Reference no: EM132873867
South Africa's Unjani Clinics
In this integrative case, we will look at a South African non-profit company that has rejected the 'command and control' model of leading organizations and successfully adopted a 'network and franchise' model, unique and far ahead of its time. Furthermore, the original founder handed the baton over to a professional CEO four years after its establishment, out of respect for the logic of a model specific to health care called task-shifting.
A primary health care provider in South Africa, the Unjani Clinics empower black professional nurses to own and operate clinics in the rural and township communities of South Africa. About 66 clinics across five provinces in South Africa had been opened by the beginning of 2019. Currently leading this inspiring venture is Lynda Toussaint, the CEO of Unjani Clinics since 2014. An experienced hands-on practitioner, she has always focused on the creation of sustainable micro-enterprises and job creation, while in this venture improving access to an alternative, affordable, quality private health care service. With seven clinics already running, Toussaint opened 19 more clinics between 2014 and 2016, bringing the then total number of clinics to around 25. Since 2016, about 30 more clinics have opened, with more on the drawing board.
Attracted by the opportunity to play a role in the sustainable initiative, the American multinational Johnson & Johnson agreed to provide funding for 12 Unjani clinics in 2018 and will continue to fund new clinics in 2019. In addition, Johnson's Baby brand launched the Johnson's Baby Healthy Skin Project, in partnership with Unjani Clinics, in June 2017. Aiming to improve the health of more than three million babies by 2020, the brand wants to educate mothers who visit Unjani clinics about skin health for babies.
Each clinic is franchised to a qualified dispensing African nurse after successful completion of the application and selection process. The nurse must also choose where to locate the clinic, a key decision for sustained profitability. According to Toussaint, the two most important elements for a profitable clinic are the location and the owner-nurse. Once qualified and having chosen the location, nurses sign a five-year agreement with Unjani. When the details are formalized, the Imperial Group (see below) will build, equip, and ship customized 12 m containers to the agreed location at Imperial's own expense. A standardized design, the clinics have three rooms, one for waiting, a second for consultation and a third for storage for as many as 150 medicines. As the CEO, Toussaint provides leadership to the growing network of nurse-owners, along with day-to-day operational management and ongoing education.
Since its launch in 2010, Unjani Clinics have provided more than 350,000 patients with several health services, including primary health care, vision screening, wellness services and chronic disease management. Clinics typically have three staff members: the nurse-owner, an assistant and a maintenance specialist. Nurses deal with patients and manage medicines. Assistants do quality control, work the front desk, sell over-the-counter drugs and keep the books.
Unjani was founded by Dr Iain Barton, the CEO of a now defunct third-party logistics provider called RTT, which delivered medical supplies in the country. Dr Barton had also been a medical practitioner in a previous career for ten years but had been frustrated by South Africa's strained health care system, which charges high consultation fees to patients with simple problems. He believed one way of making primary care more accessible was to deploy qualified nurses to treat poor people needing basic attention in South Africa, where the ratio of nurses to doctors is about 5:1.
In so doing, Dr Barton was following the 'task-shifting approach' recommended by the World Health Organization. In this approach, 'specific tasks are moved, where appropriate, from highly qualified health workers to health workers with shorter training and fewer qualifications in order to make more efficient use of the available human resources for health.' In making use of this approach, Dr Barton believed that Unjani Clinics would strengthen the number of human resources for health in South Africa.
In 2011, his newly merged company, now called Imperial Health Sciences, invested R37 million (€2.24 million) in his innovative idea, which he called Unjani Clinics. The name Unjani means 'How are You?' in the language spoken by the Zulu people, the largest ethnic group in South Africa. With the investment, Imperial became the first private sector organization in the country to start a nurse-owned and -operated primary health care network.
It was a win-win on many fronts. For its part, Imperial can use its extensive logistics network to deliver medical supplies to the growing network of Unjani clinics throughout the country. In addition, Imperial was able to take advantage of a tax scheme in South Africa that required large companies to donate 1 percent of their earnings for 'enterprise development', that is, funding small and medium-sized companies owned and managed by Africans. It is also a win-win for the nurses who buy into the scheme, since the networked, franchise model enables them to increase their ownership share annually based on an agreement with Imperial Group, while continuing to receive training from central headquarters.
Covering a range of conditions, Unjani nurses charge about R180 (€11) per consultation, which is half the cost of other primary care services. A typical Unjani visit includes diagnosis and basic medicines for each treatment. Toussaint knows that a new clinic takes time to reach profitability and indeed provides a basic allowance to nurse-owners for the first two years of operation. Having conducted a cost-benefit analysis, she discovered that a clinic needs 250 consultations per month before it can become profitable. To achieve that level of patient traffic can take as long as two years. That's why location is key to success.
THOSE INTERESTED TO KNOW MORE MAY READ: https://www.pioneerspost.com/business-school/20191022/the-unjani-story-the-nurse-entrepreneurs-bringing-sustainable-healthcare
The Unjani story: the nurse-entrepreneurs bringing sustainable healthcare to South Africa
1. Describe the role that the current CEO of Unjani Clinics, Lynda Toussaint, plays in developing the network of nurse-owners.?
2. Evaluate the risks that nurse-owners take when signing a contract with Unjani Clinics. Explain why the World Health Organization encourages the task-shifting approach