Jamii Life

Black and Coloured communities in South Africa were designed to be unhealthy, resulting in 3x higher levels of hypertension and heart disease and ultimately in disproportionately more people suffering from heart attacks and stroke.

There is limited caregiving infrastructure for post-acute care in the public health system that serves 82% of the population. Of the 2 million people that need help with daily living (as a result of chronic illness), only 7% of people (usually the wealthiest and typically white) can afford private care. Currently, 60% of those that need care have no access to it.

For most others, family members (usually women who forgo education and career opportunities) stay home to be family caregivers, further decreasing household income and perpetuating the cycle of poverty in communities where unemployment often exceeds 50%.

The number of people that need care daily is expected to increase to 5 million people in South Africa and 66 million people across the African continent by 2050.

Due to caregiving shortages and the high cost of private care, this fragile population finds it more difficult to receive their care. Families that already struggle to make ends meet also forgo family members' income to share home to care for loved ones.

COVID-19 highlighted how many family members are the primary caregivers for a loved elderly family member. The constraints of social distancing made caregiving even more inaccessible and underscored the need to support family members to provide care to minimize external personal risk to immuno-compromised patients.

We train family members to become accredited caregivers for their loved ones, helping give families peace of mind and upskilling the otherwise unemployed with transferable skills to provide healthcare services for others in need and thereby generate an income. Accredited family caregivers can choose to join our team alongside other home-based carers to support families with no access to care.  Caregivers are supported by a care platform that records health worker activities and shares a set of wellness data with family members and doctors (with consent).  Jamii Life health workers are trained to support transitional care after an acute event and support families with an intentional focus on care coordination.

We deliver:

Home-based Care: Our home-based carers provide transitional care after an acute health event and long term care service. Pricing is on a sliding scale to ensure that those that cant afford care also have access to it.  Our carers coordinate with family members and health care providers to make sure that the transition from hospital to home and that families are as connected to the care as possible.  We track and monitor health vitals, emotional well-being, food and liquid intake, etc. to help patients and families follow the best path to recovery or to maintaining a healthy lifestyle. 

Remote Nursing Support: Both health workers and families often need a trusted advisor. A nurse oversees health worker activities and acts as on-call advisors through a hotline for family caregivers that may need quick advice.  Nurses provide personalised and live text, WhatsApp, phone and video consultations and home visits for patients.

Family Caregiver Training: We train family members that cant afford care or who prefer to care for family members themselves.  Combining traditional clinical home-based care training (delivered with a non-profit partner) with communication, community activation and interdisciplinary training to support rehabilitation.  Training is provided free to those that can't afford to pay. A sliding scale pricing system to make sure that the training is as financially accessible as possible, whilst allowing Jamii Life to sustain its operations.

Family caregivers: Training and accreditation allow for better quality of care, a career path for them and potentially over time, the opportunity to earn an income. 

Health workers: Are trained to facilitate collaborative care and communication with family members. In Black and Coloured communities, care is often provided in community with several family members helping to provide care.  Health workers are trained with specialized skills to provide expert care for patients with these diseases irrespective of their socio-economic status.

Patients (care receivers): Data shows home health visits can reduce the likelihood of hospital readmission by as much as 25%, significantly improving patients’ quality of life.  They are able to make more informed health decisions with access to health vital and emotional wellbeing trends.

Families: Have peace of mind that loved ones are well cared for.  They have access to a dashboard visualising health vitals and emotional wellbeing over time to support the care receiver to make more informed health decisions.

Black and coloured communities: We work with the community and religious groups to create events for families and patients to interact socially to further build community support networks.

Target population: Our current target population is the Cape Flats population of the Western Cape. Apartheid race-based legislation forced non-white people out of more central urban areas into government-built townships in the Cape Flats or made living in the area illegal, forcing many people into informal settlements elsewhere in the Cape Flats. Since the end of apartheid, these communities are no longer legally bound by racial restrictions; but history, language, economics and ethnic politics still contribute to the homogeneity of local areas. [source: Wikipedia] Over time, we will expand to the nine South African provinces, starting with Gauteng. We also plan to work in Zimbabwe, Ghana and Kenya within two years.

Jamii Life is located in the community where I grew up in. Our initial focus is on my community and five adjacent communities that span various income levels across black and coloured communities.  This is where we conducted our family caregiver and community health worker research which gave us rich insights into the broader needs of family caregivers, patients and families.  My grandmother was bedridden for 16 years.  We never thought that we could afford expertly trained health workers to help us with caring for her.  My cousin, who is two years older than me cared for her for several years forgoing education and work opportunities.  I started Jamii Life to provide the kind of care that I wish we had access to when my grandmother was still alive.

Three of our four team members, including myself, are from the communities that we serve. Family caregivers and our health workers come from the same communities. This is crucial to our service design. Our health workers are actively involved in designing the training 

curriculum, including leading some of the sessions with family caregivers.  Our training incorporates the rich experience of family caregivers as recognition for their existing skills and to enhance the caregiving experience. Those that receive the training free of charge ‘pay it forward’ by facilitating support groups for other family caregivers that need emotional or practical support in their community.

I hope that Jamii Life can help to provide better health outcomes and to provide opportunities for meaningful work thereby creating a sense of hope in my community and others like it.

Everyday we come across another need that the organisation has to grow, these include several professional services and general mentorship advice on how to grow our team and how to structure our services.

Specifically e need access to professional services - including but not limited to:

• legal support, 

• financial services,

• human resources and recruitment support, 

• data management, 

• advice on how to structure our entity and 

• how to leverage technology in communities, by communities and for communities. 
  

Our hope is that the Solve community can help is to gain access to some of these services.

The Solve team’s ability to be able to support us by helping with in-kind resources and overall mentorship for our leadership team would be invaluable as we grow from pilot stage. 

Furthermore we admire the commitment to social impact of the current Solver’s.  Being a part of the community to share ideas and support each other would be invaluable for our team. 

• We leverage the rich lived experiences of family caregivers in our training elevating their role to trainer and educator in addition caregiver.  They formally leverage experience to value-added to their communities in this way.

• Family caregivers that receive training free of charge ‘pay it forward’ by facilitating support groups for caregivers in their community that need emotional or practical support.

• We leverage existing systems, for example, we partnered with Robin’s Trust (a local non-profit) to deliver clinical training rather than creating another clinical training programme ourselves.  Instead, we focus on training collaborative, communication, conflict resolution, community organizing and interdisciplinary skills.

• We offer families and patients support with bi-weekly ‘outings’ for patients to foster community spiting and a sense of fun while also using the time outside the home to streamline clinical checks in a pleasant environment, allowing us to optimise clinicians time.

• We intentionally focus on care coordination and collaboration with in-built processes to ensure efficient transition from hospital to home and communication between patient, their family, our carers and remote nurse support.

We aim to serve 120 care receivers by December 2023 either by directly serving them with our health workers or by training family members to be health workers.  

We are on track to have 10 health workers by end of 2022 and to train 50 family caregivers. 

We aim to serve least 10,000 care receivers by year five either by directly providing care or by training family caregivers.

We are in the process of designing a community research intervention evaluation with the support of a teaching team at Harvard Chan School of Public Health.  In addition we will track the following as indicators of process on health outcomes and employment generation.

Number of family members trained

Number of health workers employed

Number of care receivers served

Rehospitaisaltion rates (compared to average rates in the district by disease profile)

Inputs: We empower health-workers and family-caregivers of colour to provide care to people who are unable to access or afford expert homecare. By doing so, we empower providers (mostly women) to grow their careers, increase their respect within families, and become valued members of society.  

Activities: 

1. Home-based Care: Our homebased carers provide transitional care after an acute health event and long term care service. Pricing is on a sliding scale to ensure that those that cant afford care also have access to it.  Our carers coordinate with family members and health care providers to make sure that the transition from hospital to home and that families are as connected to the care as possible.  We track and monitor health vitals, emotional wellbeing, food and liquid intake, etc. to help patients and families follow the best path to recovery or to maintaining a healthy lifestyle. 

1. Remote Nursing Support: Both health workers and families often need a trusted advisor. A nurse oversees health worker activities and acts as on-call advisors through a hotline for family caregivers that may need quick advice.
   

1. Family Caregiver Training: We train family members that cant afford care or who prefer to care for family members themselves.  Combining traditional clinical home-based care training (delivered with a non-profit partner) with communication, community activation and interdisciplinary training to support rehabilitation.  Training is provided free to those that can't afford to pay. A sliding scale pricing system to make sure that the training is as financially accessible as possible, whilst allowing Jamii Life to sustain its operations. 

Outputs: Those in need are able to access affordable high-quality care and caregivers no longer have to leave employment to care for loved ones.  Therefore aim to facilitate and support the creation of social infrastructure that provides access to homecare to everyone that requires it, while empowering providers through tools and training while earning a living wage and ensuring that caregivers (especially women) can seek full employment if they so desire.

We built Jamii Life around three guiding principles - community, collaboration, and care. We imagined Jamii Life as an organization rooted in community. We believe that by meeting people where they are, we can find and provide what they most value. Our initial efforts focused on researching the daily lives and health needs of people in the Western Cape against the backdrop of its economy, social groups, and nuanced history. Our aesthetics, inspired by the art and nature of South Africa, reflect this sense of place and space. We hope these designs, with their familiar nod, will invite people into our community - our jamii.

Community, however, is nothing without people working together. The context and practices people use to communicate shaped our product and service design. Knowing that connectivity can be a challenge, our caregivers will be given data plans and our mobile application will be a progressive web app (PWA), so that it loads quickly and doesn’t need consistent internet connection. We also plan to integrate WhatsApp with our application (through the Twilio API), so it is quick and easy for families and caregivers to stay in touch and informed.

We rely heavily on WhatsApp communication because families use it as their primary tool for communication.  We are testing other exisiting tools like Otter.ai to transcribe health worker inputs so that families are closely connected to the activities of the caregiver/ health worker and that they feel part of the process.

Most importantly, we are committed to caring for the whole of Jamii Life. We built our service by mapping the patient and family journey to understand when they need the most assistance. We know that acute and chronic health conditions are a heavy load, and our goal is to restore peace of mind to over-burdened families. Drawing on Hick’s Law, we reduce choice overload for families by streamlining the process of finding a caregiver and by offering personalized care plans. Jamii’s product design also reduces the burden on caregivers, making their jobs easier. Our UI, which follows accessibility guidelines, gives caregivers important information at a glance and makes it simple to complete a care plan. We anticipate these design choices will result in better service, better health outcomes, and happier communities.

Our primary goal, at this stage of our progress, is to use as much of existing tools as possible and to make sure that the tools we use are already a part of the daily habits of caregivers and family members to support 'stickiness'.

Four of our five (all female) team members are black and coloured South Africans. 

We primarily serve black and coloured communities.

Our black and coloured leadership team provide oversight to our services, but we involve community and family members in the design and delivery of our solution.

Jamii Life is equitable by design and as a function of who we are.

We aim to use pricing as a tool for economic justice and by price differentiating we hope to cross-subsidize lower-income services by providing differentiated services A sliding scale pricing system to make sure that the training is as financially accessible as possible, whilst allowing Jamii Life to sustain its operations. 

The hope is that families (for caregiving services) and trainees (for training) feel empowered to choose honestly based on affordability to enable us to offer the training at no cost to people who would otherwise be unable to access training.

We operate both a for-profit and not for profit service enabling us to provide paid and free services in South Africa.  Our paid services cover the cost of health workers (with a shortfall currently to cover other operating costs).  Our free service is funded by grant funding.  We expect to continue operating a hybrid model for at least 5 years.

We fund our operations through paid customers.  Our primary channel is from private sub-acute facility partnerships.  We currently cover 80% of our total operating costs after six months of operations.  We hope to scale to cover all costs within three years.

Our free services are grant funded.  As we gain traction we aim to demonstrate a reduction in hospitalization rates and apply for Government funding to complement international grant funding.

Grant Funding received:

1. $30,000 Harvard Social Innovation and Change Initiative

2. $10,000 Harvard Chan School of Public Health

3. $38,000 Skoll Early Venture Award

4. $80,000 Social Innovation non-profit funder