How a Kenyan social enterprise is using FedEx to deliver babies

Jacaranda’s 60 strong team works day in day out to provide affordable, high-quality maternal and child health care services to poor urban women in Kenya. Heading up the organisation is Nick Pearson, who has spent his career in business serving the urban poor. Pearson is driving the creation of a self-sustaining, scalable chain of maternity care clinics using the latest technology, business and clinical innovations. Interestingly he’s taking inspiration from FedEx and fast food chains.

Fergal Byrne: Can you tell me a bit about the state of provision of maternity care in Kenya?

Nick Pearson: When a woman goes into a maternity hospital, it's overcrowded, the quality of care is not respectful, the level of training and competency of the providers is highly variable, the diagnoses aren't solid, there is a shortage of basic supplies and equipment, and the outcomes are very poor. In Kenya, a mother giving birth is 100 times more likely to die in childbirth than in Europe.

We have a very strong focus on building systems – the same kinds of systems that businesses like FedEx and some of the fast food chains use to drive down the costs and improve the systematization of their processes

FB: What is your approach to dealing with this problem?

NP: It's one thing to say, “We want to provide high quality, low cost care.”  The implementation is more complicated and really the only way that you can succeed in a lot of these markets where you are dealing with significant constraints, in terms of money and people's ability to pay, is to be extremely efficient. 

Jacaranda Health clinic. Photo credit: Nick Pearson

We're essentially trying to create a set of systems within a network of our own facilities that can provide higher quality and more affordable care – we want this to be a demonstration for better opportunities and ways of delivering care in these lower resource settings. We have a very strong focus on building systems and – the same kinds of systems that businesses like FedEx and some of the fast food chains use to drive down the costs and improve the systematization of their processes.  

So we use very tight clinical protocols that are evidence based and focus on the smart use of human resources. In the health landscape, this is called 'task shifting', effectively getting lower cost health workers to take on chunks of work, allocating the tasks among them and creating teams that can provide low cost care. We use technology and mobile phones intensively.  

In my experience, healthcare is a sector where there can be considerable pressure to move up market if you have for-profit investors

FB:  You have a for-profit arm and a non-profit arm-how did you approach this decision? 

NP:  I think sometimes people think, “For profit is better,” or, “Non-profit is better.”  The reality is that the right decision is highly contextual and it depends on the industry and the kinds of margins that you can get. If you really want to serve low-income people but it costs a substantial  amount-as is the case with some types of social services where there is a significant amount of capital expenditure involved, it may very well be challenging to run it as a full-profit model.  

In our case, we launched as a nonprofit with a for-subsidiary in Kenya. We are fundamentally a non-profit. There was significant investment required to build these systems and in R&D and we want to maintain an emphasis on serving the poor. In my experience, healthcare is a sector where there can be considerable pressure to move up market if you have for-profit investors. I have seen that pressure in for profit social enterprises where you have shareholders asking for better margins when cash flow is tight. That was our decision at the time.  I have seen people do it other ways.  I do not have a particular dogma about it.

The only way that we are really going to budge the needle on maternal health is through influence

FB: What is your vision for the future? 

NP: Our goal is to be one of the biggest providers of maternity care in the region building these hospitals and providing great direct service starting in Nairobi and then moving into other cities in East Africa. At the same, there is an imperative to capture what we are doing well, disseminate it to influence the sector. Frankly, if we are just a chain of 10 or 20 hospitals delivering 20,000 or 30,000 babies is a tiny percentage of the needs of total market.  

Jacaranda Health nurses. Photo credit: Nick Pearson

The only way that we are really going to budge the needle on maternal health is through influence, and there are a couple of different ways to get there, we are on this journey. Our goal is to demonstrate and prove our direct service model, continuously build our systems.  We’re looking at how we take this improved model and get it replicated, adapted and scaled up in the public sector amongst the private sector of maternal healthcare in Kenya.  

Many of the most successful social enterprises have figured out how to do this, either through advocacy and policy setting, or through strong partnerships, franchises and through other organizations that are able to operate at that scale. The question of how you take a direct service model and create change in the ecosystem is a crucial one for any social enterprise that wants to create change at scale. 

Fergal Byrne has been interviewing entrepreneurs, executives and thinkers of every stripe for almost 20 years. Look out for the next Q&A in the series here on Pioneers Post. You can hear Fergal’s interview with Mike Quinn and other inspiring social entrepreneurs and changemakers here and on iTunes.   

Photo credit: Allan Gichigi for the Center for Health Market Innovations.