"And we give them tea"

Every Tuesday and Thursday morning the women of Sinai slums in Nairobi, Kenya gather at the Olivelink Healthcare Clinic. They bring their children for immunizations (for which they pay KES 20) and some bring Mandazi. I ask what Mandazi is and Josephine Suleiman, Founder of Olivelink Healthcare, explains with a smile and some amusement, “Mandazi is slightly sweet fried bread (think of it as the Swahili version of a doughnut) that can be bought on the street for 5 Shillings (approximately 5 cents US). Whenever they (women) come we give them a cup of tea and we are packed until 12:30”.

It’s a powerful cup of tea. Since they began serving tea in (August 2016) the clinic has seen their numbers grow significantly (from 392 babies in the month of August 2016 to 565 babies in the month of December 2016). But the impact of the tea is not only the increase in numbers, it is the behavior change triggered. “As you can imagine some of these mothers don’t have breakfast in the houses due to high poverty levels and when we realized that, we thought why don’t we give them a cup of tea as an appreciation of them bringing their babies for immunization.” The tea gives mothers a reason to buy Mandazi on the way to the clinic and more importantly a reason to feed themselves. As Josephine says, “a cup of tea and Mandazi - breakfast is done and they really appreciate it”. Over breakfast while the mothers bond the Olivelink Healthcare staff give them health talks, encourage them to breast feed their babies and the importance of mothers to care of themselves. The mothers are also taught the various methods of family planning available for them and how this can help in spacing of their babies enabling them to bring up strong and healthy babies.

Intuitive Design Thinking

As Josephine shares her story you realize that her patient-first concerns and thoughtfulness is exactly what human-centered design was meant to be.

Observation and problem identification

Josephine who lives 3 kilometres away from the clinic was a Level 4 hospital[1] administrator and what she saw at the hospital convinced her there was an unaddressed need. Mothers coming to the hospital (Kayole Hospital which was 10 kilometres away) for services often would not have bus fare to go back to their homes after their appointments and even those who had given birth. It was not uncommon for Josephine and other hospital staff to contribute or pay for patient’s fare back home. And after seeing this scenario repeat continuously she wanted to understand why this was happening. “I felt there was a need for services to be brought to them so I decided to conduct a survey to find out what was there.“

Unbiased inquiry

“I didn’t have the means to conduct a proper survey. I used to visit the slum area and just chat with the women because they were easy to reach, and ask them what they would want to see happen just by word of mouth, nothing scientific’’.

The survey she conducted took two years and looked at what other services were available, the catchment population and most importantly asked people what they wanted. They wanted maternity services that were closer to where they lived but not at the expense of substandard services (that is, they wanted quality services and to be treated respectfully as human beings). Josephine and her team learned there were facilities closer than the Kayole Hospital but the mothers weren’t happy with the services they were receiving. What Josephine decoded is that “better services” actually meant mothers wanted their local clinics to understand them better, not just as patients, but as people.

Listening and ideation

“Before we opened the Olivelink Healthcare Clinic we used to visit them and give services for a day, for a period of about a year, mainly family planning services. At first my main line was maternity because that was the need I had seen from the onset. The mothers had to go so far to seek the services but as we came in we also saw the need to provide the general services for babies under five and everybody. So we had to incorporate that.”

For Josephine and her team two extraordinary things were achieved with their service days. First, in addressing a problem of distance they prototyped the solution – they travelled to the catchment population they intended to serve. Secondly, the family planning dialogues permitted them to interact with the patient population which facilitated learning about community values and what the community valued. The distinction is significant. Understanding and respecting community values builds trust. Understanding what the community values most builds a service and pricing model.

Constant iteration

“It took a lot of mobilizing the community and doing medical camps so they can get to know that the facility existed and what type of services they could expect. We also needed the community to understand that we were committed to give them quality services. We were just getting established and the first years were very slow but I want to think that the first two years were also slow because I wasn’t onsite working on this full-time.”

When Olivelink Healthcare opened in December 2012 Josephine was working at the Kayole Hospital as the administrator. She funded Olivelink Healthcare with her bank administrator pension, where she had worked for 18 years prior to the hospital administrator position. To mitigate the risk of launching her clinic she continued to work at a Kayole Hospital and spending all her free time at the clinic. Olivelink Healthcare is open 365 days a year, 24/7 with two staff shifts for a total of 15 staff. After two years of toggling both a full-time job and a full-time clinic she committed herself solely to Olivelink Healthcare. The number of patients surged (see above graph); quadrupling in number of patients from 2014 to 2015 and doubling 2015 numbers in 2016. ‘’2017 we are targeting to reach 20,000 patients’’ Josephine says

The extraordinary growth of Olivelink Healthcare, which Josephine attributes to the quality services they offer, brings with it challenges. Located in a slum the consultation fees are commensurate with the impoverished community. At 50 KES per consultation, cost and overhead are strictly monitored as there is not much flexibility in margins. However, wage is not the only reason for staff turnover, location or working in a better one is nearly impossible to counter. Yet most pressingly is the limitations of the clinic’s space. They have already reached capacity. “Oh yes I am thinking of expanding, actually I have a dream hospital….(then she shows us the architects drawing of the dream hospital on a notice board in her small room) as you can see we are running out of space”.

Josephine has already commissioned renderings and that the bills of quantity have all been calculated. The current clinic would continue to serve the community with the hospital constructed nearby within the slum area) on land she owns. Currently she is now reaching out to potential funders and estimates come to 18.9 million KES ($180,000 USD) to build the hospital (equipping and staffing not included). The architects rendering below.

The drawings show a top floor housing laundry, kitchen and support services. The ground floor will accommodate maternity unit complete with a delivery room, first floor will accommodate women medical ward pediatric ward, pharmacy and laboratory, and administration office, and second floor will have male medical wards and dental unit. Construction would take approximately eight months and the hospital would expand the maternity services to include inpatient medical services and pediatrics which are desired services the current clinic cannot provide. She understands that raising funds won’t be easy but she is optimistic and thankful. Before leaving I asked her how she has changed since she started the clinic.

“Appreciation. Personally, I have learned to appreciate life because when I compare myself to the people we are serving I count myself very lucky. I think it has really humbled me. “

Josephine Suleiman can be contacted at –olivelinkhealthcare@gmail.com or josephinesuleiman@gmail.com.

[1] (Each district in Kenya has a Level 4 Hospital(s), which is the coordinating and referral centre for the smaller units. Level 4 Hospitals provide comprehensive medical and surgical services.)