Pre-opening Community Event at Our Maternity Clinic

Thursday, August 16 was an important day for Jacaranda Health – it was also a lot of fun. To celebrate the opening of our maternity clinic for deliveries on Sunday, August 19, we held an open house at the clinic for existing clients, new clients, community members, our staff and many, many energetic children. In addition to offering health services – including prenatal care and ultrasounds – we had delicious snacks and beverages prepared by our staff, clinic tours, activities for children (the bouncy castle was a huge hit!), and even the planting of a jacaranda tree in the courtyard. Approximately 70+ new and old friends of Jacaranda Health helped us celebrate.

While the goal of the event was to open our maternity clinic, we also wanted to demonstrate that we are a good neighbor who will provide an important and needed public service to their community. Based on the feedback of the first non-Jacaranda person to show up – a neighbor named Timothy who has lived in the Ruiru community for almost 20 years – I think we are off to a good start. He pulled up in his truck, jumped out, shook my hand, and told me, “I had to stop by to thank you for coming to our community. We are very happy you are here.”

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Jacaranda’s team and our new maternity hospital!

Here is a picture of the Jacaranda Health team in front of our first maternity hospital! We are all thrilled to begin serving patients tomorrow in Ruiru, on the outskirts of Nairobi.

Jacaranda provides high-quality maternity care to women in Kenya and our mission is to make maternal and infant mortality a problem of the past. We have a sustainable, scalable model that provides friendly, end-to-end maternity care to hardworking urban women. Our goal is to share our innovations in cost-effectiveness, clinical quality, and IT with the global health community as we grow to become the largest network of maternity providers in East Africa. We currently operate mobile clinics in several neighborhoods of Nairobi, and this is our first hospital. We plan to open our second and third facilities in the next 8 months.

For more pictures of the inside of the clinic — labor wards, new equipment, outpatient rooms, and the nurses in action — stay tuned! We’ll post links to them here.

Jacaranda Health maternity and team
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Jacaranda receives Health Market Innovations Award in Kampala

Last week, Jacaranda Health won an important recognition in the first East African Health Market Innovations Awards. Jacaranda was identified among several hundred programs as the Most Promising Health Market Innovation in the category of “Organizing Delivery”, which recognizes “programs that reduce fragmentation and informality of health care delivery”. The awards event was funded by the Rockefeller Foundation and organized by the Institute of Health Policy Management and Research (IHPMR), and aims to identify outstanding programs in the East African region that have increased access to health services, improved quality of service delivery and have provided financial protection to the poor and vulnerable. Other winners included well-known organizations such as Mothers 2 Mothers, PSI’s Tunza Family Planning Network, Living Goods, and Nairobi’s microfinance giant Jamii Bora.

We are humbled and excited by this recognition of Jacaranda’s work to date and potential to change maternal healthcare delivery in East Africa — and we are honored to be working alongside such esteemed peers. Faith Muigai, Jacaranda’s Clinical Operations Director, was on hand in Kampala to accept the award for Jacaranda.

Congratulations to Maureen Nafula and her team at IHPMR for organizing the event and awards. You can read more about the event on their blog post here:

http://ihpmr.wordpress.com/2012/05/05/pomp-and-colour-characterizes-the-health-market-innovations-awards/

 

 

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Patient-centered design: Maternity care designed by women, for women

Imagine waiting for six hours for antenatal visit, only to be seen by a nurse who doesn’t have time to answer questions about your pregnancy, or doesn’t bother to treat you with respect. A recent Kenyan government survey indicated that bad patient experience is one of the major reasons that women in Kenya avoid giving birth in hospitals and other birth facilities. The vast majority of women who participated in Jacaranda’s field research in Nairobi complained of long waits, poor treatment from nurses, crowded labor wards, and difficulty getting education and birth-preparedness counseling.

If you have any doubts about the pervasiveness or the detrimental effects of this problem, read the eye-opening “Failure to Deliver: Violations of Women’s Human Rights in Kenyan Health Facilities,”  by the Kenya Federation of Women’s lawyers, or USAID’s powerful “Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth: Report of a Landscape Analysis.”

This issue of poor service is one of the biggest hurdles to increasing delivery in facilities. Jacaranda aims to change that dynamic by providing care that is respectful and responsive to the needs of mothers. One of the most interesting ways we’re meeting this goal is by following the lead of organizations like the design consultancy IDEO and the Mayo Clinic, who advocate for a principle known as “patient-centered design.”

Patients draw their ideal waiting room

Patient-centered design reflects the notion that healthcare can be more responsive and respectful if providers engage patients in the design process. It sounds straightforward, but patient-centered design is far from the norm; this really is a new frontier in healthcare. Some of the best hospitals in the States are starting to do it; both Kaiser Permanente and the Mayo Clinic have crack teams of designers who work with clinicians and patients to design friendlier, more effective care. A greater focus on the patient results in improvements like physical spaces that encourage recovery, scripts and settings for better doctor-patient interaction, and better ways to exchange information during nurse shift changes. For an example see: http://www.ideo.com/work/nurse-knowledge-exchange/

Here in Kenya, Jacaranda Health has approached patient-centered design in a similar way.  Over the last year and a half, we have held design sessions with groups of prospective patients and nurses to get their help in developing our model of care. In these sessions, we borrow from the playbook of design firms like IDEO, using tools like brainstorming, role-playing and sketching to develop basic prototypes of potential tools and solutions.

The result is not only deeper knowledge of our patients and insights about the most effective ways to provide care, but a patient experience designed by patients for patients.  Our patient-centered design process has led to a number of additions to our standard services, including:

  • Greeters to guide patients through the delivery process;
  • A performance-review process that evaluates our nurses not only on clinical quality, but also on patient satisfaction and respect;
  • Group birth-preparedness education and Q+A sessions, led by community health workers in our waiting rooms; and
  • Strategies to better accommodate fathers during antenatal-care visits.

Clients give feedback on audio presentations for birth preparedness

As is the case with everything we do, our patient-design process is intentionally a work in progress. Each phase of Jacaranda’s growth will offer us more opportunities to seek ideas from our patients and learn how we can serve them better. Involving our patients in designing their own care gives Jacaranda a competitive advantage over other facilities. But just as importantly, it lets the women of Nairobi design the maternity care they want, so that more of them will seek skilled care, resulting in healthier outcomes for mothers and babies.

 

 

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Medical records and mobile phones for maternal health

As an organization dedicated to providing great care while being financially sustainable, Jacaranda Health is a strong proponent of automated health management information systems and electronic medical records (EMR), so called ‘eHealth’ systems. A good eHealth system will help us keep rigorous track of our time management, our inventory management, our money management – and, most importantly, our patients’ health outcomes.

Setting up an EMR system is challenging. Even in well-funded practices, implementers struggle to digitize existing paper records, design electronic forms that are easy for clinicians and administrators to use, and establish tech support to maintain the digital records.  So although the benefits of EMR are widely acknowledged, EMR systems haven’t seen broad implementation.

Jacaranda is well-positioned to leap some of the most common EMR hurdles: As a young organization, we don’t have reams of old paperwork to convert or entrenched habits to break. We also have strong technical expertise. But we do have some specialized needs and constraints that will sound familiar to many health providers in Africa and Asia. Power outages are common in east Africa, so our systems can’t rely on consistent electricity. We are operating a mobile clinic, which means that desktop computers – increasingly a fixture in Western exam rooms – are too bulky for us.  And in order to keep our fees low and our business scalable, we have to be ruthless about keeping our costs low: Laptops and netbooks are not great options for us, and it goes without saying that we won’t be able to give each of our nurses an iPad.

For us, the solution has been mobile phones, whose long battery life and portability are tough to beat. Phones with data connectivity to the near-ubiquitous mobile broadband network in Kenya are widely available, and getting cheaper all the time. It only takes a few minutes for patient-data forms to be installed on mobile phones, and if we need to update the forms in the future, doing so is as easy as another download.

Another key advantage is that phones are not intrusive. It’s important that our nurses explain what the phones are for – “here, I’m entering your blood-pressure numbers” – so that our patients understand that the phone is part of, and not a distraction from, their care. Once that’s established, though, our nurses can hold the phone and talk to a patient at the same time, rather than shifting focus back and forth between the patient and a computer screen.

When there is electronic medical record-keeping at the actual point of care, a provider can pull up a patient’s history in real time and figure out if she has suffered from previous pre-term labor without having to rifle through a sheaf of papers. Even more critically, a good EMR system can help catch warning signs: a patient whose hemoglobin is on the low side will be flagged for anemia treatment, and a high blood glucose test result will trigger a suggestion for further testing for gestational diabetes. An electronic system can even integrate how-to training videos, or timers that require that rapid tests have been given enough time to work before the provider enters the results.

These benefits are plenty valuable within the traditional physician-centered paradigm for medical care. But they can be game-changers in contexts where physicians are too few or too expensive. At Jacaranda, our services are provided by skilled nurses. An EMR system accessed through a smartphone or low-cost tablet that provides guidance on care protocols will let us open more clinics quickly while ensuring a high standard of care – meaning that we can see more patients, sooner, and grow into more areas where high-quality maternal-health services are not currently available.

The smartphone or tablet-enabled EMR system of our dreams is not yet available off the shelf. While we design and build that system, we will be using combination of open-source products: OpenMRS  for the records themselves, OpenXData  for the mobile forms that work on the phones, and a pioneering service called MOTECH, which our Chief Operating Officer, Aliya Walji, developed for use in Ghana, to link the two together. The important thing for us, though, is that we have built it into our practice from day one: Our nurses have been entering data electronically from the very first patient, and we are using this opportunity to define and refine our needs based on our experiences in the field.

Ultimately, the benefits of our point-of-care EMR will be visible in every part of our business. We’ll be able to automate reminder messages to our clients’ mobile phones, sending targeted appointment reminders based on gestational age and our mobile clinic schedule, and savings-plan reminders for mothers who are saving up for delivery. At the same time, our system will help us monitor how many antenatal and post-natal visits we are doing per clinic or per month, and understand our major sources of financial profit and loss. We will be able to track the rates of the various obstetric complications we treat, and make sure we’re handling emergency situations and referrals in accordance with our protocols.

Healthcare providers all over the world are excited about the possibilities of EMR. At Jacaranda, we are evangelists for it. A good records system can be what makes high-quality care at a low cost possible. We will update you with our experiences of our point-of-care EMR and other eHealth and mobile technology based health innovations in action.

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