Enterprise for Development (EfD) series on models of best practice for socially and
environmentally sustainable private enterprise and social enterprise
Case study: Jacaranda Health
Background
Kenya has a large and growing urban population (11 million in 2013 and growing at 4% per
year), particularly in Nairobi where the population has grown from 862,000 in 1980 to 3.4
million 2009.1,2
Evidence suggests that the dramatic increase in the slum and peri-urban populations in and
around Nairobi has been accompanied by increasing rates of poverty and poor health
outcomes.3
Figure 1: Typical peri-urban settlement
Public provision of health services to these populations is
limited, with the vast majority of providers being private
for-profit institutions – the latter are mostly unlicensed
clinics and maternity homes, with no working guidelines or
standard protocols for services.4 Despite the low quality of
services provided, many women choose to deliver in such
facilities, due to both a lack of alternative options and the
low cost of delivering in these facilities.
Jacaranda business model
Figure 2: Jacaranda maternity hospital
Jacaranda Health (Jacaranda) is a nonprofit social enterprise focused on
providing comprehensive, integrated, low
cost and high quality maternal and
newborn healthcare in Africa. Services are
provided through maternity hospitals with
12 to 15 beds, equipped with a
laboratory, pharmacy and the essential
equipment needed for delivery and
postnatal care. Services provided include antenatal care, delivery and postnatal care,
newborn care and child wellness care, as well as family planning services.
1
World Bank data.
http://www.unicef.org/sowc2012/pdfs/SOWC-2012-Focus-On-Maternal-and-Child-Health.pdf
3
Ibid.
4
Ibid.
2
1
Figure 3: Jacaranda client
Jacaranda’s target customers are women that are often
the primary breadwinner for their families living on
approximately $3-$7 per day. They usually work in the
informal sector (e.g. as domestic help, vegetable sellers
or shop-owners), or are lower-middle class professionals
(e.g. factory workers, security guards or school
teachers). They are busy, cost-conscious women, who
must carefully balance the demands of pregnancy and visits to clinics with taking care of
their families and their businesses.
The business model is designed to be highly sustainable and scalable, generating revenue
through affordable user fees while continually innovating in the following areas to minimise
operating costs and improve efficiency:

Human resources: Jacaranda places particular emphasis on training nurses to be
strong leaders and managers, from handling obstetric emergencies to running
clinical case reviews and quality initiatives. Non-financial incentives for hiring and
retention, as well as models for task shifting and task sharing, are also being tested,
with a view to disseminating knowledge on the utility of such practical facility-based
approaches to improving service delivery efficiency.

New technology: Jacaranda is developing, testing and introducing a series of
technology interventions to help get to know clients, guide clinical decision-making,
and improve efficiency. This includes mobile phone technology, electronic medical
records, and mechanisms to improve the financial accessibility of services.

Patient-centred care: Jacaranda brings models of best practice for providing
maternal health care from around the world into low resource settings, and is
instilling a culture of respectful maternity care in its facilities. This includes tailoring
clinical safety guidelines to the resources and cultural background of clients, training
staff in customer service, engaging men in decision making processes, providing
home visits, and exploring new ways to improve education and birth planning, such
as group antenatal care education and mobile phone health messaging.

Quality improvement: Jacaranda is developing a set of practical and tested tools
that healthcare providers in all low-resource settings, including Jacaranda itself, can
use to deliver high quality, low cost, patient-centred maternity care. This includes
evidence-based protocols and tools, regular clinical case and chart reviews,
measuring impact through a mobile phone database and electronic medical records,
and building decision support tools into electronic health record systems to help
nurses manage care in emergencies and increase adherence to obstetric protocols.
2
Jacaranda past, present and future
Jacaranda opened their first maternity hospital for low-income women in 2012. This hospital
is in Ruiru, a peri-urban area on the outskirts of Nairobi, and has proven successful in
delivering high quality care, receiving one of the highest ratings for care quality of any health
facility in Kenya. Jacaranda opened their second facility in 2014 in Kahawa West, a Nairobi
suburb.
With an established and skilled team, facilities and equipment in place, key partnerships
formed, and a very popular service offering (almost 1,000 patients visiting Jacaranda’s
facilities each month), Jacaranda are looking at options to further scale and replicate their
service offering.
Figure 4: Jacaranda staff
Firstly, Jacaranda aim to create direct impact at
scale by expanding the network of Jacaranda
maternity hospitals and developing them as
‘centres of excellence’. There are however some
constraints to scaling the business in this
manner alone – principally that setting up a new
maternity hospital is time and capital intensive.
nJacaranda is also considering initiating
management partnerships as a mechanism to deliver a defined package of maternal and
newborn health services through existing health providers. Such an arrangement would
allow Jacaranda to instil its business and clinical practices in a health facility, without owning
the facility or the equipment. This would be a much quicker and less capital intensive
approach to scaling Jacaranda’s operations, albeit with considerable risks associated with
successfully negotiating and initiating such a management partnership. For this reason,
Jacaranda is currently pursuing this option with caution and anticipates undertaking
groundwork to create the model and undertake a market landscape assessment before
entering into such an arrangement.
To achieve further impact at scale, Jacaranda aim to influence the practices of other health
providers operating in the region by promoting the work of the Jacaranda facilities as centres
of excellence. Jacaranda also intend to make available their evidence-based tools and
systems for improved efficiency and quality of service delivery in other public and private
health facilities.
3