The ubiquity of mobile phones and decreasing cost of SMS are beginning to transform healthcare systems in some of the most impoverished regions of the world—places such as Kibera, Nairobi, Africa’s largest urban slum.
But even as Kenya’s mobile penetration is nearing 80 percent, better access to health information doesn’t always translate into more health services for all – development organizations and government institutions still can’t get medicines and services to many families in the poorest areas, and the private sector is still struggling to cover costs.
This is the case even though technology is also facilitating cheaper medical services and better diagnostics all over the world. There is a need to ensure that these benefits are actually passed on to all urban and slum residents.
“Poor communities in regions with inadequate health care resources are severely affected by a lack of access to preventive and life-saving treatments,” said David Barash, MD, chief medical officer for GE Foundation. And people often resort to self-diagnosis and purchasing unregulated medicines when it is costly and time-consuming to go to public facilities.
“We can change this by investing in the simplest and most innovative solutions in order to make health care accessible to those who need it most,” Barash argues. Social innovators across Kenya and beyond are developing low-cost models that democratize health care. Their financial success and high impact are rooted in two very key characteristics: the simplicity of their models and iterative approaches that incorporate patient feedback.
Access Afya is an example of a social enterprise that is making this happen. It is creating a chain of ultra-mini-clinics that provide standardized outpatient services targeting the extreme poor, using a simple model that focuses on community marketing and branch locations that are conveniently located to serve impoverished populations.
Each Access Afya clinic has a registered nurse, an electronic health system to manage patient files, and a dispensary to fill prescriptions onsite. With patients paying small fees for individual services, each mini-clinic is projected to break even and cover costs in about one year.
Access Afya was one of two winners of the Ashoka Changemakers and General Electric Foundation Health on the Ground: Uncovering Solutions That Save Lives competition. It engaged innovative organizations that are creating models for infant and maternal care, emergency and surgical care, and biomedical practice in urban and semi-urban settings in Africa, Southeast Asia, Brazil, Honduras, and Peru.
Melissa Menke, co-founder of Access Afya, argues that despite common perceptions, there is demand for private-sector health care delivery at the base of the pyramid, and a willingness to pay for health services. “This is evidenced by the prevalence of informal chemists profitably peddling medications in the slums, and the early successes of organizations around the world rolling out low-cost clinic models,” she said.
Testing the model externally by having honest dialogue with patients will be the secret weapon to ensure scalability. Access Afya hopes to increase the number of clinics from two to four in the coming year, and ultimately roll out a franchise network that share the organization’s distribution chain more broadly.
Kennedy Odede, founder of Shining Hope for Communties (SHOFCO) and the other winner of the Health on the Ground competition, agrees that community feedback and a simple, low-cost approach to health care delivery have been central to the success of his PatientPower model, which launched a 14-room clinic in Kibera and works to ensure that grassroots community leaders retain power and control within their local healthcare organizations.
“In extremely low-resource areas, the educational, class and racial divides between medical professionals and their patients run deep—such that despite millions of dollars of foreign-aid, health outcomes remain dismal, and patients experience constant frustration and loss of dignity,” Odede said. “Growing up, I never felt in control of anything—especially not of my own health.”
Beyond supporting patient dignity, responding to feedback helps sustain demand, as it can lead to the implementation of new clinic programs that better serve specific sectors of the community. “Focus groups and community advisory boards have provided honest descriptions of the state of health care in Kibera, seen through the eyes of those who use the centers,” Kennedy said.
To sustain its health care operations and boost economic empowerment in the region, SHOFCO relies on selling community services that are in high demand, such as clean water, biolatrines, and vertical gardens. The organization has already served more than 40,000 people through its community-led services, and the impact in the region has been immense: Kibera’s cholera outbreaks and other public health issues have come down to a manageable level, and family planning usage has increased by 20 percent.
The initial proven success of these simple, distributive health care models allows philanthropy and investment to push forward and replicate these solutions in other cities and communities across East Africa and beyond, and the innovators are already making headway. “We are planning each element of the organization for scale—from recruitment and hiring criteria to training plans to clinical and operational protocols,” Menke said.
Access Afya is investing $25,000 from General Electric foundation to pilot its health care model in a rural area, something that has not yet been done in Kenya on a self-sustaining basis due to the high risks and uncertainty of financial return. “I view the value of philanthropy as essentially an R&D lab, guiding both the market forces, and encouraging health organization to maintain wellness as their end goal,” Menke said.
Shining Hope for Communities plans to increase its health care impact by further expanding paid social services. “To us, scaling means documenting our operating systems and creating leadership guidelines so that anyone can apply our successes,” Odede said.