A social enterprise approach to improving rural healthcare

In Homa Bay County, inadequate access to health services is among the main reasons for low service utilization and poor coverage of key maternal and newborn services. The available public health facilities are few, far apart and poorly resourced. Given high rates of poverty, mainstream private sector healthcare providers do not find it commercially viable to set up in these areas. This leaves many poverty-stricken households in the hands of poorly regulated private practitioners, quacks and traditional healers. The majority of households struggle to pay for health care, sometimes forcing them to sell off household assets or make difficult trade-offs between spending on medical care or other basic needs like food and education.

Against this backdrop, Afya Research Africa (ARA), a Kenyan social enterprise, focused on sustainable solutions to address these challenges in the health system. It developed an innovative pro-poor healthcare financing and delivery model. The model consists of a network of community medical centres, known as Ubuntu-Afya Kiosks, whose innovative co-ownership and cross-subsidisation enable them to thrive in areas previously considered too difficult or not profitable to reach with health service.

Don’t let the name fool you, this kiosk model has three unique and promising features. Foremost is strong community partnership. Recognizing the critical role the community plays in ensuring the success of the kiosks, ARA works with community groups whose contribution typically includes donating land, building the structure, providing furniture, and assisting with marketing. Second is co-ownership whereby kiosks are co-owned by ARA, the community groups and the attending health workers. Many of the groups are pre-existing self-help groups or saving cooperatives. The groups are mentored to improve their entrepreneurial skills, enabling them to co-invest in the kiosks, with up to 49% stake in the kiosk in exchange for resources contributed to set-up, manage, market, and ensure the success of the kiosk. This relationship guarantees that the kiosk has a core group of users, and once the kiosk is profitable, it supplements the groups’ pooled savings funds, which are sometimes invested back into the kiosks to expand services offered. The third feature is complementary income generating social enterprises. Because ARA serves very low-income communities, it has minimal fees for health services, while offering at least one additional service to the community. Service offerings are chosen by group members, and include safe water sales, motorbike taxi services, and mobile money services. Income from these enterprises is used to cross-subsidize the cost of clinical services. With the support of these entrepreneurial activities, the kiosks are able to generate a positive cash flow.

On its successes, the ARA Executive Director, Dr. Samson Gwer says, “By engaging communities in the health system, we improve our services, patient trust and loyalty, and encourage community ownership of available healthcare services. 60% of Ubuntu-Afya Medical Centres break even within the first 12 months of operation, and more thereafter, which is a measure of sustainability that has eluded other private sector players working with our target population.”

ARA has established 16 Ubuntu-Afya Kiosks in Homa Bay County. Within one year of operation over 30,000 clients, including 11,000 mothers and 5,237 children, have been served. The ARA model of diversifying health care financing has proven to be effective in enabling poor households access services thus contributing to Kenya’s aspiration to achieving universal health coverage by 2030.