The full impact of the South African government’s interventions in the HIV and Aids epidemic, and promises of improved primary health care through the National Health Insurance system has still not been felt.
The reality for many South Africans is that efficient and accessible care for their most basic medical needs remain out of reach.
The private sector has stepped in by building capacity and skills through corporate social investment programmes, although these sometimes tend to focus on closed groups or are limited in scope.
Imperial Health Sciences, a division of multinational company Imperial Holdings, developed the Unjani clinic model.
It is an innovation based on building sustainable businesses at micro-sites around the country.
Unjani is part of Imperial’s enterprise development programme and is being implemented on a franchise model, says programme manager Trixie-Belle Nicolle.
“It is important for us is to build sustainable small black businesses,” she says.
“We funded the initialisation and pilot programme out of the enterprise development budgets of the group’s divisions for the past four years, but it has now been adopted under the group’s enterprise development programme.”
Seven clinics have been set up so far, and there are plans to open another 50 over the next two years, she says.
The concept of the Unjani clinic is based on providing basic primary care at clinics housed in 12m converted shipping containers. The franchise owner-operators staff the clinics.
Each of the clinics create employment, usually part-time initially, for five people including a nurse, an administrative assistant, a cleaner, gardener, security guard and community marketer. Nicolle says the basic requirement is that all applicants
have the necessary professional nursing qualifications as well as a dispensing licence.
“The recruitment of the franchisees has all been by word of mouth and we already have a waiting list in Gauteng of 150 people,” she says.
Imperial has identified the sites where the new clinics will be located, which are not in areas devoid of other medical facilities.
“We have adopted a clustering [of clinics and with other facilities] approach as we believe that we can show greater impact by grouping four of five clinics in an area,” she says.
Once applicants have passed the selection and background checks, they are required to pay a once-off fee of R10 500 to initiate their relationship as a franchisee.
They are then provided with a fully equipped clinic from which they provide basic health care, eye care, family planning and communicable disease medication dispensing.
Since this an enterprise development programme and not a CSI initiative, the franchisees are expected to operate a sustainable business.
This means they have to set revenue targets and strict repayment terms on the five-year loan granted for the infrastructure and setup costs.
On passing the five-year mark, ownership of the clinic and equipment transfers to the franchisee.
Imperial provides ongoing business and subject-specific training to all franchisees throughout this period to ensure they are able to meet their targets and sustain their business.
Imperial Health Sciences also uses its mass buying power to procure medication centrally so that franchisees receive preferential pricing.
This supports the business model that is predicated on affordable care, provided by a franchisee from that community.
“The overriding feedback from patients is that they are less concerned about saving time to get medication or treatment than receiving quality and individual attention,” says Nicolle. “The nurse has to be from that community or close by — we discovered this in our pilot project when we had one nurse who was not local and it didn’t work.”
Consultation fees are capped at R150, although franchisees are able to adjust their pricing lower if their market cannot bear this price mark.
Clinics supplement the fees by offering other products and services, such as selling nutritional supplements, reading glasses and sunglasses.
Nicolle is convinced the business model supports the long-term sustainability of the clinics.
Projections show a clinic can break even in the third year and generate income of more than R50 000 a month by the fifth year of operation.
“We see this as going on a journey with the franchisees. The more they succeed, the better for us,” she says. “We do all that we can to support them because we don’t want to abandon them.”
The judges of the Investing in the Future and Drivers of Change Awards praised Unjani for its partnerships, rating it as “a feeder model that works in rural areas. It’s innovative and can be replicated,” the judges said.
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