How one social enterprise is packaging quality

The nurse-midwives who work at Jacaranda Health’s two maternity hospitals in Nairobi believe deeply in providing the highest quality care to the women who visit the centers. It’s why they take seriously their commitment to implement the “5S” — sort, set-in-order, shine, standardize, sustain — quality improvement system, an innovation that is anything but typical in health care of low-resource areas of the world. Using the 5S roadmap, the nurse midwives ensure that each “delivery trolley” is complete with the necessary tools for birth. They make certain that the delivery pack, medication, and essential equipment is available in the right quantities, easily accessible, and in a consistent place as they anticipate the upcoming arrival of a new baby. Nurse-midwives are not only responsible for providing the care, though. They “own” the quality initiatives undertaken at Jacaranda Health’s maternity hospitals because, as front-line staff, they are trained as quality ambassadors to carry forth both the implementation of and messaging about quality improvement as a key innovation in the quest to improve maternal and newborn health in low-resource settings. Every year, 7,700 women in Kenya die from complications stemming from pregnancy or childbirth. What makes this issue so pressing is that we know what needs to be done: Mortality can be cut by 75 percent through improving access to high-quality reproductive health services and ensuring that childbirth happens with skilled providers. Improving the quality of obstetric care in facilities has been identified as a neglected and essential approach to reduce maternal deaths and enabling developing countries to achieve Millennium Development Goals 4 and 5 — to reduce child mortality and improve maternal health. In order to impact maternal health on a large scale, Jacaranda Health realized it needed to look at developing replicable quality improvement systems. But what’s so “innovative” about establishing high-quality care at a low-cost? A lot, as it turns out. Jacaranda Health, founded in 2010, is a nonprofit social enterprise focused on improving quality of maternal and newborn health care in Africa. In 2012, we opened our first maternity hospital for low-income women in Nairobi, and this year we launched our second fully owned and operated facility, also in the Kenyan capital. Our centers, of which we will be opening more over the next three years, do not only provide care. They also act as “implementation labs” to pilot innovations that, if successful, can be replicated widely to save tens of thousands of women's and newborns’ lives. Our quality improvement leader, Eric Wachira, came to our organization from Kenya Airways. Eric’s job is to look at how our organization can continually improve upon our systems in order to establish the highest-quality care at a low cost for women and newborns in the communities we serve. Though implementing quality improvement initiatives is common within health care settings in the United States, it is rarely seen in sub-Saharan Africa. Eric and I are also responsible for developing the strategy for working with public and private health facilities throughout Kenya and, ultimately, East Africa to replicate this innovative model. When Eric looked at the set up of our birthing room in our first center, he immediately saw the potential to implement the 5S roadmap for quality improvement — a low-cost, yet high-impact way to standardize and improve safety in our delivery ward, processes that most maternal health facilities in Kenya do not consider. But it’s the nurse-midwives who are responsible for the sustainability of the innovation. By applying the 5S roadmap, they can efficiently and effectively set every patient interaction up for success. This is why the set of quality improvement tools we bring to government facilities in other low-resource areas is exciting. It offers a low-cost way to improve health systems, and in turn increase the service quality and, ultimately, yield better health outcomes for women and newborns who need them most. Want to learn more? Check out the Healthy Means campaign site and tweet us using #HealthyMeans. Healthy Means is an online conversation hosted by Devex in partnership with Concern Worldwide, Gavi, GlaxoSmithKline, International Federation of Pharmaceutical Manufacturers & Associations, International Federation of Red Cross and Red Crescent Societies, Johnson & Johnson and the United Nations Population Fund to showcase new ideas and ways we can work together to expand health care and live better lives.