Rose Weeks

Improving Mother, Newborn Care is Aim of Jacaranda Health

Jacaranda Health is a maternal healthcare provider based in Nairobi offering low income women high-quality, friendly and affordable care. Jacaranda runs mobile clinics that provide antenatal care, and fixed clinics where women can go for obstetric care, safe delivery, post-natal care and family planning.

As a private, not-for-profit provider, Jacaranda charges modest fees for services, like $1.25 per consultation and $8 for a full set of prenatal lab tests, with an aim to recoup costs and expand into a chain of clinics serving Kenya and East Africa. Named after the Jacaranda tree that is ubiquitous in urban East Africa, Jacaranda opened its first mobile clinic on July 13 in the neighborhood of Kariobangi in northeastern Nairobi.

Founder Nick Pearson last appeared on NextBillion in his former role as a Nairobi-based water and sanitation portfolio manager for Acumen Fund. He recently shared his top five lessons for new businesses providing maternity care. Following up on these insightful tips, I asked him what major market and service delivery challenges Jacaranda addresses and what investors and government can do to improve maternal health care for all Kenyans.

Rose Reis: Did you learn about health enterprises during your time at Acumen?

Nick Pearson (pictured left): Part of the inspiration for Jacaranda came from Lifespring hospital, a private maternity hospital chain in Hyderabad that Acumen had invested in. There wasn’t anything like that in East Africa.

Reis: Why did you decide to focus on delivering maternal health services?

Pearson: Women are not getting good maternity health care. My wife is an obstetrician in western Kenya and every day she is confronted with the system’s limitations-even middle class women in decent facilities die in childbirth.

For Jacaranda, we honed in on the shortfalls in peri-urban areas. People generally pay out of pocket for health services, but they are not good quality. Levels of maternal and newborn mortality are high in the city – in some places as bad as in rural areas, and a hundred times higher than in Europe.

Reis: What problem in Kenya’s health marketplace does Jacaranda address?

Pearson: Few private sector providers target lower income people-it’s a harder money-making proposition. If you are marketing services to people earning a couple dollars a day, your fees have to be lower-and your volume has to be high enough for revenue to offset your considerable fixed expenses, like rent, salaries, and equipment fees. But in peri-urban areas, there is not only a desperate need for better services but also high population density and a bit of disposable income, making it feasible to generate enough volume to cover our costs.

Reis: What service delivery problems did you seek to address?

Pearson: We discovered through focus groups, surveys, and workshops that one of biggest barriers to women seeking maternity care is actually poor treatment from providers. Lot of women don’t go to facilities for that reason-above other issues like cost or distance. Our providers are trained to be friendly, approachable and empathetic.

We also learned that mothers have a million questions about pregnancy and no one to ask. We are providing counseling in the waiting room so women can be better prepared.

And women wanted to deal with the same provider throughout their visit. Our nurses give blood tests, examine women and provide tetanus injections in the same exam room.

Reis: How do you collect customer feedback?

Pearson: Feedback forms allow customers to report if they thought they got privacy, value for money, and if they were treated nicely. Nurses will be evaluated on this.

A sure sign of customer satisfaction is if they come back! Last week our mobile clinic returned to a site we had visited earlier. Eleven patients were scheduled and all showed up. I was ecstatic about that! One had come back for postnatal care less than a week after delivering, which is rare. Most women just come back in six weeks for their child’s vaccinations.

(Based on principles developed by the firm IDEO, Pearson and his colleagues organized a human-centered design workshop. They brought their target clients and their nurses together to restructure maternal health services into what would be simple, friendly, and effective for women in Nairobi).

Reis: We recently started an initiative to get health programs to report their results-quantitative statements about the impact they are having-which can be helpful in lieu of formal evaluations. How are you tracking results at Jacaranda?

Pearson: We will report results by using our electronic medical record system. It is being set up by our Operations Manager Aliya Walji, who came to us from Grameen Foundation’s Mobile Midwife project, in which health workers use mobile phones to interact with patient records in rural Ghana.

Starting with OpenMRS, a database, we added an interface with which clinic staff members can enter data on mobile phones or netbooks during patient visits. This is useful for aggregating information on patients so we can track trends in health seeking behavior, outcomes, customer retention and health indicators.

It’s tremendously valuable. Besides using data to improve our own services, we have patients’ phone numbers in their records, so we can send SMS reminders about their next scheduled visits or health tips that follow the progress of their pregnancy.

Meanwhile, a couple of economists from the Harvard School of Public Health are setting up a baseline evaluation of Jacaranda which we can track our impact against. With data like this you can start speaking the language that drives funding and policy decisions.

Reis: Speaking of policy, what should government be doing to improve the ability of small health enterprises to operate smoothly and eventually scale up?

Pearson: For one thing, government should enforce quality control in private facilities in poor areas where quality of care is often low and there are many unlicensed practitioners.

The Kenyan government also has an opportunity to expand high quality, cost-effective service delivery to rural areas through contracting to the private sector. You see this happening more and more in India, where local health businesses in India like ZHL are answering government tenders to deliver contracted services at the state level. This would help expand health services efficiently in rural areas, where few people can afford to pay the $60 or so it costs to provide quality delivery services.

We’re charging fees to cover our costs and expand our services but ultimately maternity care is a basic human right – the government should really aim to provide it to all mothers, for free if necessary.

Reis: What about investors? What should they be doing to facilitate the establishment and scale-up of high quality, affordable health businesses?

Pearson: Investors have money but that doesn’t create management capacity. Most private medical facilities here are run by doctors without a lot of management experience. To build capacity in the sector, you need to bring in management support and mentorship. You should also be willing to invest smaller amounts and/or more philanthropically to seed innovation and growth in the sector.

Keep tabs on Jacaranda at their new Health Blog. Nick Pearson will soon be sharing details of Jacaranda’s human-centered design workshop, in which potential clients met nurses and explored how to excellent, friendly maternal health services. Stay tuned!

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