Read the Conversation
Conversation highlights:
- Expansion & Impact: Unjani Clinics has expanded to 275 care settings, creating over 850 permanent jobs and empowering Black women nurses as “nursepreneurs.”
- Systemic Challenges: USAID funding cuts and NHI legal battles threaten to undermine progress and intensify pressure on healthcare providers.
- Rural Access & Patient Choice: Clinics are strategically placed in underserved areas to offer affordable, dignified care and real healthcare choice.
- Values-Based Partnerships: Unjani partners only with ethical, impact-driven funders.
- Data-Driven Growth: Digital tools like WeCare and WIMMY dashboards enhance clinic performance, quality, and readiness for NHI integration.
EF: It has been two years since we last spoke. How have things evolved since then?
LT: I am pleased to say that we have made great progress. We now have 275 care settings, which puts us on track with our original goal of adding 50 new settings per year. The goal is to continue rolling out 50 care settings annually to reach the 600 mark.
Just under 7.7 million consultations have been recorded through the network since our inception. We conduct approximately 1.5 million consultations per year, or around 130,000 per month. It is still about empowering nurses, whom we call nursepreneurs, by equipping them with the business skills to run a successful, sustainable business that provides quality, affordable care in low-income communities of South Africa.
It is good to see those numbers, but another very important thing for us is employment. Approximately 850 permanent jobs have been created in these clinics. In a country where unemployment is high, especially among young people, it is wonderful to be creating employment in the health sector and encouraging more people to enter the field to explore different opportunities in an area where there is a significant need.
EF: How do you assess 2025 and its dynamics from your perspective, and what are your key priorities right now?
LT: We are in the nonprofit space, so we are probably close to the impact of the withdrawal of USAID funding, fortunately not directly, because we were not reliant on USAID; however, many of our partners, who do incredible work in the country, were. To see the impact on those organizations and the people they employ has been difficult.
The concern is that while the government seems confident that HIV programs will not be affected because they provide the commodities, the reality is that these organizations were providing the human capital and the continuous training of government employees. With that now withdrawn, a huge gap remains. People had built trust relationships with those organizations, and now must rebuild that trust with government providers. I fear it will set us back a few years in progress. And while we can be optimistic, it will have a significant impact.
For example, one organization we spoke to lost 3,000 jobs. These were healthcare workers in communities, breadwinners for their families. That will impact the economy and unemployment rates. So, 2025 started on a sad note, and many organizations are now trying to transition and find new ways to remain sustainable. However, those job losses are real, and they are persistent. In an environment with such high unemployment, it is very difficult for people to find new jobs.
On top of that, we now face potential tariff issues that will put more strain on job creation, as it will be less affordable for companies to employ people. So it has not been a great start. But as South Africans, we are a resilient nation, and we always have to look for the positive. In healthcare, the need and demand are probably even greater than they were before this year began. So we need to step up and meet that need. I think many of the organizations you have spoken with share the same view. We have a role to play, and we must put our heads down and find solutions.
That means working closer with the government on what the National Health Insurance will ultimately look like. But that is another challenge, with so many legal disputes around its implementation. It is sad because so much money is being channeled into legal fees when it could be going into healthcare. But it is also understandable, because we do need workable solutions for our people. It cannot be a political agenda; it must be an agenda for the people on the ground who need care. It must be well thought through, and we cannot ignore that corruption has hurt us, not only in government but in the health sector itself.
You must understand that people in the country are saying, “Hang on a moment, let us not put all this money into one pool without knowing what is going to happen with it.” We need to be mature about it. We need to find solutions together from the government, private, and public sectors. We have to work together to find the correct solutions and not make it about personal agendas. It has to be patient first, with the patient at the center. That is how real solutions are found.
I am encouraged because even in the work we have been doing with the national and provincial departments, there is now collaboration happening that was not there in the past. I think the Minister of Health has also taken a different stance, that it has to be about working together to find solutions. Yes, it must be driven by the regulator, absolutely, but let us also speed the process up. As these economic challenges grow, the need for healthcare becomes greater while the ability to pay for it becomes less.
Even in the medical aid industry, people are finding it more difficult to pay. Our own market, the employed but uninsured, is growing. More and more people are coming to seek affordable healthcare, something we have not seen before. So, the only way forward is collaboration across all sectors.
Hopefully, solutions are being put in place at higher levels. As a small nonprofit trying to make an impact in communities, we have to rely on the big decision-makers. I am encouraged because when faced with large problems, and we saw this during COVID, communities come together, people come together, and solutions are found. I am hopeful it will be the same situation now.
EF: How do you assess the best place for an Unjani Clinic? What does that kind of place look like, and once you establish a care setting there, how does it bring value to the community?
LT: We have found real value in using the partner we choose to help us decide where to place a clinic. There is nothing more rewarding for a community than when one of its own returns to serve it. What we often see is that nurses may be working in metropolitan or high-population urban areas, but they come from villages around the country where the need is greatest. If they are given the opportunity to operate their own business in a sustainable model that has already been proven, they can also create employment in those rural areas. That becomes a winning solution, because rural communities are where the need is most significant.
If you think about it, our aging populations are mostly in rural communities. They struggle to access transport to hospitals and other facilities. By placing an Unjani Clinic in those areas, we can help support government facilities, sharing the Primary Health Care load and strengthening the health system where it is needed most.
Many other providers tend to focus on highly populated urban areas. While we also serve in those areas, patients there have options: an Unjani Clinic, an Alma Clinic, a Clicks Clinic, and so on. But in a small village in Limpopo, the options are very limited. You may have only a government facility that is overcrowded and understocked, with long waiting times, or perhaps a small community pharmacy. That is where an Unjani Clinic can make a real difference, building capacity and strengthening the system.
National Health Insurance, after all, is about choice. Patients should be able to choose where they receive care. If government is the only option, that is not fair. By focusing strongly on rural areas, we give people that choice while still serving urban and metro populations where need exists. Today, about 90 percent of our clinics are in rural settings, and that will remain our focus as we work toward 600 clinics. The dream is to have an Unjani Clinic in every community, standing alongside government facilities to share the load.
A key to success is the role of the nurse. Nurses identify the communities they want to serve, often conducting community surveys to secure buy-in. We know there is a need everywhere, but not every community has the same ability to pay. So we also consider the economically active population, because they are the ones who sustain the clinic’s services. Alongside that, we look at practical elements like transportation and accessibility.
Taxi routes are an important factor. We try to place our clinics in communities, but also close to where people come to shop or gather. These are areas where people do their shopping, catch transport, or run other errands. So transport nodes on main roads are important, both for accessibility and for visibility. It must be easy for the community to find the nurse and access the clinic.
We use retail software called Lightstone Online, which helps us review where a nurse has chosen her clinic site and guide her on whether it is the best location. Our teams then go in to do a site inspection to make sure the spot is suitable and that she will get the best support as she opens. The most important thing for us is to set her up for success. Success means visibility, proper marketing, community support, and that the community receives the services they expect from an Unjani Clinic. That is how we go about selecting areas.
We also have target areas we have identified through our own mapping, key areas where we believe we are underrepresented. To address those, we market through word of mouth between nurses, through their colleagues, or through LinkedIn and other social platforms to say we are looking for nurses in certain regions. If a nurse comes from that area, she can then apply. So it is a combination of the nurse choosing her site and our research into areas of need.
EF: By giving patients the choice, you are also empowering them to choose between public or private services. I assume there are several factors involved in that choice, and it might not be the same choice every time, depending on those factors. So it is important to have that choice there, right?
LT: That is absolutely right. I mean, we do not know everything about every person in the country, and so we can make generalized assumptions. For example, because people do not have an income, they must just go to a government clinic. But that is not always the case. I always recall a story of an elderly lady, we call them “Gogos,” here in South Africa, an old granny.
I was in a clinic in Limpopo waiting to see the nurse, and I was sitting in the queue with this old lady. I said to her, “I am sorry to ask, but you seem to be of an age that you are retired?” She said yes. I asked, “So you must be a grant earner?” She said yes. Then I asked, “Why would you, a retired person with time on your hands and a low income, come to an Unjani clinic for your care? You could go to the government clinic; you have time, so you could wait. Why not do that?” And she said something that really resonated with me about our assumptions. She said, “I come to the Unjani clinic because it is affordable for me and it is of quality. If I don’t pay, I cannot complain.”
What she was saying is that she is looking for value. She is giving her money and expecting value for it. If something is free, you cannot really complain about it; you just have to accept it. That is such an incredible insight. I would feel that way. Everybody would feel the same way. If you are paying, you are expecting quality and value, and that should be the same for everyone.
I have always thought, and this is another debate for another day, that National Health Insurance could be looked at in a completely different financial model, where every person, whether on a grant or not, contributes something to the fund. Because if you are paying, you expect value. Whether you are a grant earner or unemployed, paying something creates the expectation of quality. If everyone expects quality, the service provided to the population would be much better, and the healthcare system overall would improve. But that is a discussion for another day.
EF: I wanted to ask you not only how important these different partnerships are for you, but also how you choose your partners. What makes a partner the right fit for an Unjani clinic?
LT: It is a great question and a very important one. We have certain partners that we will not consider purely because, as we are in the healthcare sector, we need to make sure that the partnership aligns with our values.
For example, we would not take money from a cigarette company or an alcohol company, because those are underlying causes of health issues, particularly in some of our very poor communities, where abuse is a problem. Gambling is another area we avoid, because it can become a sickness. We have been very clear about the partners we will not take funding from.
Most of our partners are in the healthcare sector. The attraction between Unjani and a partner is not about the product; it is about access to healthcare. That is an important element. When the product becomes the main driver, it is a commercial investment, not a social investment, because there is an expectation of return from the beginning. For instance, Johnson & Johnson was one of our very first pharmaceutical partners, and in their agreements with us, the product cannot be the driving element. It is against their code. We adopted the same principle: you cannot be involved with Unjani just to push your product because it may be too expensive for our patients.
Our focus is on affordability for the patient. Many of our partners, like Pfizer and Novartis, have products priced higher than generics. They understand that these products may not be suitable for our clinics, because our priority is keeping costs low for patients. The partnership is about supporting primary healthcare, enabling nurses to provide the best possible care in communities where a small clinic or pharmacy may be the only option. Access to healthcare is the driving force.
We also have partners outside the healthcare sector, like DP World. While their main business is logistics, they have been long-term supporters because they value the social impact Unjani creates in South Africa. We also have South African companies with global headquarters that invest from a BBBEE perspective, focusing on employment equity and empowering previously disadvantaged individuals, especially women, to uplift their communities. We do have black men as well. It is a wonderful partnership, and we are grateful to them.
In the last two years, we have had two philanthropic organizations come on board, providing ongoing funding. At the end of 2023, we received a particularly large unrestricted gift, which is rare in a nonprofit environment. Most of our funding is directed straight into clinics, but this gift allowed us to grow the nonprofit itself, ensuring we have the right human capital to support the nurses, implement systems and dashboards, and manage the clinics and network more effectively.
This has helped us focus on scaling more cost-effectively and efficiently, which in turn has unleashed our ability to support nurses better and step back to learn how to operate more effectively. It has been amazing, and we are truly grateful to these partners. Their support is about enabling us to continue the amazing work, not just supporting the nonprofit.
From a nonprofit perspective, the only income we get is the network fee from nurses, which we must justify by showing ongoing value. Supplemental funding allows us to continue support until we reach sustainability, which we expect early next year at around 300 clinics. Once sustainable, all additional resources can be invested back into the network, which has always been our intention.
Ultimately, it is about telling the story, and you have been amazing in helping tell that story. Letting the impact of our work resonate with partners is key. For example, my conversations with Roche began in 2016 and took time because we needed to prove ourselves. People had to see that this was not a fly-by-night initiative. Even some of our nurses initially thought it was a scam when they applied, wondering how it was possible that they could be given a clinic.
It has been a journey, but it is really about talking the talk and delivering on what we say we will do. It is about supporting every bit of funding we receive with the necessary documentation to show transparency, proper governance, and running this as the business it should be. This ensures we can be held accountable and responsible for delivering on what our funders ask us to do.
We hold our partnerships with organizations in very high regard. Some of these partnerships have lasted a long time. Johnson and Johnson started in 2016 and still funds us; DP World, from 2014, is still funding; MediClinic has come on board more recently. Many partners have committed long-term because they see the impact is continuously delivered even after funding has been provided.
This is a lasting impact because the nurse stays in the community and continues to give back. The impact keeps growing; it is not just a one-off. It is not like the money is spent and you see results only briefly. This year, we have nurses celebrating 10 years in the network, which is an incredible story. Their communities have had access to nurses and clinics for that entire period, and that sustained presence is wonderful.
Once a nurse reaches sustainability, it is a different kind of milestone. The struggle is not necessarily over, but it gives a bit more confidence, knowing that now she is sustainable, profitable, able to pay her bills, and has hit that mark.
For us, sustainability is the same principle. That is what we set out to achieve: so that the network and the nurses are not reliant on external funding. We want the nurses to be fully confident in their work, in the services they deliver to the community, and to have the correct level of support from our organization.
EF: How can South Africa use its healthcare data better to improve health outcomes?
LT: I think this is one of the critical elements for NHI. If I think about the Unjani clinic journey, people would often say to me, “What would you have done differently from the start?” And I would have said I would have implemented a patient or a clinic management system that was digitized from day one.
We have great data that was collected in Excel spreadsheets for the first five years of our lives. And while it is an Excel spreadsheet, you know that it has a manual component, and you could have errors and the like.
When we implemented WeCare, which is a clinic management system, in fact, i i’s a business tool for the nurses. What it does is manage the registration of patients and the patient’s record. What it gives us on the back end is incredible de-identified data that helps us manage those clinics better from a single point of view. We are also able to support the nurse in terms of marketing activities, and when you start to benchmark clinics in particular areas, as to why this clinic does better than another, then you look at the services they are providing. The nurse may be missing maternity services where that area absolutely needs them. We can then encourage her to either get more ultrasound training or whatever it might be, so that she can make her business more successful in that particular area.
The work that we have been doing with a company called Wimmy in South Africa, founded by Wim Delva, started in 2023. We began drawing in the WeCare data, de-identified, into their database and looking at it through dashboards so that the head office could manage our teams in the regions better and support the nurses who really needed the support more than those who did not. We almost have sustainability dashboards now, looking at our nurses and clinics from a financial, clinical, and regulatory perspective. We can view at the clinic level, provincial, district, and national levels, and drill down into the data.
For our clinical teams, it allows them to look at health outcomes and see the impact we are making in communities. We are also able to flag emergencies. For example, if a nurse has overlooked a high blood pressure reading, the system can alert the clinical team to call the clinic and double-check that patient. We look at patient records, ensuring they are complete and accurate, and that nurses are following treatment guidelines and protocols. So the data drives a different kind of management. It is not labor-intensive because you are looking at it digitally, but it makes you much more effective and efficient by flagging the problems you need to watch, while when there are no flags, it is just a matter of checking in.
It has also helped our operations teams focus on the clinics that need the most support. We call them CPR clinics, those that are not meeting the targets in our model. The Regional Support Officers then focus more on those clinics rather than on the ones that are tracking well. That is where the most care and support is needed.
We have also brought in different ways to measure patient experience. We now have a QR code going up in all clinics so patients can scan, complete a survey, and we get that feedback straight into our dashboards. From a compliance perspective, we can immediately deal with complaints, so if someone tells us how great our service is, that is wonderful, but if they had a problem, they can report it right away, and our compliance teams follow up. That strengthens the quality element, and if our payoff line is “affordable quality primary healthcare,” then we need to assure the quality element.
We have also built financial dashboards that show the history of each clinic, which helps us in our conversations with the National Department of Health. We can demonstrate how we have been able to run these clinics in a cost-effective way because we have the financial data to back it up. We know our input costs for medicines, for human capital, and that is why we have been able to keep consultation fees as low as possible over time. We can share learnings that may be useful in an NHI environment.
I think, as I said at the start, data and NHI go hand in hand. Data is the most important thing. We have lost so much data in South Africa because of the way we do it. We do it manually, and even when data is captured in a digital system, it often gets printed out and re-captured into another system. There is so much wasted time, and we have to find a solution. There is absolutely no way we can move into NHI without a government system that is interoperable.
You cannot expect Netcare, for example, which has built an incredible system to run its hospitals, to throw that out. We do not want to throw WeCare out either. What we need are interoperable systems that can talk to each other, that provide the right data, and that give us a complete view of our country, because that is the most important thing.
I am so tired of repeating my own health record every single time I go somewhere, and I am in the private sector. We have to find solutions. In an AI world, I think we will be leaps and bounds ahead in the next 18 months, particularly in health. We do need to be careful with AI, but we can also use it very effectively to make the links, whether through ID numbers or other common data points, that would allow us to pull together a single patient record. Imagine Linda’s record across her 50 years being complete and connected. That is what we need: one patient record. We have to use technology better.
EF: Obviously, you are operating as a network with standardized procedures in some sense, but there is also a degree of autonomy, because you are empowering nurses to run their own clinics. So how do you strike that balance? On one hand, you need to ensure quality across everything that carries the Unjani logo, and on the other hand, these clinics are part of their communities, so there has to be a community feel and relationship. How does Unjani find that balance?
LT: It is a very difficult one, because you do not want to stifle the individual who is a caring nurse, who has a love for her community. What we have tried to do is provide basic guidance. Certain minimums are just non-negotiable, and those are really focused on the patient.
So, for example, in terms of pricing, we try to guide, because the whole purpose of Unjani is to bring affordable primary healthcare. We set that pricing in conjunction with the nurses’ steering committee, a group of elected nurses who work with us on it. Then there is the quality side, making sure that the nurses follow treatment guidelines and protocols, stay within their scope of practice, and follow the price guidelines.
We give them those guides, but then allow them to bring their own individual flair to their practice. Around the brand, the look and feel of the clinic is important because it is patient-focused. Patients must recognize an Unjani clinic and know what services they will receive. Nurses cannot stray from that, and we drive compliance through the agreements we have in place.
What we are finding is that recognition of the brand in communities is increasing. People are asking for Unjani clinics. Five years ago, nurses might have told me they did not need the brand and could go on their own. Now, when we have conversations around graduation, they are begging to stay in the network because of the value they see in it. That is because patients recognize and trust the Unjani brand.
That makes it very important for us to protect the confidence that communities have in the brand. If a nurse breaches that, we have regulatory and legal agreements that allow us to take action. Compliance is crucial, and nurses understand that because they are in healthcare and know the importance of staying within their scope.
So I think that is how we strike the balance: we let her be the clinician she is, but we also give her the boundaries she must operate within, always to protect the patient. I think that is important, because so often you see NGOs closing when funding is withdrawn. That is why reaching sustainability is so important for us. We want to always be there to support, but not build a model that makes clinics reliant on us.
They must be able to stand alone and continue to provide the great service they do. For as long as possible, we want to keep the Unjani Clinic brand on them, because I honestly believe that even under NHI, there will be negotiations with groups. It is much easier to negotiate with a single group that complies with NHI requirements than with individual nurse clinics.
That is why I continue to encourage nurses to join a group, whoever they choose to join, but to be part of something collective. It is important for us to strengthen the healthcare system through nurses, because they are the primary caregivers and the gatekeepers to primary healthcare.
EF: What legacy would you like to leave in South Africa’s healthcare landscape?
LT: I think, quite simply, for me it is about recognizing that the patient comes first. It is one thing to have it as a principle or a policy written on the walls, but it is about genuinely seeing that every patient is unique, feeling that they have been given empathetic care, and being treated with respect and dignity.
If we can achieve that in our clinics, that would be absolutely amazing. I remember back in 2014, we had a slide deck with a little girl sitting in a clinic, and we used to say, “making a difference one patient at a time.” That is what it is about, recognizing the impact you make on a patient’s life today. Every person deserves access to the highest quality care.
For me, the ideal legacy is that every patient who walks through an Unjani clinic feels important and valued throughout their entire experience.
EF: Do you have a final message?
LT: We cannot act in silos. We need to act collaboratively to find a solution for the South African healthcare sector. We have to do it together.
