Expanding health care access across rural Uganda
When Francis Xavier Asiimwe founded an agriculture start-up in rural Uganda, he had no idea that one of his biggest business challenges would revolve around health care. He quickly found that his employees were regularly forced to miss several days of work in order to seek basic, necessary health care. People living and working in Uganda’s rural communities, including pregnant women, must travel long distances, over hours and even days, to reach the nearest hospital or health care center, resulting in absenteeism and lost productivity—not to mention further risk to health. Such long, costly journeys mean that many simply go without care, leading to preventable illness, injury, and even death. It was this loss of productivity and human life that in 2014 prompted Asiimwe to create Kaaro Health, a community health care enterprise that aims to increase access to medical care in rural areas.
In its earliest form, Kaaro Health partnered with existing health care centers to increase the services they were able to offer nearby communities, with a particular emphasis on maternal health care. The enterprise leased necessary equipment, such as ultrasound scanners, to small clinics, with the aim of reducing the number of visits to larger district or city hospitals. The business has largely focused on solar-powered equipment to overcome the challenge of unreliable energy access in rural communities. This aspect of the business continues to this day, as does a growing telehealth service that connects doctors and patients who are unable to travel, via phone and video calls.
In an effort to provide more direct, localized medical services, with the support of USADF, Kaaro Health launched an innovative new model for health care in 2017, building clinics inside shipping containers and deploying them in remote communities. The container clinics are staffed by a nurse and a lab technician from the local communities and operate on a lease-to-own basis that results in full community ownership, creating a model for medical care that is community-led and -owned. Asiimwe estimates that a container clinic can meet around 80 percent of basic and maternal health care needs on site, drastically reducing the number of people who need to travel to larger hospitals and the time and cost burdens of seeking care. He estimates that since 2017, Kaaro Health’s nurses have completed over 120,000 clinic visits and facilitated over 8,000 births via 36 container clinics and an additional 40–50 partner clinics.
COVID-19 has been highly disruptive to Kaaro Health’s operations. A combination of reduced incomes within communities affected by lay-offs and lockdown restrictions, and concerns over contracting the virus, have reduced daily visits and appointments dramatically. Asiimwe is worried about the future and particularly the impact of reduced clinic visits on rural communities, including poor maternal health outcomes and the severe effects of chronic diseases, such as HIV, that are usually manageable through regular, low-cost intervention. Despite these concerns, the pandemic has also provided opportunities for the business, as more people (both patients and health care providers) have become comfortable with telemedicine and have sought it out. Asiimwe intends to capitalize on and expand Kaaro Health’s existing telemedicine platform. He also hopes to soon re-open sixteen clinics that have temporarily closed due to lack of funds and to continue the work of deploying new container clinics throughout Uganda and beyond.
Asiimwe describes the support he has received from USADF as transformational. In his view, the agency fills a necessary role in African development as it can ease pressure on the over-stretched Ugandan government by providing grants, training, and support that unleash the potential of young entrepreneurs like himself. That support is particularly important in the face of crises like the coronavirus pandemic, during which local entrepreneurs are among those best positioned to adapt quickly to changing circumstances and the needs of their communities.