Competing With the Informal Sector in Kenya

People who fall sick in Nairobi slums often go directly to informal chemists to purchase medication. This can be dangerous when it results in treating the wrong root cause or getting the wrong amount of medication which can build up resistance to medications. My startup’s approach to healthcare—encouraging consumers to speak with a health professional or get lab work done before purchasing medicine—is disrupting the status quo.

My company, Access Afya, is creating a chain of ultra-mini-clinics for the extreme poor, starting in Mukuru, a slum in the sprawling Kenyan capital. We are redesigning healthcare delivery at the base of the pyramid, from the floor plan and build of a health facility to recruiting and training the people inside of it, to using technology as the backbone of our management systems. This approach allows us lower the price point of an average consultation, diagnosis, and treatment down to $4.00, around a fifth of the cost at the nearest private clinic. Our pilot site opened in December 2012 and has over 200 paying customers.

We make decisions every day that might seem bad for business in the short term, but we believe are ultimately better for our customers and therefore better for our venture in the long term. Sometimes this means “losing” an over-the-counter sale, for example when a customer tries to buy a malaria treatment that we won’t sell without running a test first. Here are a few examples of how this happens— stories we recently shared on our blog.

In January, a woman walked up to the window and asked for four tablets of an antibiotic that we only sell through prescriptions. Our staff explained that this medicine treats a variety of infections, and that we would like to do a consultation to get to the root of her symptoms—moreover, that four tablets was not a full dose, and she needed to purchase more for an effective treatment.

The woman was confused. She normally visited another chemist and was able to purchase a few pills at a time. They had never talked with her about dosages. She accused us of just wanting to make a bigger sale, with more drugs and the consultation fee.

Our response was that absolutely no sale size was too small from us—but we had some legitimate concerns. The woman finally agreed that we were commendable for following regulations, but said she had only twenty shillings on her. She told us she was going to a neighboring chemist, but would keep us in mind for next time.

Later that day, a woman walked up to the window and asked what medication to buy. She was feeling dizzy. Our nurse, Carolyn, asked the woman to come in and have a consultation for 100 Kenyan shillings (around $1.25) to find out what was causing that dizziness.

“You can’t just sell me something here?” The woman asked.

“No,” said Carolyn, who went on to explain why we wanted to collect a full background: dizziness could be caused by a number of issues, and there were problems with purchasing medication over-the-counter medication in inappropriate dosages.

The woman listened and said she would go to find some money and come back later. We hear this a lot. Sometimes people do come back, and sometimes it is just a polite excuse to go and buy drugs from another chemist.

But this woman actually came back. She spent 100 shillings on that consultation, and also purchased a lab test to confirm diagnosis and then treatment.

In the first instance we “lost” a sale, but stuck to our principals and gave out valuable information, and just hours later the opposite happened. Here, we made a medication sale but also provided a consultation and lab tests. We are certainly optimistic that in the long run, abiding by the maxim, “what is good for the customer is good for business,” can work for us.

Keep up with the progress at Access Afya on our blog,