In remote, rural areas of South Africa, many communities suffer from the shortage of healthcare professionals and lack of access to proper medication and health education. In many instances, a sick patient may have to travel to several health clinics to receive care, often losing a day’s wages due to the journey. At the same time, 84% of families in South Africa are dependent on an overburdened public sector healthcare system, a system of care based on treatment rather than prevention.[1]

Dr. Iain Barton, executive vice president of healthcare at Imperial Logistics, South Africa, saw an opportunity to help the vast underinsured patient population and the country’s healthcare system by tapping into the potential of a vital but underrecognized group – entrepreneurial nurses. As a result, Dr. Barton created the Unjani Clinics Network, a nurse-led network of primary healthcare container clinics in the communities of South Africa. The non-profit company, Unjani Clinics NPC, raises the funding to purchase used shipping containers and equip them with the necessary medications, examination rooms, and furniture to empower black women professional nurses to own and operate their own sustainable healthcare clinic, often enabling them to become the first level of primary care for members of their community.

“Patients were being charged a doctor’s fee for something that could be done at the nurse’s level,” said Lynda Toussaint, chief executive officer of Unjani Clinics NPC. “These nurses are extremely qualified and knowledgeable, but there is very little empowering them to pursue the entrepreneurial side of the profession. The Unjani Clinic Network is able to provide the ‘how’ of setting up a clinic, so the nurses can focus on delivering efficient, convenient and affordable care.”

This innovative enterprise initiative is designed to be nurse-led and nurse-owned, and all of the nurses are trained to fully operate their own clinic after a five-year period. After initial funding provides the infrastructure and operating capital to set up the clinic, most clinics reach full monetary sustainability in their communities in less than a year by using a fee for service model.

“In the beginning, it was hard to charge clients for healthcare services because generally nurses were known to work in hospitals and weren’t expected to get paid privately for their services,” explained Sister Cynthia Yeko, RN, an Unjani nurse who has operated her clinic in Orange Farm, City of Johannesburg, Gauteng for almost four years. “That is now beginning to change, and our clinic has been the most consistent and fastest growing in terms of attracting more clients.”

Like many of the Unjani Clinic nurses, Sister Cynthia learned about the program and application processes through word of mouth.

Once a nurse applies to participate in the program, they undergo a rigorous selection process which includes selecting a site in a commercially viable area and performing a survey of at least 200 community members to determine the primary healthcare needs for that area.

“Our clinic has brought relief to the health public sector because people are now being diagnosed and treated at the primary level, reducing queues at tertiary hospitals that are already overloaded with patients,” said Sister Cathy Seakamela, RN, who has operated her Unjani Clinic in Kagiso, West Rand, Gauteng for two and a half years. “Our clinic has also brought great change in our community, as people are now able to make a choice which facility they would like to visit to receive care.”

The Unjani Clinics initiative succeeds in part due to the partnership between the clinics and local doctors and hospitals. The Unjani Clinics have helped alleviate some of the burden on the government healthcare system by providing to their community primary care services like laboratory blood services, wellness screenings, wound care, family planning, ultrasounds, and health education.

“Unjani nurses play an enormous role in their communities by actively seeking out those who are unable to get to the clinic, creating safe places to openly share fears and experiences and educating community members on healthy behaviors and preventive strategies,” said Laura Nel, Director of Global Community Impact for Africa at Johnson & Johnson, who leads the J&J commitment to the Unjani Clinic initiative.

Because of the high burden of HIV and AIDS in their local communities, HIV counseling and testing is one of the biggest roles of Unjani Clinic nurses. The Unjani Clinics work closely with South African HIV/AIDS organizations in the region to provide free testing and counseling and to connect positive patients with additional clinics to initiate therapy and treatment.

“We’re making significant headway in preventing and treating HIV and AIDS, due in large part to our nurses being trained in testing and counseling as a service,” said Lynda. “The clinics are making it easier for patients to start and continue treatment, and also provide a stigma-free place to receive care. There isn’t a separate waiting area for HIV and AIDS patients- everyone is received in the same place.”

By owning and operating their own clinic, Unjani Clinic nurses take on the role of employer as well as entrepreneur and caretaker. Each Unjani Clinic can create up to six jobs in their community in the form of assistants, administrators, and security guards. And according to Sister Cathy Seakamela, employing people in her community has helped people who have been unemployed for years to provide for their families.

“Unjani nurses have become more than healthcare workers and entrepreneurs, they’ve blossomed into highly respected leaders and role models in their community,” said Laura. “There is still a lot of work to be done to improve the perception of nurses as healthcare leaders in South Africa, but as the Unjani Clinics have shown, we cannot transform health in this country without nurse-led care.”

While there are currently 65 clinics in the Unjani Clinic Network spread throughout eight of the nine provinces in South Africa, Lynda hopes the initiative can reach 100 operational clinics before the end of 2020, expanding to other regions within South Africa and potentially other countries. She also hopes that government leaders and healthcare workers in the country can see the value of the clinics, which are aiming to reduce the burden on the public health system, and will support more referrals to the Unjani Clinic Network.

“Funding is key to what we are trying to accomplish, but we can’t do any of this without on-the-ground support,” Lynda explained. “The nurse’s relationship with her community is the most vital part of the program. The majority of these nurses build their clinics in their own communities, so they have grown up there, understand the need and are better able to build trust and engage with the people.”

As Unjani Clinics continue to grow across the country, the network hopes this will help improve the perception of nurses as healthcare leaders and changemakers, empowering black women nurses across South Africa to not only deliver care, but also develop professionally and take an active role in the health of their community.

“It is my dream come true to own a clinic- I have tried a lot of projects in the health sector and this is the only project that has sustained me and my family financially and professionally,” said Sister Cathy. “I have been empowered as a business woman and I am fulfilling my purpose in life by serving my community.”

In 2016, Johnson & Johnson became the first corporate company, alongside Imperial Logistics, to offer funding for the Unjani Clinic initiative. Over the years, J&J has partnered with universities to provide leadership development programs and other trainings for nurses in South Africa to help sharpen their professional education. To date, J&J has funded 11 Unjani Clinics, empowering 11 nurses to become business owners. J&J recently renewed its commitment to the Unjani Clinic initiative and has pledged to support an additional nine Unjani Clinics by 2021. Learn more about our commitment to the Unjani Clinic Network here.

Pictured above in the header image is Sister Patricia Mbatsha of the Unjani Clinic in Atteridgeville, Tshwane, Gauteng.

[1] Doke, L. (2017, March 7). Primary healthcare for empowerment. Retrieved from https://mg.co.za/article/2017-03-07-primary-healthcare-for-empowerment