The largest barrier limiting employment in the healthcare sector for nurse practitioners in South Africa is a lack of empowerment to take on increased responsibility. Nurses with specialist training and skills are inefficiently placed to deliver care in the system and a lack of financial support for professional nurses to open their own private practices means many cannot pursue an entrepreneurial route.
Unjani Clinic is a network of primary care clinics owned and operated by black females, providing accessible, affordable and quality healthcare to communities in poorly served, low-income areas in South Africa. Since its inception in 2014, Unjani Clinic has worked to empower nurses through introducing increased paraskilling within the country’s healthcare system to cope with the shortage of doctors and the changing healthcare demands of South Africans. The Unjani Clinic model also allows selected nurses to access a fully funded investment to take their profession and training to another level and to give back to their communities.
Since 2016, the Johnson & Johnson Family of Companies in South Africa and the Johnson & Johnson Foundation have worked with Unjani Clinic to expand the network, operationalizing 17 clinics across the country and providing more than 322,000 consultations to patients in need.
When awarded an Unjani Clinic, nurses enter into an enterprise development agreement—a comprehensive five-year program that trains, coaches and supports them to develop the business skills required to run a successful business. Sister Nomthandazo Lerumo, based in KwaMhlanga in South Africa’s Mpumalanga province, recently graduated from the program, making her the owner of the first-ever Johnson & Johnson-funded Unjani Clinic and the first nurse in the province to graduate.
“It is such an amazing milestone for any of the nurses in the Unjani Clinic network to graduate as an owner of their clinic, but it is the outcome of dedication, compliance, perseverance and lots of hard work,” says Lynda Toussaint, CEO, Unjani Clinics NPC. “Sister Nomthandazo Lerumo has been a perfect example of a nurse who has taken a once-in-a-lifetime opportunity and made the most of it for herself and for her community. We are extremely proud of her achievement, and we are grateful that she has chosen to remain in the Unjani Clinic network as a shining example of her commitment to the brand and what it represents for communities.”
Strengthening healthcare systems and enterprise development through innovation
Only a small percentage of South Africa’s population has access to private healthcare insurance. The vast majority self-insures, pays out-of-pocket or relies on the government’s provision of free primary healthcare. This places severe strain on the public healthcare service industry and on healthcare professionals, compounded by inadequate equipment and medication and a shortage of trained medical doctors.
Unjani Clinic is the only nurse-led network in South Africa and it focuses on underserved markets, targeting the employed but uninsured. Unjani Clinic aims to strengthen infrastructure by offering an affordable alternative to patients who cannot afford private medical insurance or general practitioner rates, but who can pay something toward their healthcare. These patients move away from the government healthcare facilities, relieving the burden on these facilities and freeing up their capacity to care for the unemployed and destitute.
The nurse and patient statistics across the Unjani Clinic network since inception reflect the support for this model and its innovation:
Unjani Clinic aims to change the status quo by empowering the community with the knowledge, skills and access to affordable care to manage their health independently and by educating and training nurses for positive developmental outcomes, including enterprise and socioeconomic development in South Africa. Each clinic guarantees three full-time sustainable jobs and has the potential for an additional two jobs as patient numbers increase.
Through the provision of enhanced skill development, entrepreneurial opportunity and job creation, the model empowers nurses, their clinic staff and other women who play an important part in their communities’ social networks to fundamentally change the base profile of communities.
Our collective effort to support scale, sustainability and impact
The Johnson & Johnson Center for Health Worker Innovation is working to drive scale and sustainability for the Unjani Clinic model. With support from the Johnson & Johnson Family of Companies in South Africa and the Johnson & Johnson Foundation, the Center will work with Unjani Clinic to establish an additional six clinics a year for the next three years. Furthermore, our support will enable Unjani Clinic to develop and test a new blended finance model to allow the network to scale faster, strengthening the Unjani Clinic brand as a unique model of care bringing improved quality of life to more South Africans.
“I choose to remain within the network because of the Unjani Clinic brand,” says Sister Nomthandazo Lerumo. “It is the sense of belonging to such an incredible national brand that offers quality healthcare at an affordable price and improves the livelihood of ordinary people and improves my livelihood, too.”
Having reached her entrepreneurial milestone, we asked Sister Nomthandazo Lerumo to share her journey with Unjani Clinic and her motivation for doing the critical work she does every day.
Sister Nomthandazo Lerumo: “Being a nurse came naturally to me. I was always taking care of sick people at home, and it was easy. Being the only daughter among three boys, I was a nurse already. I derived a satisfactory feeling from caring for people who could not do things themselves. When the opportunity availed itself for me to train as a nurse, I did not hesitate. I grabbed it with both hands, and it is such a fulfilling career.
“The greatest reward comes when patients value the service you give to them.”
I am most fulfilled when, together with the patient, we achieve the set goal. My profession is about caring and nurturing. It is about restoring health to patients in a dignified way, respecting all patients—irrespective of age, gender and social stature—and changing the lives of ordinary people.
We face many challenges as nurses in South Africa. We are overworked and need to care for very sick people with minimal resources. We give so much of ourselves that we face burnout.
The burden of disease in South Africa is huge, and most people who are sick are unable to access quality healthcare and die from diseases that can be easily managed. HIV and the COVID-19 pandemic and its changing dynamics pose the greatest challenge facing healthcare and health workers in this era.
Another challenge is the fragmentation of healthcare and the fact that primary healthcare is not given the priority it deserves, even though it is critical in preventing hospitalization and providing quality of life for people.
It is these challenges that make the work we do so important. Being a qualified nurse is an achievement on its own. I am a community builder and unite diverse communities. I am an essential worker who cannot be replaced by a robot. I worked when most people stayed at home during the hard lockdown, and I was able to give some comfort and hope in an uncertain time. I can change a life by human touch alone and as the self-employed owner of an Unjani Clinic, I am able to empower other women.”
‘A journey of a thousand miles’—the opportunity that changed everything
“The opportunity to join Unjani Clinic came at the time when my professional nurse journey was at a crossroads. Although my career path was on the upward trajectory, emotionally I was empty. I felt that my contribution did not mean that much. I wanted more. I wanted to give all my experience toward helping people.
Joining Unjani Clinic was natural and seamless and has truly been a ‘journey of a thousand miles.’ A friend introduced me to the concept and model, and it did not take a lot to convince me to join the Unjani Clinic network. The rest is history and I have now graduated as the proud owner of an Unjani Clinic. It is a great joy and a great sense of achievement, both personally and professionally, to reach the stage of ownership—an indescribable feeling.
Unjani Clinic has given me specific skills to run a successful business and to be an entrepreneur, such as financial management, sales, marketing and organizational skills. I am a qualified sonographer, I can analyze the community and its needs, and I am able to manage stakeholders and other service providers with whom I interact in my daily duties, such as companies providing medication, waste disposal companies, laboratory services and many more. I am an employer responsible for the employees who work with me and a brand ambassador for Unjani Clinic.
Having a supporter like Johnson & Johnson in my corner has empowered me to be the best server of the community. To Johnson & Johnson, for all the contributions you have made to support me, I am so proud to be the first Johnson & Johnson-supported nurse to graduate and to be an Unjani Clinic owner. Thank you. Ngiyathokoza.”