Imperial

The Unjani Clinics initiative empowers black women professional nurses to operate and ultimately own primary healthcare container clinics in their communities. The clinics offer an affordable quality healthcare service to the employed but uninsured population (estimated between 10 and 12 million people), who are able to pay a small fee towards their healthcare needs. The model shifts primary healthcare services to professional nurses and away from government facilities, which are stretched and underresourced. The clinics provide access to essential medicines and primary healthcare, reducing the vast amounts of time and travel costs patients incur to receive attention at a state facility.

In addition to the entrepreneurial opportunity provided to professional nurses, each clinic creates between three and five sustainable jobs.

Professional nurses and clinic assistants receive three days of training on basic business management as well as training on the onsite electronic patient management and ordering systems. They are further supported with ongoing mentoring and guidance to ensure their success. Engagement with nurses is ongoing and includes networking and conference sessions. In addition, a provincial nurse representative attends quarterly meetings to discuss provincial issues and provides feedback to all clinics in the province.

We apply strict criteria to the selection of nurses, who must comply with our five-year enterprise development agreement which covers patient confidentiality, compliance with health regulations and legislation, and the responsible use of products. Compliance is monitored through operational and financial audits.

A confidential feedback facility and complaints line are available to patients. Facebook and Twitter are additional engagement channels and each nurse has her own Facebook page and Google Maps review page. Unjani Clinics non-profit company (NPC) monitors and manages all engagement mechanisms and follows up with nurses when complaints or negative feedback are received. In general, patient feedback is positive with the most common complaint being that the waiting areas are too small. Some nurses have funded the expansion of their waiting areas and we continually redesign the infrastructure to ensure the best use of space and that patients are comfortable.

Unjani Clinics NPC operates 63 clinics funded through the enterprise development spend from Imperial Logistics (25 clinics), Johnson & Johnson (11 clinics), Rand Mutual Assurance (two clinics), Tiso AEL Development Trust (four clinics), Pfizer South Africa (two clinics) and the Jobs Fund (20 clinics). The network provides primary healthcare to more than 35 000 patients a month in eight provinces.

With support from the Jobs Fund, the network will expand to 70 clinics by December 2019, reaching approximately 500 000 patients annually. Our fundraising efforts have secured a commitment from Johnson & Johnson for R1,5 million each year to 2021. Pfizer South Africa and AVI have agreed to each fund a new clinic in 2020.

Unfortunately two clinics were closed during the reporting year. The pilot bricks and mortar clinic at Pretoria’s Bosman train station was closed after 11 months and we learnt two valuable lessons. First, the lack of opportunity to own the clinic impacted the nurse’s motivation, and second, primary healthcare needs are better served in communities rather than along commuter routes. Unjani Clinic Mogogelo in the North West province was also closed after four years of operation as the population in the area is too small to sustain the clinic. Affected patients have been referred to other clinics in the vicinity.

Additional funding from the Pfizer Foundation was used to train new nurses and equip facilities with additional basic sonar machines. Sonar scans are now offered in 57 clinics and an average of 676 ultrasounds are performed each month, with 17 500 ultrasounds provided since 2017.

We continue to work with local partners like the Aurum Institute – a leading health impact organisation – to provide free HIV screening and pre- and post-test counselling. During the year, we extended the HIV service offering in Gauteng to Tshwane and are in talks to develop local partnerships in the City of Johannesburg and the West Rand. We have also applied to the National Department of Health to have the network registered as a service provider of its Central Chronic Medicine Dispensing and Distribution programme, enabling state patients to collect prescribed antiretrovirals at an Unjani Clinic.

The Imperial and Motus Community Development Trust contributes to education in South Africa by investing in fully resourced libraries for public schools, primarily in underprivileged communities in Gauteng. In celebration of the legacy of Nelson Mandela, the Trust opened a newly built library and resource centre at Elsie Ngidi Primary School in Chiawelo, Soweto, on 18 July 2019. The libraries are open daily until 16:00 as well as on three Saturdays of every month.

Each child from grade 1 to grade 6 must attend two compulsory reading periods every week. Reading levels are tested every two years and, to date, the assessments have shown that the compulsory reading programmes and related activities (such as book clubs, book quizzes and spelling competitions) are contributing to better than average reading, comprehension and numeracy scores.

The Trust employs two qualified teachers to upskill educators on how to use the resource centres and equipment. Pleasingly, educator motivation is increasing as a result, and the presence of our teachers has helped us understand the level of teaching delivered, how equipment is used, and where there are opportunities for improvement.

The library assistants are previously unemployed people from the local communities who have completed matric and are provided with in-house training by the Trust. The project has also helped to grow two small businesses offering signage and building services.

The Trucking Wellness programme is a network of 21 primary healthcare roadside wellness centres along major routes, as well as a fleet of seven mobile wellness centres that travel across South Africa to visit road freight companies. We support additional permanent roadside wellness centres – one in Tugela and the other in Ventersburg – for drivers who do not belong to the NBCRFLI Wellness Fund Health Plan.

Visitors to the centres can access free primary healthcare services and other support from registered nurses and counsellors. The centres operate mostly at night, which is the most convenient and accessible time for long-distance truck drivers. Wellness services are available to truck drivers, their partners, commercial sex workers and the broader community. Imperial Logistics is the largest contributor to the initiative.

The programme also provides medical insurance for bargaining council employees, with employees contributing 1% of their salary to the fund and Imperial Logistics matching this. For the reporting year, our employer contribution to the NBCRFLI Wellness Fund Health Plan totalled R7 million. The fund provides members and up to two eligible spouses with access to certain medical benefits. Drivers testing HIV positive are immediately referred to the fund’s HIV Treatment programme at no additional cost.

During the year, there was a 16% increase in the uptake of HIV counselling and testing services across the wellness centres and the two Imperial Logistics-sponsored centres, with more people enrolling in the HIV Treatment programme. The decrease in the number of people treated at the Imperial Logistics-sponsored centres is due to the sale of the Imperial Logistics Mooiriver centre last year and unrest on the N3, which impacted the Tugela centre. The Ventersburg centre was relocated during the year due to decreasing visits and we foresee an improvement in the reach of the centre in the coming year.

Helping hearing and deaf people communicate

With funding from Imperial Logistics, the Mbula Research and Development start-up is teaching coding to deaf students and helping them find work. During the year, students attending the year-long course created Reah, an app that bridges the communication barrier between hearing and deaf people. The app helps users learn to sign, communicate with a deaf person using an interpreter and find a sign language interpreter.

If help with a translation is needed, the app can be used to stream a live video of a deaf person signing to the Mbula call centre and an agent will provide a transcript. The service is offered between 8:30 and 16:30 during the week. The app’s creators are hoping to use artificial intelligence for live translation to extend the service beyond office hours.

As part of the project, industry-specific words such as “download”, “cloud” and “database” – which do not exist in sign language – were created in collaboration with sign language experts and deaf people. This is a unique feature of the app.

A children’s version of the app includes sign language-based games. The Android app is available in the Google Play Store and an IOS version is being developed.

The Sinawe Fund – an enterprise and supplier development intervention – aims to grow and develop two black-owned small businesses in our supplier network through growth capital and business support, and enable the transformation of a white-owned transport company. Going beyond transforming our own supply chain, we are promoting the Sinawe Fund to our clients to achieve transformation at scale in the transport and logistics sector.

Awethu provides black-owned equity and its share in each business will be retained for a minimum of five years. The fund provides technical and general management support customised to a beneficiary’s individual growth stages and development gaps. In addition, SMMEs receive exposure to black talent to support their succession plans. Over and above our investment in the fund, we provide the SMMEs with specialist logistics mentorship and access to markets through our procurement processes and supply chains.

The SMMEs’ financial statements, B-BBEE ratings and legal compliance are monitored monthly, the number of jobs created is tracked and we evaluate the work undertaken for Imperial Logistics.

Targeting fast-growing strategic suppliers with turnovers of less than R50 million, the fund has made the following three deals:

• A 26% stake in Engamanzi Transport: a 51% black women-owned transport company specialising in tanker transport for Imperial Logistics as well as several fast-moving consumer goods manufacturers. The business operates routes in South Africa and Mozambique and has good growth potential.
• A 26% stake in Kagiso Tarpaulin & Net Manufacturers (Kagiso): a 74% black women-owned business that manufactures, cleans and repairs tarpaulins, tautliners, cargo nets, branded curtains, cargo equipment and trailer accessories, and which is a longstanding service provider to Imperial Logistics.
• A 51% stake in Canterbury Transport: a white-owned transport and logistics operator that specialises in the supply of heavy-duty vehicles, and which is a longstanding supplier to Imperial Logistics’ managed solutions business. The deal will help the business achieve its transformation objectives, enhancing black ownership and bringing a new black manager into the team who will be trained for a leadership position.

Since these deals were made, all three businesses have grown their revenues and their outlooks remain positive. However, increased operating costs, particularly for Engamanzi Transport and Kagiso, have resulted in lower than expected earnings. Cost management plans have been put in place for both companies and are monitored monthly. A portfolio manager has been assigned to Kagiso to assist with cash flow management. During the year, Kagiso employed an additional 16 people and has moved to bigger premises to accommodate the growing demand for its products. Canterbury Transport's extensive recruitment process has sourced a suitable black candidate, who will be legally incorporated as a shareholder at the end of September 2019.

Despite initial teething issues, particularly around meeting shareholder expectations and reporting requirements, we are pleased with the progress made during the year. We expect to see improvements in the coming year along with the first set of dividends from the portfolio. Going forward, the focus will be on improving financial management and reporting processes and monitoring targeted strategic interventions to ensure that each business is able to sustain its progress.

The response from investees has been positive and the project is also receiving interest from young black entrepreneurs wanting to leave their corporate jobs and join an SMME for a meaningful equity stake. A key lesson learnt is that many successful SMMEs operate with a very high client focus, sometimes at the expense of tight administrative, procedural and financial control. Key to achieving success is finding ways to professionalise these businesses without losing their entrepreneurial culture.

Worldwide Healthcare has invested USD1 million over a four-year period in the new world-class eye hospital in Abuja, Nigeria. The state-of-the-art facility uses the Aravind Eye Care System (AECS) to provide affordable specialised ophthalmology services. At full capacity, the hospital is able to perform 15 000 surgeries annually. Revenue generated from the care provided to paying patients is used to cross-subsidise community services. The hospital employs 51 people, 30 of whom are healthcare professionals who have received eight months of AECS training in India.

Outreach camps are undertaken weekly to identify underprivileged patients needing cataract and other eye surgeries in communities within a 100 kilometre radius of Abuja. Transportation to and from the hospital, surgeries, boarding and lodging, medication and post-operative review are provided to these patients free of charge. Worldwide Healthcare provides funding to the outpatient clinic. Phase one of the project comprises 54 beds of which 40 are for free surgeries, 12 for paying patients and two in an intensive care unit.

Since the opening in January 2019 and mid-June, 754 surgeries had been performed, of which 635 were at no-charge, benefiting the poor. A total of 5 376 outpatients were treated, excluding patients seen at the outreach camps.

The prevalence of vision impairment and blindness in Nigeria is reportedly among the highest globally, with an estimated 4,25 million adults older than 39 being visually impaired or blind. Since 1992, the non-profit Tulsi Chanrai Foundation has established five eye centres in Nigeria and restored the vision of 110 000 people.

Future plans for the facility include increasing its capacity to 100 beds, provided the hospital achieves optimum utilisation, and establishing a training programme for all levels of eye care. Primary and secondary eye care centres are also in the pipeline.

In line with Nigerian regulation, the project received an Environmental Impact Clearance Certificate prior to construction. During the construction phase, focus was placed on maintaining and nurturing the trees in the area, and energy efficient light-emitting diodes (LEDs) have been used within the facility as far as possible.

Worldwide Healthcare’s employees are able to give back to their communities by sponsoring eye surgeries.

During the reporting period, international aid organisations again turned to our sourcing and procurement business, Imres, which specialises in the delivery and warehousing of emergency supplies. The Netherlands-based company has 35 years’ experience in supporting NGOs, governments and aid agencies execute their emergency relief programmes. It keeps stock of prepacked Interagency Emergency Health Kits (IEHK) – standardised kits of essential medicines, supplies and equipment – ensuring that these supplies get to areas affected by disease as well as man-made and natural disasters as swiftly as possible. One kit is able to meet the basic health needs of 10 000 people for approximately three months.

The eruption of Guatemala’s Fuego Volcano in 2018 and the more recent torrential rain, severe flooding and strong winds of cyclones Idai and Kenneth in southern Africa, left hundreds of thousands of people homeless and in need of essential supplies and life-saving medicines. We supplied IEHKs to health facilities in Guatemala and Mozambique, and also delivered reproductive and cholera kits to Mozambique.

We are supplying cholera kits in the ongoing humanitarian crises due to famine and cholera in the Republic of Yemen and certain areas in sub-Saharan Africa, and are supporting the humanitarian aid efforts to assist the ongoing refugee crisis in Yemen and Syria. In Venezuela, the evolving crisis has resulted in a deterioration of the healthcare system and people are increasingly dependent on international aid. We are supplying IEHKs as well as non-communicable disease, midwifery and anti-diarrhoea kits, serving at least 1,4 million people.