On The Ground

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Launch of the first Jacaranda Maternity mobile clinic

Nick Pearson worked with Acumen Fund in Nairobi before founding Jacaranda Health, a social enterprise dedicated to maternal and newborn health in East Africa. Nick discusses Jacaranda’s first mobile maternity clinics below:

Five weeks ago, Jacaranda Health opened our doors to the low-income mothers of Nairobi. In the peri-urban neighborhood of Kariobangi, our nurses, receptionists, marketing staff and our clinical advisor all pitched in to set up the exam rooms, lab tests and welcome tent on the grounds of Full Gospel Church, the community partner who hosted our mobile clinic for the day.

Photo by Emily Puckart

Our first antenatal patients walked in off the dirt road as soon as the gates were open, and the day brought us more patients than we could see in a single day — we had to reschedule several women for future dates. In the weeks since, we have rotated clinics among our seven community partners, and have been fine-tuning our clinical processes, testing different marketing approaches and doing focus groups with patients to improve services – all working toward our goal of creating a scalable, cost-effective model of maternity care for urban mothers.

A few highlights for us:

We are reaching the women we intended to, from a single mother of 17 getting her first medical visit 36 weeks into her pregnancy, to a mother on her fourth pregnancy who had experienced preterm labor and didn’t know where she should plan to deliver.

Our systems and protocols are working. We’ve been putting to test the application that lets us create medical records by mobile phones, our inventory management system and our clinical and emergency protocols. And they’re working: Our patient data is at our fingertips. Patients have successfully been referred to partner facilities for complications and delivery, and are already returning to us for postnatal care. Meanwhile, our partners from Harvard’s School of Public Health are progressing quickly on their baseline evaluation that will enable us to measure and report on our impact.

Integrated care works. Our patients get a truly one-stop antenatal visit, with every step from beginning to end — history taking, counseling, physical exams, lab tests, and birth planning — done by our nurses in the exam room. This integrated service means less wait time and continuity of care from a single provider. Our patients love it, and it’s clearly paying off in terms of patient retention. Our nurses have loved it too: One said that in her previous jobs, she had never been able to treat a “whole patient.” Overall, our nurses are responding well to the job’s mix of autonomy, training, emphasis on customer service, and involvement in quality improvement and problem solving.

Patients are sticking with our services. One of the big tests came last week, four weeks after the first clinic day. Would the women who’d come to the clinic on our first day come back for the antenatal follow-up visits that we’d recommended? Ten out of 11 of them showed up and paid full price, a level of customer retention and satisfaction that even surprised us. Our clients are pushing us hard to get our first fixed clinic up and running so they can deliver their babies with us, and our feedback forms so far show 95% of customers giving us 5-stars for patient satisfaction. As much as any of our clinical and technology innovations, this customer satisfaction is what will change the way that maternity care is delivered in Africa.

These are still early days and there are plenty of challenges ahead, but we’re optimistic based on what we’ve seen so far. We’re moving quickly toward launching our next clinic — the fixed facility that will provide deliveries. We are also starting a blog to record the thinking behind our business and our experience providing maternal healthcare in east Africa. We hope you will come back to learn more about our progress.

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