'Clinic-in-a-Box' seeks to improve South African healthcare

The "Unjani" -- Zulu for "how are you?" -- Clinic-in-a-Box is part of a private initiative to improve access to quality healthcare in rural South Africa.

While some people still consider Daveyton part of Johannesburg, the township feels like it's a world away from the massive skyscrapers and bustling taxi ranks of one of the continent's largest cities. The modest houses, corrugated metal shacks and small fields of maize that make up the township are home to over 100,000 people, many who live without the advantages of modern healthcare facilities that dot downtown Johannesburg, more than an hour away.

A small white shipping container with the word "Unjani" -- Zulu for "how are you?" -- painted on its side aims to improve local residents' access to quality healthcare. The Unjani Clinic-in-a-Box, one of 500 rolled out over the past two years across the country, is part of a private initiative through the BoP Learning Lab at the University of Stellenbosch Business School and the RTT Group, a logistic services company.

First-rate medical care is available in South Africa, for a price. It's estimated that only 8.1 million South Africans can afford high-quality healthcare. The rest, nearly 41 million people or 84 percent of the population, depend on the spotty South African public healthcare system. A full 9 percent of the country's GDP is dedicated to healthcare spending.

In places like Daveyton, the need for small clinics that serve poor residents is clear. Nearly 60 percent of the people here are unemployed, and even those that can find work are often unable to afford private doctors.

"Many people who seek public healthcare do so for illnesses and problems that are both easily diagnosed and treatable" by nurses, said Ken Fullerton of Reciprocity, a small consulting company that works closely with the BoP Lab. Each clinic employs a trained nurse who is allowed to prescribe and dispense up to Schedule IV drugs, which are classified by the U.S. Drug Enforcement Agency as having a low potential for abuse and dependence.

The Unjani Clinics operate on a sustainable franchise model, with the trained nurse practitioner acting as the individual franchisee. Over five years the nurse is expected to pay back half of the $30,000 set-up cost. Ownership of each franchise is also slowly transferred to the nurse that runs it.

The clinics, each prefabricated from old shipping containers, include running water, a toilet, a bed and refrigerated storage for medicine. It takes just four weeks to deliver a clinic from the time it's first ordered. Patients can visit the clinic for between $10 and $15 -- not cheap for many South Africans, but not as expensive as a trip to a public hospital that may be hours away. The busiest Unjani Clinics can see between 400-500 patients a month.

Unjani clinics become part of the community and often start local marketing campaigns with nearby schools and taxi companies.

While they all look the same on the outside, every Unjani Clinic is uniquely equipped for the area it's in. "Each Clinic-in-a-Box site has the ability to be more adaptable to specific healthcare issues in specific areas -- more focused on malaria in Limpopo and on TB in the Western Cape," said Fullerton.

The BoP Lab -- short for Bottom of the economic Pyramid -- was established as a partnership between the University of Stellenbosch and American professors Michael Gordon and Stuart Hart. The lab spans four continents and aims to "provide coverage and exposure to local inclusive business models and innovative business approaches with a high socio-economic impact." The Unjani Clinic is the lab's first crack at testing this model with rural healthcare.

The program has faced some difficulties. In order to cover operating costs, each clinic needs to see roughly 400 patients a month, or 20 a day, which can be hard in some underserved communities.

The RTT Group, Unjani's main developer and funder, is still looking to partner with the government to expand the program across more rural communities. Yet even it notes that forging a partnership with a government that is wary of a for-profit healthcare model will be difficult.

Photos: Flickr/Center for Health Market Innovations

This post was originally published on Smartplanet.com

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