Nurse Opens Clinic in Nairobi Slum
When Public Meets Private – The Story of a Nurse Turned Entrepreneur
To meet Dorah Nyanja you have to zig zag your way through the narrow and winding alleys of Kibera, one of the largest slums in Africa, home to close to 1 million people and situated in Kenya’s capital city of Nairobi.
Once you are deep into the heart of this landscape made up of tin roofs and muddy shacks, you will come face to face with a gentle and focused healer who, besides working 12-hour shifts and being the mother of three children, is a registered nurse and a successful entrepreneur running her own health clinic in one of the most challenging urban environments you can imagine. “Every day I encounter at least one case of abortion-related complications,” says Nyanja as she swings open the door of her two-room clinic, one used for consultations and the other one for examinations. “Not to mention the regular ailments I always come across such as malaria, opportunistic infections, upper respiratory diseases and dysentery.”
Though she could be working in a posh Nairobi private hospital, this energetic 30-year-old nurse has deliberately chosen to serve the poorest of the poor in an area that has a population density of 82,000 residents per square kilometre.
It all started 18 months ago, when she saw an advertisement in a local newspaper by the HealthStore Foundation (formerly known as SHEF) seeking qualified health professionals who wanted to set up their own private practice. “I used to work in a nursing home but wanted to return to my community and do something for my people. I wanted to teach them basic health practices. This society suffers because there are many quacks and not enough trained people,” Nyanja says.
She applied for a loan and got selected. She is now one of 65 Kenyan entrepreneurs, for the most part women, supported by the HealthStore Foundation, an organization that developed a franchise of micro pharmacies branded as the Child and Family Wellness Shops (CFW Shops) whose mission is to provide access to essential medicines to marginalized populations in developing countries. The company describes itself as having a market-driven approach that combines micro-enterprise principles with proven franchise business practices to create a micro-franchise model. It is, in other words, a socially responsive version of a McDonald’s chain that caters to basic health needs in poor communities.
In Kenya the Foundation has four outlets in Kibera while the rest are in the western and Nyanza regions of the country, both underdeveloped rural areas. CARE is supporting the Foundation through its CARE Enterprises Partners, a unit that seeks to link the informal sector with the formal economy. “CARE supports innovative market-based approaches, like the HealthStore model, that address issues of poverty and have the potential of becoming self sustaining,” explains Jiwa Farouk, director of the CARE Enterprise Partnership. Similar and equally successful projects have already been undertaken in the areas of horticulture and animal husbandry. “The idea,” continues Farouk, “is to move away from ongoing donor support and to enable the market to cater to specific needs of the community.”
The franchise network operates two types of outlets: the basic drug shop run by community health workers and clinics operated by nurses like Dorah Nyanja who provide a longer list of essential medicines as well as basic primary care. “Dorah is one of our most successful entrepreneurs,” says Esther Njuguna, executive director of HealthStore Foundation Kenya. “Initially the goal was to provide only basic medicines but it soon became clear that women need help with child deliveries as well as guidance on how to treat basic ailments.”
Nyanja sees an average of 65 patients a day, about five patients per hour in a 12-hour day, a clear indication of the thirst for services in this overpopulated and neglected area of Nairobi. Since the Senye Community Clinic has opened its doors in May 2006, the average number of monthly clients has risen from 350 to more than 1,300, and Nyanja’s monthly turnover has gone from $879 to $1,500. This has enabled Nyanja to hire an assistant whom she has trained in delivering babies. There is an average of four to five deliveries per day. Though currently successful, the clinic’s startup phase was rough. Finding a good location was particularly challenging. “It took me months to find this place,” says Nyanja. “I walked around so much that my third baby was born premature.”
Then there was the issue of security, as slums are notoriously high in crime, as well as the need to find a place with access to safe water and a reliable power supply. And since the majority of people in Kibera live on less than $1 a day, paying for basic health services can be a real struggle. To help the poorest, Nyanja waives the 30 shillings (US 44 cents) consultation fee for those unable to pay, while sticking to the fixed rate for the medicines she sells over the counter. Nyanja prefers not to skip the consultation altogether as she wants to, in her own words, “change the mentality about over the counter drugs,” in Kenya.
Over the next three years HealthStore aims to expand the network in Kenya to 200 outlets, serving up to 1.5 million patients visits per year. “The idea is to expand in concentric circles, in order to maximize services and increase the density of coverage,” explains Njuguna. But, she adds, one of the hardest tasks will be to recruit nurses like Nyanja, who are highly qualified, compassionate and with a sound business mind.
For more information, visit http://www.care.org.
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