your hard work in the field. We are excited to archive your entry to serve as a leading solution for the worldwide community of innovators. We wish you continued luck with your innovative, sustainable, and socially impactful initiatives.

All the best, The Changemakers Team

"This is a very entrepreneurial initiative, with a strong social purpose. The focus on urban slums is wonderful, and it's great that it's a mobile maternal health clinic that doubles as emergency transport. I think they're excellent candidates!"

- Changemakers "Healthy Mothers, Strong World" Judges

To promote the current stage of maternity health, we have found non-profitable organizations are taking beneficial steps to improve the current health care condition of several rural sectors. These programs including good maternity care, child care, health care and different types of suitable medical facilities. In this way, we are able to get sufficient maternity and other care facilities. Basically, we know about the current condition of health and care in rural divisions, so it is quite better to promote current health and other medical care systems under different projects to develop the current maternity position.