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Meaningful Business

Kisimbi Thomas Nu’02 W’02, graduate of the first class of the Penn Nursing and Health Care Management Program (NHCM) and a health care innovator in Kenya, describes how care can be brought to underserved patients in Africa, and not just as a charity.

Kisimbi Thomas spent a decade with the Clinton Foundation’s Health Access Initiative, helping governments develop, implement, and large-scale, high impact strategies for health programs. He has raised more than $750 million in grants and support for governments and organizations with which he has collaborated or worked. Now funded by the Aspen Institute, he continues to bring change to African health care. Mr. Thomas also serves on the board of Jacaranda Health, which aims to make pregnancy and childbirth safer for women and newborns by transforming maternity care in Africa.

He spoke with the magazine in January. Among other things, we asked him why his Skype handle reads “President of Kenya 2017.” -The Editors

Inspiration to manage health care

From a very young age, I realized that our health system was broken. When I was ten years old and living in Mombasa, my grandmother suddenly became ill. My sister and I were alone in the house; my mother was away. We ran to our neighbor and together we rushed her to a government hospital. The scene remains seared in my mind. It took nearly an hour to get her admitted to a general ward, a single room lined with rows of beds. The staff didn’t seem to care whether she lived or not. My grandmother shared a bed with a man who was moaning in pain and being ignored. I realize now he probably had bone cancer. A single night nurse was on duty. We didn’t even have paracetamol available. It was horrible.

Lucky for us, my mother came home and, finding we weren’t home, received the news from the neighbors. She got my grandmother transferred to a private hospital. My mother had insurance through her employer; we were lucky. The quality of care was night and day. I felt that this was extremely unfair, that our family had access to this care and millions of others didn’t.

I decided on three ways I could help. First, I wanted a career in medical care. Second, I realized that what I saw was a management and leadership problem, having to do with things like supply chain, organizational challenges, remuneration, and staff motivation. Third, I needed to look into the fiscal and political environment behind our broken hospitals. This addressed what I could do myself, how hospitals and health providers could change, and how I could change systems for the better.

His education

In elementary school in Mombasa, I had a keen interest in politics. In high school, I attended one of the best boarding schools in Kenya called Alliance High School that brings together the top students from each district in the country. Here they develop your body, mind, and character through sports, a great academic foundation, and community volunteering opportunities. There, I came across a brochure for the Penn NHCM program. It was just what I was looking for. It clicked for me. I didn’t apply to any other colleges.

Coming to Philadelphia was definitely tough, but I settled into a good community with Africans. Penn was a culture shock all its own. It was just one of those things where I had to soldier on. I was taking 6.5 CUs, and only realized later what a daunting task I took on. I was lucky for the foundation I had in high school, but even luckier for support I received from faculty at Penn, especially those at Penn Nursing. It was amazing.

Current work

My paycheck comes from the Aspen Institute through the Aspen Management Partnership for Health (AMP Health). We’re all about leadership and management and systems change. We’re like McKinsey, only embedded within governments. My office is within the Ministry of Health. Right now, the Kenyan government is looking to launch universal health care and scale up a community health package— a number of effective health promotion and prevention services that can be delivered in households, eliminating the need to seek higher cost hospital care. We’re now working through the nitty gritty of how to reach tens of millions of Kenyans with insurance and these high-quality services. Besides Kenya, AMP Health works in Malawi and Sierra Leone, and looking to expand into Zambia, Ghana, and other African countries. We address bottlenecks in institutions and build the management and leadership capacity to drive evidence-based public health decisions. In short, we help governments do their work better. This is a foundational principle. The systems we work in are complex, and sometimes they don’t produce predictable results; sometimes they are even stubbornly resistant to change. But we know that change happens most effectively if we’re able to engage and work closely with the government so that the change we are driving is sustained.

Jacaranda Health & Maternity

Across Africa, pregnancy and childbirth are significant risk factors for women. Childhood is no cakewalk, either! With members from the U.S. and Kenya, Jacaranda is a leading social enterprise, moving the needle to provide high quality, respectful maternal care for low-income women to make pregnancy and childbirth safer for women and newborns. Its model is driven primarily by excellent nursing care.

The enterprise got its start four years ago and has shown that it’s possible to be profitable without relying exclusively on donor funding. We’re within nine months of breaking even. We’re separating out the Kenyan and U.S. entities; the Kenyan organization is in the process right now of hiring a CEO on the ground. This is the for-profit entity— a social enterprise providing safe maternity and newborn care. Then there’s a non-profit 501(c)3 registered in the U.S., which takes the best practices we’ve gleaned from clinics and approaches donors and partners to support governments to scale them up. We can’t keep the good stuff to ourselves when they save lives.

At the moment we have a site in a low-income suburb of Nairobi where there’s a long history of poor care. In the public hospitals there, nine out of the last 12 months in 2017 saw strikes by doctors, nurses, clinical officers, and public health officers. The worse alternatives have been for mothers to give birth at home or to go to pop-up clinics where unqualified people provide substandard care, or to get expensive, sometimes low-quality private care. Jacaranda offers family-centered care, helping mothers through their pregnancies and working with their partners on family planning, HIV prevention, and through the entire continuum of care. A C-section in a private hospital in Kenya will cost about $1,000 to $1,500, and about $500 for a normal delivery. At Jacaranda, the charges are $300 for a C-section and $100 for a normal delivery. We consistently hear from mothers who lost the baby in their first pregnancy and then came to Jacaranda in their second pregnancy that they received respectful care, they felt safe, and that we were not terrible for their budget.

In Kenya, we do have private health insurance accessible through most employers. But we don’t have exchanges like the ones in America. Jacaranda helps fill that gap in a sustainable way where outof- pocket payments are the norm and can be what drive a family even further into poverty. Hopefully, with the current push for universal health care, we will get more people on government-sponsored insurance in a population where nearly 50 percent subsist on less than $2 a day. The government already took steps to fund free maternity care in government hospitals, but more still needs to be done to address the supply chain as well as staffing and financing challenges in these public hospitals.

His future

In the end, I’d like to be a great public servant. It’s a story that began when I was ten. It’s still bubbling in me, still alive. Sometimes I don’t have the stomach for what it takes to be a politician—all the fundraising and special interests that pull you here and there. But I want to impact large-scale change in the public health sphere. Your geography, where you’re born, should not impact your life outcomes. That’s what I believe. In Kenya, you have as equal a chance at survival as you do in the rest of the world. It will take time. I’m cognizant of the implications of what that requires. But it’s a goal I’ve wanted to pursue for a very long time because I have come to understand that we face windows of opportunity to make a huge impact on the lives of poor and sick people in many countries; when we delay, people die needlessly. I can’t give up. In 2022 there won’t be an incumbent President of Kenya. This provides an opportunity for change. Let’s see what’s in the cards.