Read the Conversation

EF: How did you develop and form Unjani Clinics, and how has it created a positive social impact?

LT: Dr.Iain Barton, the founder of Unjani Clinics, developed the concept of task-shifting primary healthcare from doctor to nurse level in response to the shortage of doctors in South Africa. With a scarcity of medical professionals,exceptionally trained nurses have taken on the responsibility of running government and community health clinics, despite being prepared to handle simple primary healthcare issues. However, these nurses have limited career advancement opportunities, and most of South Africa's population relies on government clinics for their healthcare needs, causing overcrowding and poor service experiences. Unjani's mission is to empower black women nurses to become "nursepreneurs" and operate their private practices in low-income, rural communities where enhanced access to primary care is needed. By providing business skills training to nurses, Unjani creates sustainable businesses that sustain healthcare provision and offer employment opportunities.

Unjani's impact is significant, with over 150 facilities on the ground in South Africa and over 600 jobs created through those facilities. The network provides valuable primary healthcare consultations to the employed and uninsured market, with arecord 100,000 consultations in March 2023 and over 3.7 million consultations since inception in 2014.Unjani Clinics' focus on the employed and uninsured market, which is between 12 and 15 million people, provides an affordable alternative to government clinics, ensuring that the queues in government facilities become shorter and the unemployed can access care more quickly. The organization aims to have 600 clinics by 2030, increasing the number of annual consultations to make a more significant impact. Ultimately,Unjani Clinics' mission is to capacity build in government facilities, by providing patients with an alternative, more convenient healthcare model.

EF: What strategies do you have to achieve your goal of scaling up to 600 clinics by 2030?

LT: Unjani Clinics aims to provide sustainable healthcare infrastructure in underserved communities and is funded by foundations and corporates. The organization operates as a social franchise, managing the back end and infrastructure deployment while allowing nurses to focus on patient care. Rather than nurses being solely trained in clinical skills, Unjani provides them with business skills to become"nursepreneurs." Unjani has implemented electronic patient management systems, stock management, and other important tools to ensure efficiency and sustainability.

Unjani is seeking ways to reduce its reliance on grant funding and increase its ability to open more clinics. To scale its operations,Unjani has worked to reduce its reliance on grant funding by implementing our evolving loan system. Nurses now repay 50% of the investment in their clinics,which is then reinvested to open more clinics. This creates an independent funding source, allowing Unjani to scale and expand its operations. This system allows for continued grant funding and the possibility of attracting debt and enterprise development loan funding. Unjani has created a separate entity, 100% owned by the nonprofit company, for this purpose.

While grant funding will likely always play a role in operations, Unjani's innovative funding model provides a pathway to continued growth and expansion in the future. Furthermore,Unjani has received value from South Africa's Broad-Based Black Economic Empowerment (BBBEE) policies, which incentivize local companies to fund enterprise development. Through these measures, Unjani is empowering nurses through enterprise development and paving the way for sustainable growth in the healthcare industry.

EF: What advice would you give to other business or social entrepreneurs seeking to establish businesses with social impact?

LT: To design a successful product, it is crucial to understand the target market’s needs. Social entrepreneurs should conduct thorough market research and engage with the community to build their products based on their needs. This approach ensures that the product aligns with the market's demand and solves existing problems.In the case of Unjani Clinics, the model's success lies in its community focus.By employing nurses from the local community, the clinics establish a personal connection with patients and are more responsive to their specific healthcare needs. Before launching in a new community, Unjani Clinics conduct surveys to understand the local demand and tailor their services accordingly. This strategy has been integral to the success of Unjani Clinics and serves as a valuable lesson for all social entrepreneurs.

EF: What data and trends can be gleaned from various communities to enhance the healthcare system and industry?

LT: In hindsight, I would have established a robust data system when we started in2014 to capture data properly as the model has evolved. It took us nearly five or six years of various systems and development and realizing that our data platform needed to improve. We needed a platform that provided uniform diagnoses, uniform product names, and the ability to search through data effectively. Our current system allows us to manage diagnoses, medication dispensing, patient management records, and track vital signs from one visit to the next. We can also store laboratory test results and any scans taken.

We launched our We-Care system six months ago and are already seeing some good data. We can analyze what services we're providing,what revenues are being generated, what medications are being dispensed, and what the main diagnoses are. We follow the treatment guidelines and protocols of the Department of Health and can see the impact we're making on the lives of our patients, including those with chronic diseases such as HIV and diabetes.Our database is cloud-based, but we can continue operating offline during load shedding. We want to use our rich database to show the positive health outcomes we're achieving for our patients, not just for sharing with the government but also to prove that we're making a real difference in people's lives.

Thorough testing has highlighted a need for more comprehension among healthcare professionals regarding their data, exacerbated by the Department of Health's outdated and often unreliable information systems. The absence of real-time data makes it difficult to make swift decisions and identify potential pandemics or outbreaks without reporting from individuals, as exemplified by delayed recognition of recent measles and mumps cases.

Our database could provide real-time data that the Department of Health's systems may not offer, allowing us to respond quickly to outbreaks and pandemics. Our next goal is to demonstrate the health outcomes of individual patients through data-driven results. By establishing a comprehensive database, we can collaborate with the government and illustrate measurable health outcomes. While it's valuable to quantify the effects of our services on nurses, communities,employees, and their families, we must also examine our impact on patients by managing their specific needs. For instance, managing a diabetic patient requires monitoring HBA1C levels, medication stability, and measuring overall quality of life improvements.

We want to showcase the positive things that are happening in South Africa, despite the negative issues that the country is facing. As the pandemic has shown, our resilient nation has the resources and ability to become self-sufficient. Seeing our nurses’ daily impact on people’s lives is a blessing.

EF: Other than celebrating your tenth anniversary,what other accomplishments in Unjani Clinics will you celebrate this coming year?

LT: We aspire to reach significant milestones, with the target of establishing 200 clinics by the end of this year, which would have created employment opportunities for nearly 1000 individuals. Of utmost importance, we aim to achieve 4 million consultations by that time, marking an exceptional accomplishment. Furthermore, we anticipate having a year's worth of valuable We-Care data, enabling us to conduct extensive analyses. However, more than anything else, we aim to celebrate the loyalty of our patients who had chosen to seek treatment at our clinics, even when they had the option of waiting in the government queue, costing them time and money. This would be an acknowledgment of the exceptional achievements of the nurses who have been given a chance and have impacted their communities, as well as the 200 “nursepreneurs” who have established employment opportunities, provided quality consultations, and transformed the communities.

EF: Do you have any final message for investors,nurses, and the young generation?

LT: The impact is crucial when it comes to investing and funding. Investors must prioritize positively impacting people's lives rather than just adding points to their scorecards. Unjani's journey is a prime example of the positive outcomes that can be achieved through strategic funding. Unjani's sustainable businesses have created more jobs, and its nurses have been allowed to run their clinics,providing patients with a choice in their healthcare provider. Furthermore, Unjani's learnership program has significantly impacted the lives of young South Africans, providing them with opportunities to work and giveback to their country. By empowering nurses to run their businesses, Unjani has helped prevent the loss of nursing talent to other countries and contributed to the growth of South Africa's healthcare industry. Ultimately, giving people choices and opportunities is essential, and limiting those choices would go against our constitutional principles.

May 2023
South Africa