Jacaranda Health: Sustainable maternity clinics in urban slums
- Health care
- Gender equity
- Infant health
- Maternal health
- Reproductive health
- Women's issues
- Social enterprise
Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.
Impact: What is the impact of the work to date? Also describe the projected future impact for the coming years.
Financial Sustainability Plan: What is this solution’s plan to ensure financial sustainability?
Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?
Founding Story
Nicholas
Pearson
Jacaranda Health
Kenya
No
Jacaranda Health
+254 (0) 716 534 294
Nairobi, Kenya
Kenya
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Kenya, NA
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.
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).
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.
See "impact" above.
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.
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.
More than 10,000
Less than $50
Operating for less than a year
Less than a year
Yes
Yes
Yes
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.
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.
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.
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.
Friend or family member
Comments
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.