manasa tanuku

Seeking the Balance of Mission and Margin

In March, I had the opportunity to make a two-day field visit to Kenya’s second largest health sector hub – Eldoret – with my friend and colleague, Rob Katz. The purpose of our visit was simple – to map out the local healthcare provider landscape: identifying key players and the systemic issues in developing models to serve the poor. Of course, we hoped to uncover another entrepreneur or two brave enough to tackle these issues in a way that reflected our Acumen Fund mission – delivering services to the poor with integrity, dignity, and quality.

In theory, investing in sustainable and scalable enterprises as a means of delivering social impact seems straightforward enough. However, the reality of Acumen’s mission for the past 9 years – learned over countless due diligence trips and new field visits like this one – is that finding these pioneering enterprises within our parameters is a challenge.

Furthermore, there are so many ways to approach these challenges, and Acumen Fund cannot support them all. Along the journey, we often find opportunities that don’t quite fit our investment criteria, but are ones we wish we could help because of their noble missions and the leaders behind them. In Eldoret, we came across one such opportunity in the form of Dr. Hillary Mabeya and the Gynocare Fistula Center.

After starting his medical career in Nairobi as an obstetrician and gynecologist, Dr. Mabeya first began visiting rural regions of the country as a member of AMREF’s Flying Doctor program. During these missions, he became increasingly aware of the plight of gynecologic fistula patients. These patients were often either young female victims of sexual abuse or obstructed labor survivors, who now faced daily physical difficulties in the most routine of tasks. In addition, once victimized, they could not marry and faced social ostracization, as well as the economic challenges of supporting themselves. Soon, Dr. Mabeya began increasing his tours of the region to serve these patients specifically – all operations and services were voluntary and free of charge.

Ultimately, Dr. Mabeya moved his family from Nairobi to Eldoret to be closer to these regions, to set up a higher quality, affordable facility – the Gynocare Fistula Center. In addition to all surgical and gynecological services offered at his clinic, there is also counseling, education, trainings, and other programs to support socio-economic development of women. Though currently a standalone clinic with limited facilities, he hoped to be able grow and eventually, expand across the region.

Dr. Mabeya had the character of all that we hope for in our entrepreneurs. He was extremely intelligent, compassionate, and dedicated to delivering help to those who needed it the most. Most importantly, he was invested in creating a better quality of life for them, beyond just a one-time operation. His commitment could not have been clearer.

In the post-election violence of 2008, he was one of the few doctors to remain open and operational, often conducting surgeries free of charge despite threats to his own life. He teared up as he told us that as a father of three daughters, he just wanted to ensure daughters like his own were taken care of, and given a means to support themselves to thrive and be economically independent.

Through his clinic, Dr. Mabeya is trying to make a scalable, and sustainable social impact. But in the time since he has opened the center, he has been struggling to cover his costs. His staff is often paid through his supplementary salary at the government teaching hospital, and the counselor at the center is actually an unpaid Mrs. Mabeya. With low price points, he is serving the poorest of the poor, but future projections don’t look promising, and surgeries are often done free of charge. Despite knowing his business is bleeding, he is committed to trying to make it work by stretching his personal finances as far as possible.

So while the Gynocare Center had the right mission, it had neither the margin nor as yet, as a small standalone private enterprise, the mandate for an Acumen investment.

This is the messy reality and challenge of investing in social enterprises. There are a committed few, those who seek to serve the greatest needs and beyond. But doing so in a financially-viable and sustainable manner is the hurdle. So while we may not be able to support Dr. Mabeya and his Gynocare Center as an investment, we wholeheartedly support his mission, and everything that he represents.

Editor’s note: This post first appeared on the Acumen Fund blog.