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The mission of the Your Mark on the World Center is to solve the world's biggest problems before 2045 by identifying and championing the work of experts who have created credible plans and programs to end them once and for all.

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Devin D. Thorpe
Devin Thorpe

When Free Maternity Care Isn’t Worth The Price

Shalom Mbungua Kang’ethe was born healthy on February 21, 2017 at 5:00 AM at Jacaranda Maternity Hospital in Nairobe. His mother, Lydia Wangui, paid about $100 to deliver her baby there; her first son was born at Mama Lucy Hospital, a public hospital where the delivery was free. Let’s find out why she didn’t want a free delivery for Shalom.

Lydia Wangui and her newborn son Shalom Mbungua Kang'ethe

Lydia Wangui and her newborn son Shalom Mbungua Kang’ethe

At the public hospital, women are expected to bring a birth kit. Of course, you say. Every woman in the world has a kit ready to go to the hospital when it is time to deliver. It isn’t that kind of kit. This kit would include the hospital essentials like rubber gloves for the nurse or midwife that delivers the baby, a string to tie off the umbilical cord, a razor blade to cut the umbilical cord, two sheets–one for the baby and one for the mother, and a maternity pad. If they want the bed sterilized following the preceding delivery, mothers are expected to bring bleach.

Oftentimes, however, the bleach is irrelevant. The hospitals are so overcrowded and understaffed that multiple women may be laboring in the same bed. One nurse described a scene with ten women laboring in one room with three beds.

Jacaranda Health was founded by Nick Pearson, who is from North Carolina. Nick came to Kenya several years ago while working for the Acumen Fund. He fell in love with Kenya and with an obstetrician here. He confessed that part of his motivation for leaving Acumen to start Jacaranda Health was to impress the woman who would become his wife.

Lydia seems to think that Nick and his team are doing a good job. Her first observation about the difference between delivering at Jacaranda compared with the public hospital was the nurses were nice. Seeking to understand more fully, I asked what the worst thing about the public hospital was and she reiterated that the nurses there were “not polite.”

She also liked the hot shower, clean facilities and good food.

Of course, these things don’t just happen in Kenya. It has taken Jacaranda five years to create a model maternity hospital that it hopes to replicate across the continent eventually.

Faith Muigai, Chief Medical Officer

Faith Muigai, Chief Medical Officer

Faith Muigai, the Chief Medical Officer, was trained as a nurse in the U.S. and worked at Johns Hopkins. She provided a guided tour of the facility to the visitors from Santa Clara University’s Miller Center for Social Entrepreneurship. Jacaranda participated in the school’s Global Social Benefit Institute program in 2014.She explained that the

She explained that Jacaranda initially opened a smaller facility that was intended to serve the same purpose. Staffed only with nurses and midwives and without an operating theater for performing C-sections, care could be provided even more affordably but even women who received their pre-natal care there chose not to deliver there. They made it clear that they wanted to deliver in a facility with a doctor and an operating room in case there were complications.

So, the new hospital was built. During the tour, the visitors saw a newborn that had been delivered via C-section only moments earlier. The fifth such delivery of the day.

Midwives use donated, modern ultrasound equipment from GE to spot complications as soon as women arrive.

Most of the women who deliver at the facility live in Nairobi’s slums. Urban poverty is different from rural poverty; people have money and incomes, but not enough. To help the women plan and prepare for the cost of delivering a baby, the prices for the services are posted on the wall on a giant sign. A normal delivery like Lydia’s costs about $100. A C-section costs about $350.

Posted prices at Jacaranda Maternity Hospital

Posted prices at Jacaranda Maternity Hospital

Women living in the slums don’t routinely have access to that much money. They are forced to save for the expense.

It isn’t just poor women that are delivering at Jacaranda. Faith admitted that she didn’t know what to think of it when women started showing up to the hospital in cars, “even a Range Rover.” The quality of care at Jacaranda now matches the most expensive private hospitals in the city, but at a fraction of the price.

Nick says the hospital recovers about 80 percent of its operating costs. Faith adds that they are exploring services they can offer at a premium, to improve profit margins for affluent patients.

As Lydia she was preparing to leave the hospital with Shalom, I asked her if it was worth paying so much. Without hesitating, she said, “Oh, yes.”

This week, I’m traveling in Africa as a guest of Santa Clara University’s Miller Center for Social Entrepreneurship’s Executive Director Thane Kreiner and namesakes Karen and Jeff Miller. Read all my reports.

#17africa

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