Mobilizing with a smile

Jacaranda's mobile clinic is set up in Lucky Summer, a low-income Nairobi neighborhood. A neat reception table at the entrance is topped off with a vase of its namesake purple flowers. The reception is open air, but outpatient services are performed in an empty room of an adjacent school house. Jacaranda Health is a full-service maternity care model that prides itself on providing much-needed and quality antenatal, delivery, postnatal, and basic obstetric emergency care to poor communities in Nairobi both through a mobile outreach van and a soon to be opened static clinic.

From 9am to 4pm women stream in to receive antenatal care and health counseling. Jacaranda runs mobile clinics in five locations across the city, some weekly, others bi-weekly. Incoming patients’ information is recorded both in a paper form and through a mobile phone application by a receptionist–Jacaranda maintains comprehensive electronic records of all operational, financial, and patient data, which helps the venture to easily analyze and tweak its model. Nurses also use mobile phones to collect patient data during examination.

Direct patient outreach is an essential component of Jacaranda’s business model and key to raising awareness among low-income women about the importance of receiving proper maternity care. Carol and Brenda are community mobilizers for Jacaranda. They go door-to-door to speak to pregnant women about the importance of antenatal care and to market Jacaranda’s services. We accompany them on a mobilization into a nearby community of Ngomongo. Within minutes of entering the community, Carol approaches a pregnant woman sitting by a brightly blue painted stall. Yes, she would like to receive maternity care. No, she cannot come to the clinic right now. Yes, she will most certainly stop by later in the day. Carol takes down the woman’s mobile number and will follow up with her to make sure that she was in fact able to attend the clinic.

Carol talks to a pregnant woman about Jacaranda's services during a mobilization.

As we walk deeper into the slum, we notice a woman walk by holding Jacaranda’s brochure. Neither Carol not Brenda had ever talked to her. Although direct community mobilization is a key demand-generating activity for Jacaranda, many of their clients hear about the service through word of mouth.

We ask the women about the biggest challenges they encounter as mobilizers. One, says Carol, is the lack of static clinic to which they can refer patients for deliveries–the first Jacaranda clinic is set to open this month. Carol herself is patiently waiting for the static clinic to open. Currently pregnant, she has been using Jacaranda’s services for antenatal care and would like to eventually use the new static facility to deliver her baby.

Another challenge is the expectation of free care. Although Jacaranda makes its prices affordable to the poor, it is a fee-based model and needs to generate enough revenue to cover its operating expenses. The mobile clinic staff does treat patients for free in case of an emergency and pays upfront for ambulatory services if necessary, but they are also keenly aware of the need to sidestep earning a reputation for delivering free care.

Glory, a Jacaranda nurse, interacting with a patient.

Back at the mobile clinic, we tour the converted school house room, now a proper examination space. Glory, a Jacaranda nurse has neatly laid out all of the supplies needed for the day. Three chairs are placed beside the supply table, one for the nurse, one for the woman, and the other for her partner. Jacaranda stresses male involvement in the process, and although only about 20% of women are accompanied by their partners to a first consultation, the third “ghost” chair is meant to encourage their participation in subsequent visits.

Jacaranda’s brand is marketed for the high quality of its services and the friendliness of the staff–many women cite rudeness and inattention among public sector workers as a reason for not obtaining care from public facilities. Neither my colleague Trevor nor I have ever had our blood type tested, so we decide to take this opportunity to personally challenge the brand promise. Glory draws three drops of blood from my finger onto a clear plastic strip and dilutes them with three additional substances, one each. Reading the test, she delivers the verdict: A+. I think I’ll give her the same!

Click here to see more photos from the Jacaranda mobile health camp.