Access to healthcare is still a challenge in sub-Saharan Africa, but among households living in urban slums the problem is exacerbated by overcrowding, inadequate water and sanitation infrastructure and limited affordable care options.
In Kenyan slums, healthcare services are often provided by chemists or NGO-funded facilities. Unorganised and informal clinics may be operated by a clinician but are often not licensed or up to speed with modern standards and regulations.
In 2012 American entrepreneur Melissa Menke and seed investor Duncan Goldie-Scot established Access Afya, a social enterprise that is building a chain of micro-clinics to provide standardised outpatient services in Nairobi’s slums.
After nearly a decade working in social businesses in various sectors in Kenya, the US and Jordan, Menke noticed a lot of attention being given to microfinance yet poor families needed other services as well, including education, housing, and healthcare.
“I had worked in Kenya before and seen the lack of healthcare services in most slums. There was a narrative that there might not be willingness to pay but when I walked in the slums I could see a chemist everywhere,” says Menke.
Access Afya currently runs two clinics in Nairobi’s Mukuru slums offering primary healthcare services focused on diagnosis and treatment of infectious diseases, family planning and immunisation. It plans to open a third clinic in October, and four more by the end of 2016.
Strong demand for healthcare
Kenya is seeing a rising number of small healthcare chains targeting the poor and lower middle-class who often don’t have insurance and cannot afford expensive fees charged at the country’s best hospitals. Menke says this trend is driven by the fact that there is an obvious demand in the market.
“We have over 5,000 customers, and we get 100 new customers every month so there are definitely enough people in slums who will pay for decent healthcare services,” she says.
Besides its physical outlets, Access Afya also runs a Healthy Schools programme. When a parent signs up their child gets access to a full check-up every term, a health report card and follow-ups at the clinic if needed. Parents pay a total of Ksh.900 (US$9) per year.
“The parent also knows that their child will be dewormed every month, and that a clinical officer will stop by their school every week to check on them. When we sign up 50 pupils in a school we start to offer the school other services like free check-ups for teachers, first aid training [and] hand washing campaigns,” Menke explains.
The programme has been successful in helping prevent diseases or catching them in good time, but also helps Access Afya in client acquisition. So far 200 pupils have signed up. The target is to reach 700 by the end of the year.
Challenging work environment
But running any business in a slum is challenging, with limited and inconsistent access to basic utilities, rampant insecurity, and uncertainty on land-ownership.
“There are frequent electricity surges. We probably go through computer chargers at three times the pace we would if we were in a different environment. Even with security we have to hire locals to walk our staff home at night,” she says.
But even with these hurdles Menke says it was important to have Access Afya’s clinic located in the slums to ensure convenience and easy access for customers, and to build community integration.
“If someone runs a small shop next door they can come in and get a consultation. They don’t have to take the bus or spend two hours. Again because we are located in the community people have become familiar with our clinicians. We buy tea from our patients, our community health worker lives nearby and that helps with integration and trust.”