Women in East Africa’s Cities Need a New Model of Maternity Care

This article originally appeared on the Skoll World Forum web site as part of their series “Advancing Health in an Increasingly Urban World.”

In Kenya maternal mortality remains distressingly high. It is also a country, like many other developing countries, which has experienced rapid urbanization. In Nairobi, more than two million people live in sprawling, low-income areas where sanitary conditions are poor and it is difficult to access quality medical services.

Although Kenya remains largely rural, urban areas are experiencing the most growth. Public services, including health and sanitation, have not kept pace. Nairobi’s health outcomes are better than Kenya’s overall, but there are broad disparities between the women and newborns who live in low-income settlements and Nairobi as a whole.

In some low-income settlements, maternal and neonatal mortality rates are double those of Nairobi overall. Though 70 percent of women in Nairobi’s peri-urban areas give birth in health facilities, only 48 percent of these facilities meet minimum quality standards. For Jacaranda Health, this is a call to action.

From its beginnings in 2011, Jacaranda Health zeroed in on a desperate need for patient-centered, quality maternity care, delivered by skilled healthcare providers. We launched a new model of maternal and newborn healthcare that sought to transform maternity care in low-resource, urban settings and save hundreds of thousands of lives. And it’s working. Jacaranda Health has a greater than 99 percent maternal and newborn survival rate.

Using the small maternity hospitals that we build and operate in these peri-urban communities as global innovation laboratories,we are developing a model of high-quality care that is affordable for patients and can be delivered at low cost.

We provide a full range of healthcare to women and newborns, from pregnancy through to postpartum, at a fifth of the cost of other private hospitals in the region. We aim to share our model with both public and private facilities that provide services to many of the women seeking maternal and newborn healthcare in these peri-urban communities.

We can only reach a small number of women through our maternity hospitals. But there are far too many public and private facilities in these cities that are providing sub-par services. Our goal is not only to use the most effective health innovations to provide affordable and quality care, but also to learn from and adapt to our clients as we create a replicable maternal health model aimed at reducing cost, increasing uptake of health services, and improving quality of care.

For example, we are building and implementing the next generation of mhealth technology to enhance patient-provider communication, in part through a partnership with Johnson & Johnson. This includes promising family planning initiatives that use SMS text messages to increase the number of women who return, after delivery, for family planning. Jacaranda’s innovative, patient-centered approaches have already resulted in nearly 40 percent of women returning for postpartum family planning, which is four times the national average.

Technology is an important part of innovation, but it is not the only part. We focus on quality improvement, using the famous “Lean Methodologies” continuous improvement processes developed by Toyota. We’ve built a toolkit to improve quality of care in both government and private health facilities.

We see this as extremely innovative. Jacaranda Health is one of only six healthcare facilities in Kenya to receive the highest quality of care rating from SafeCare.

Innovation and efficiency in healthcare require a focus on patients’ evolving needs, especially as the demographics of cities change. We must continuously work to improve the patient experience, using feedback from families and the communities where we operate.

Together we can build a new model for maternity care in low-resource, urban areas – one rooted in efficiency, affordability, and built on world-class care delivery systems. It is a model borne of our increasingly urbanized world where maternal and neonatal healthcare delivery must grow and change in order to ensure a healthy world for all.

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