Diploma in Health Planning, Policy and Finance (HPPF) alumna (1995) Elizabeth Sheehan founded Care 2 Communities (C2C) in 2008. At the time, having worked as a physician’s assistant in the developing world for more than 10 years, she saw women and children dying, and families falling apart, simply because they had no access to care. Elizabeth consulted with health and development experts to explore innovative solutions, and came up with a concept: convert the surplus of used shipping containers around the world into clinics. C2C ensures these clinics provide comprehensive primary care and education closer to where women and children live. The clinics offer quality pharmaceuticals and a lab where patients can get accurate results and diagnoses on-site. C2C hires talented local clinicians who are a part of the communities in which they work. C2C builds a strong supply chain and efficient operations so the clinics are open to serve families every day. Elizabeth refused to accept the status quo and instead combined quality services and innovative design. Since she founded the organization, C2C has opened three clinics – two in Haiti and one in Namibia, which have served more than 15,000 women and their families. Learn more about the work of C2C in this alumni report written by Elizabeth Sheehan.
In poor countries like Haiti, the major causes of death and disability are treatable, preventable illnesses. The need for accessible, affordable primary care is urgent. According to a study from the World Bank, interventions at the primary care level are able to address 90% of community health care demands (Doherty & Govender, 2004). In fact, a health system based on strong primary care delivers better health outcomes at lower cost (Starfield et al., 2005). Primary care affords greater accessibility to the community, especially the poor.
In 2013, Care 2 Communities launched a social enterprise model for primary health care delivery to low-income communities in northern Haiti: one of the most challenging global markets for healthcare operations. The need for high-quality, community-based care is urgent: government facilities are under-resourced and care standards are low, operations costs are high, and market forces are distorted by an influx of subsidized, intermittent operators that do not meaningfully or reliably reach those in need.
Using the social enterprise model (Figure 1), Care 2 Communities seeks to deliver high-quality health services to poor and low-income families in Haiti. C2C is a fundamentally “mission-driven” organization which has borrowed elements of a private-sector operating model. This is because we believe that Haitian families need and deserve a reliable, long-term solution to their health challenges — a solution that cannot be achieved through donor funding alone.
Poor families are made more vulnerable by inconsistent or unreliable health service providers. We intend to change that. By running clinics as social enterprises, C2C offers something unique and important to our patients: a guarantee that low-cost, high-quality services will keep the community healthy. C2C offers quality services at the lowest possible cost, and uses these affordable patient fees to support clinics consistently. Focusing on primary care “brings the greatest benefits to the health of families and communities”. Mothers are able to care for their children, children can stay in school, and the entire community will benefit from a healthy workforce.
Maylennie’s story highlights the impact C2C clinics have on the communities in which they serve:
Maylennie is just over two years old. Her mother was 22 years old when she was pregnant with Maylennie and her twin, who did not survive past four months. As Maylennie’s father lives in the bordering Dominican Republic and can rarely afford to send money home to his family, her mother struggles with caring for her four children on her own. Since birth, Maylennie has experienced numerous health issues. She was hospitalized at two months of age for weight loss and skin infections, but her health never really improved.
Last August, Maylennie was the first child to join C2C’s malnutrition program. On her first day, she weighed 6.8kg (14.9 lbs) and had an arm circumference of 11 cm and edema on her feet, both clear indicators of Severe Acute Malnutrition (SAM). After 12 weeks in the program, Maylennie reached a target weight of 8.6 kg (19 lbs) and her health has significantly improved, with her playful personality showing.
With the personalized nutrition education Maylennie’s mother received, along with continued support from community health workers and C2C medical staff, we know that Maylennie now has a fighting chance for a healthy future. In a landscape of under-resourced, low-quality clinics, C2C sets itself apart with a commitment to the highest standard of care, from nutrition support for little ones like Maylennie to using a social business model to ensure that care can continue to be accessible for poor families that need it most.
For more information on Care 2 Communities, please visit their website at care2communities.org.
Doherty J, Govender R. Washington: World Bank, World Health Organisation, Fogarty International Centre of the U.S. National Institutes of Health; 2004. The cost-effectiveness of primary care services in developing countries: a review of the international literature. Working Paper No. 37. Disease Control Priorities Project.
Contribution of primary care to health systems and health. Starfield B, Shi L, Macinko J. Milbank Q. 2005; 83(3):457-502.
Images courtesy of Elizabeth Sheehan