Business Plan Heri Wema Health Centre

Maternity Ward Including a women’s and children’s ward

Carolien Abheiden M.D. December 13th, 2015

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Contents

Introduction .................................................................................................................................................. 2

Author ....................................................................................................................................................... 2

Kenya ............................................................................................................................................................ 3

General information ................................................................................................................................. 3

Geography ............................................................................................................................................ 3

Politics................................................................................................................................................... 3

Population ............................................................................................................................................ 3

Education .............................................................................................................................................. 4

Income .................................................................................................................................................. 4

Healthcare in Kenya .................................................................................................................................. 4

Nairobi ...................................................................................................................................................... 5

General information ............................................................................................................................. 5

Healthcare in Nairobi ............................................................................................................................ 5

Private hospitals ................................................................................................................................... 6

Public hospitals ..................................................................................................................................... 7

Ruai ........................................................................................................................................................... 7

General information ............................................................................................................................. 7

Healthcare in Ruai ................................................................................................................................ 8

Birth centres in Ruai ............................................................................................................................. 9

Plans for the Maternity HWHC ...................................................................................................................10

Business model canvas ...........................................................................................................................10

Floor plan ................................................................................................................................................11

SWOT analysis ........................................................................................................................................12

Legislation and regulations in Kenya with regard to healthcare ................................................................13

Licences ..................................................................................................................................................13

Inspection ...............................................................................................................................................13

NHIF ........................................................................................................................................................13

Planning ......................................................................................................................................................14

Focal areas ..................................................................................................................................................14

Financial model...........................................................................................................................................15

Investment ..............................................................................................................................................15

Human Resources ...................................................................................................................................16

Financial projections ...............................................................................................................................17

Conclusion ..................................................................................................................................................18

References ..................................................................................................................................................19

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Introduction

This document contains the business plan for the Heri Wema Health Centre (HWHC) and was prepared on the authority of the Talud Foundation. This business plan is the result of five months of part-time research to determine whether it would be feasible to construct a maternity ward in Ruai. The initiative for HWHC originated with Marjolein van der Kolk and Wasilwa Lusweti and forms part of the larger project initiated by the Watoto Wema Centre (WWC). WWC is a children’s home in Ruai, a town just outside the capital city of Nairobi, which offers a safe haven to children between the ages of 2 and 17. The project is largely dependent on contributions and donations and in order to reduce this dependence, WWC has organised activities to generate additional income. The HWHC is one such initiative that should generate additional income. The HWHC opened an outpatient clinic on the WWC premises in May 2015. During the construction of the outpatient clinic, a designated space for the maternity ward was reserved (on the ground floor).

We focused on the following research topics:

Various visits and discussions with the initiators;

Getting acquainted with and working at the healthcare clinic;

Visiting various public and private hospitals and clinics in Nairobi;

Visiting companies/organisations active in the medical sector (such as Philips);

Holding discussions with local and international gynaecologists and physicians in Nairobi;

Carrying out interviews with women who have given birth in Nairobi;

Taking part in the Net4kids project trip to Tanzania/Kenya where, for example, the WWC business case was discussed;

Visiting government healthcare institutions in Kenya.

Desk research.

The business plan consists of a number of chapters. The first part is an introduction to the country of Kenya and healthcare provisions in both Nairobi and Ruai. We then focus on the project and feasibility of the HWHC.

Author

The author is Carolien Abheiden, a physician with two years of work experience as a midwife and gynaecologist in both the Netherlands and Indonesia. Carolien is currently working on her PhD with research topic: ‘Anticoagulant use to prevent pre-eclampsia in high-risk women’. Carolien will be starting the Gynaecologist degree programme at the VU University Medical Center Amsterdam in April.

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Kenya

General information

Geography Kenya is situated in East Africa and borders Somalia, Ethiopia, South Sudan, Uganda, Tanzania and the Indian Ocean. Politics Following its independence in 1963, Jomo Kenyatta was president until his death in 1978. Daniel Arab Moi was then elected president and there was only one party (Kenya African National Union; KANU) until 1992. Elections were held in 1992 and 1997, which were marred by violence and fraud. The outcome, however, was considered the will of the people. In 2002, President Moi stepped down and was succeeded by Mwai Kibaki, who was the leader of a new party (National Rainbow Coalition; NARC). During the election, Kibaki defeated Uhuru Kenyatta (son of Jomo Kenyatta) from the KANU party. During the 2007 elections, the political parties KANU and NARC formed a coalition (along with a number of other parties) called Party of National Unity (PNU) and Kibaki came into power again. The 2007 elections were tainted by considerable violence, which resulted in 1,500 casualties within a two-month period. In the aftermath of the elections, charges were brought against Uhuru Kenyatta and William Ruto by the International Criminal Court in The Hague, as both were considered key individuals responsible for the violence. During the most recent elections in 2013, Ruto and Kenyatta formed a coalition, having been rivals in 2007. They defeated Raila Odinga’s opposition coalition party with a slight majority. In the meantime, the case against President Kenyatta was dismissed by the ICC, but the charges against the sitting Deputy President Ruto are still ongoing. Population Estimates put the local population at 45,925,301 inhabitants, comprised as follows:

The annual population growth rate is 1.93% and the life expectancy of men at birth is 62.3 years, while that of women is 65.3 years (2015). The two most prominent religions are Christianity (82.5%) and Islam (11.1%), and a majority of the Islamic population lives along the coastal region. There are also 42 tribes in Kenya and the three largest are: Kikuyu (22%), Luhya (14%) and Luo (13%).

41,56

18,66

33,17

3,76 2,850

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10

15

20

25

30

35

40

45

0-14 15-24 25-54 55-64 65 and over

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CEN

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AGE CATEGORY

Age distribution

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Education A total of 78% of the population age 15 years and over can read and write (81.1% male, 74.9% female). The average age at which children stop attending school is 11 years (both boys and girls), and around 6.6% of the GDP is allocated to education. Income Although Kenya’s economy is growing strongly, approximately 44% of the population lives below the poverty line of USD 1.25 per day. In addition, 16.7 million Kenyans (37%) live on USD 1.25 – USD 4 per day. Part of this group that earns between USD 2-4 per day is considered the floating middle class. This means that they belong to the middle class, but during difficult times they are the ones who are vulnerable to falling below the poverty line. It is estimated that 16.8% of the population falls under Kenya’s middle class and lives on between USD 4 and USD 20 per day.

Healthcare in Kenya

The table below provides insight into Kenya’s most important healthcare statistics compared to those of South Africa and the Netherlands. These countries have been included in the table in order to put Kenya’s figures into perspective. The Netherlands is considered one of the best-performing countries in the world when it comes to healthcare. South Africa, on the other hand, is one of the leading countries in Africa.

HEALTHCARE STATISTICS Kenya The Netherlands South Africa

Healthcare costs as % of GDP 4.50% 12.50% 8.50%

Physicians per 1,000 inhabitants 0.2 3 0.6

Hospital beds per 1,000 inhabitants 1.4 5 3

Birth rate per 1,000 inhabitants 26.4 10.83 18.94

Mortality rate per 1,000 inhabitants 6.89 8.57 17.49

Number of children per woman 3.31 1.72 2.41

Infant mortality per 1,000 live births 39.38 10 34

Underweight children up to 5 years 16% <1% 9%

Maternal mortality per 100,000 births 510 7 138

The table shows that investments into the healthcare sector lag far behind, for example, South Africa’s investments. The number of physicians and hospital beds per 1,000 inhabitants confirm this as well. Also, Kenya does not perform well in the area of birth care. Approximately 39.38 children per 1,000 live births die yearly and there are around 510 maternal deaths per 100,000 births. Maternal mortality during childbirth is considered a global issue and has therefore become one of the UN Millennium Development Goals (no. 5). Despite the fact that the maternal mortality rate has dropped by 44%, the goal of 75% was not reached. In 2015, around 303,000 mothers passed away during childbirth worldwide, of which 201,000 in sub-Saharan Africa. Around 10 countries, i.e. 59% of the total, are responsible for the maternal mortality rate. In 2014, Kenya ranked 7th, with a total of 8,000 mothers passing away during childbirth. Lastly, HIV/AIDS is a large problem in Kenya. Kenya ranks 13th in the world, with a prevalence rate of 3.5%. Moreover, there are around 1.4 million Kenyans that live with HIV/AIDS and around 33,000 people (2014) die annually as a result of this disease.

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Nairobi

General information Nairobi’s population is estimated to be 3.6 million inhabitants, of which 60% live in slums. The number of inhabitants in Nairobi is increasing tremendously because many people move from the countryside to the city each year. The male to female ratio in Nairobi is 50/50. Nairobi is the 14thlargest city in Africa and the 2nd largest city in East Africa after Dar-Es-Salaam (Tanzania). Nairobi is a regional hub for companies and organisations. This means that more than 100 (large) international organisations are located in the city, including the headquarters of UNEP and UN-Habitat. Healthcare in Nairobi

Hospitals in Nairobi can be divided into private and public hospitals. The most important private hospitals are:

The Aga Khan University Hospital;

The Nairobi Hospital.

And the most important public hospitals are:

Kenyatta National Hospital;

Mama Lucy Kibaki Hospital;

Pumwani Maternity Hospital.

The map below shows where the hospitals are located.

Detailed statistics pertaining to healthcare for Nairobi is not readily at hand.

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A number of statistics (somewhat outdated) are as follows (data dates from 2012):

Additionally, women in Nairobi believe that HIV/AIDS, unwanted pregnancies and abortion are the three prominent issues that play a role in birth care. Around 80% of Nairobi women ultimately choose to give birth in a healthcare clinic. Private hospitals In general, the more well-off middle class, the Kenyan elite and expats choose to give birth in a private hospital. These hospitals have put together a special package for this target group. The Nairobi Hospital, for example, offers two delivery packages:

Standard package:

6 check-ups during pregnancy and iron supplements if needed;

Blood screening during the 1st trimester;

20-week scan;

Supervision and care during vaginal delivery;

1 check-up after delivery.

The cost of a standard package are Kshs. 98,000 (EUR 900)

Caesarean delivery

All of the above options from the standard package;

Caesarean section instead of vaginal delivery

The cost of this package are Kshs. 220,000 (EUR 2,000) Giving birth in the Aga Khan University Hospital costs USD 2,000 (EUR 1,800). This amount does not include check-ups or medication. Please note that maternity care is not being provided in Kenya. This means that, after giving birth in a private hospital, women spend a few days longer in the hospital to recover from the delivery.

Birth rate 32.9 births per 1.000 inhabitants

Childeren 3.5 per woman

Neo-natal mortality (<28 days after birth) 14.4% in the slums

Maternal mortality 7.06% in the slums

Contraceptive prevalence 40.1%

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Public hospitals The documentary Birth Day by Lieve Blanquaert provides important insights into the mother/child care in public hospitals in Nairobi. It shows how deliveries take place at the Pumwani Hospital in Nairobi. http://www.npoplus.nl/play/birth_day/2015-06-28/VPWON_1240768/191437

The three pictures portray the care that public hospitals in Nairobi provide. These pictures were taken by Lieve Blanquaert and published in her book Birth Day. The pictures show that several women (sometimes also with their newborns) have to share a bed. There is also little to no care or supervision provided during childbirth, so in many cases women have to endure delivery on their own. Moreover, women are treated in an unfriendly manner (sometimes even harshly) by the nursing staff and crying and screaming is forbidden. A reason for this

behavior lies in the fact that the workload of the nursing staff is very high. In the Pumwani Hospital, around 50 infants are born per day and an average of 120 infants per day in the Kenyatta Hospital. By comparison, an average of 8 infants are born per day in the OLGV Amsterdam, one of the largest hospitals in the Netherlands.

Ruai

General information Ruai is part of Nairobi and is located just outside the city. This neighborhood is growing rapidly because it is fairly affordable to live here and you can easily access the town centre from here. There are no recent statistics available for Ruai. The last census was conducted in 2009 when around 35,961 people lived here. Ruai forms a part of the Kasarani district in Nairobi, where an estimated 200,000 – 250,000 people live. Kasarani is a popular area to live in because it is situated on the outskirts of the industrial heart of Nairobi.

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Healthcare in Ruai Reliable statistics on healthcare in Ruai are difficult to obtain or unavailable. That is why the information is this chapter is limited and some assumptions are made based on the broad statistics of Nairobi/Kenya.

The following clinics are active in Ruai and the surrounding area and are also shown on the map below:

Heri Wema Health Centre;

Ruai Family Hospital;

Adolife;

Reinha Rosary;

St. Raphael’s clinic (no maternity care, only outpatient care).

The birth rate for Ruai was 256 babies in 2013 and 304 in 2014. This indicates a growth of 18% in one year’s time. These statistics were provided by the Ruai Family Hospital, a clinic that provides care to the wealthier part of Ruai. These statistics, however, do not include the following two groups:

Women who live in Ruai, but have not given birth in Ruai. This is an important group because they are diverted from Ruai to hospitals in Nairobi for delivery. In the future, these women could give birth at the HWHC. Women would be able to deliver their babies in their own city for an affordable fee.

Women who live outside of Ruai and give birth either at home or at their local clinic in Nairobi. These women may also be interested in giving birth at the HWHC. Having a good reputation would attract people from outside of the immediate area.

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Based on Ruai’s population (2009) and the birth rate of 32.9 per 1,000 inhabitants in Nairobi, it can be concluded that around 1,183 children are born in Ruai each year. There are around 6,580 births in the entire Kasarani district. Based on population growth, urbanisation and Ruai being an attractive location, it is reasonable to assume that the number of births is currently higher due to the increasing number of inhabitants. It is also plausible that this number will continue to increase in the future because the number of inhabitants in Ruai is expected to increase even more. Birth centres in Ruai

There are a number of birth centres in Ruai and the surrounding area that the HWHC will have to compete with. These are:

Ruai Family Hospital: situated approx. 3 km from the HWHC. This hospital is intended for Ruai’s middle class. Compared to other clinics, the costs here are higher and this clinic therefore is not an immediate competitor.

Adolife: situated approx. 4 km from the HWHC - Facilities:

1 maternity ward with a normal bed (no leg support) and vacuum pump ;

2 post-natal wards with wider beds;

No Caesarean sections are carried out here. If needed, they refer the patients to other clinics;

Costs Kshs. 8,500 (EUR 75) per delivery and post-natal admission, Kshs. 100 (EUR 0.85) per consultation during pregnancy;

All in all, the clinic does not appear to be equipped for maternity care because there are, for example, no special beds available.

Reinha Rosary: situated approx. 10 km from the HWHC - Facilities:

1 maternity ward with a delivery bed; 2 post-natal wards with 6 beds;

Larger hospital with an outpatients' clinic with various specialist areas and hospital with 1 OR. Empty when visited;

Costs Kshs. 6,000 (EUR 55) per delivery and post-natal admission, Kshs. 100 (EUR 0.85) per consultation during pregnancy.

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Plans for the Maternity HWHC

Business model canvas

As part of the business plan, a business model canvas session was carried out by an external consultant. The business model canvas is a well-established method to provide insight into what lies at the core of the business plan. The canvas was discussed in detail with the initiators Marjolein and Lusweti. The outcome of the canvas model can be seen below:

An analysis of the business model canvas shows the following:

Target group/clients: the most important target group of the HWHC is women and children. This does not imply that men are not welcome (hospitalisation as a result of frequently occurring illnesses), but the focus is not on them. The care pertaining to women and children focuses on:

Family planning;

Birth care (check-ups, deliveries, post-natal check-ups);

Basic care (malaria, dehydration, etc.), including hospitalization;

The HWHC is planning to set up a private room in the clinic that can be used for patients with a need for privacy and who are willing to pay extra for this.

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The total market in Ruai and surrounding area is estimated at 6,580 births a year. Based on Kenya’s income statistics, women living below the poverty line will not be able to afford the care that the HWHC provides. The HWHC therefore focuses on women just above this line. It is reasonable to assume that no less than 50% of the inhabitants in Ruai live above the poverty line. This is a conservative estimate because the largest percentage of the 44% Kenyans living below the poverty line are located in rural Kenya. Based on this assumption, the target group consists of approximately 3,000 - 4,000 women per year.

Value proposition: the HWHC’s value proposition is to provide affordable care to (primarily) women and children, with a target group that feels safe and is treated respectfully.

Income: main income (+/- 65%) is generated by means of pregnancy healthcare packages consisting of check-ups, delivery and post-natal care. The cost of KES 7,000 (EUR 70) make the HWHC a competitive player and much more affordable than other competitive clinics in the area.

Additional income is generated by other healthcare provisions such as basic healthcare, including desired hospitalisation. In addition, the HWHC would like to set up non-medical activities related to pregnancy to generate income, such as selling clothes, nappies and breastfeeding products.

Costs: the most important and primarily costs for the HWHC are personnel costs (75%). The success of the HWHC is also based on the qualitative and quantitative staff because HR also needs to safeguard the clinic’s value proposition (safety/respect).

Floor plan

The floor plan of the HWHC was drawn up with the assistance of the Product Development Manager Mr Romijn of Koneksie B.V. in the Netherlands. See below:

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The facilities in the clinic are as follows:

Delivery room (for dilation, actual delivery and post-delivery);

Sick ward for children;

Sick ward for women (not related to pregnancy);

Private room;

Separate kitchen and laundry room.

There are three separate rooms for delivery, each focusing on a different stage of delivery (each room has separate requirements). Initially, there were also plans for a cold room (mortuary), but people tend to mostly associate this with a place where people die and this does not contribute to a positive image for the other activities in the clinic.

SWOT analysis

Based on:

Strengths Weaknesses

Initiators: see plenty of opportunities/ complement each other/driven/have proven success with the WWC.

Affordable and qualitative healthcare.

Organisational capacity (financially/admin) WWC umbrella.

Initiators have no medical background.

Opportunities Threats

Ruai is a rapidly growing region; this applies to both income and population.

Limited competitors: especially with regard to facilities for patient admission.

Competitors: potential new players can become competitors of the HWHC.

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Legislation and regulations in Kenya with regard to healthcare

This chapter focuses on the legislation and regulations in Kenya with regard to healthcare. Kenya is a strongly emerging market and recently the country climbed to 108 (from 129) in the World Bank's Doing Business rankings. Although this is a positive sign, there are still several obstacles pertaining to legislation and regulations.

Licences

In order to legally run a healthcare centre, the following two licences are required:

City Council Business License, certifying that the healthcare centre has been approved as a business;

Ministry of Health License, certifying the provision of healthcare.

An annual inspection takes place for both licences and they are renewed annually. Both licences are already possessed by the HWHC. For the maternity ward, an extra licence from the Ministry of Health would be needed in which inpatient care also needs to be approved. The current licence is only valid for outpatient care.

Inspection

As part of the abovementioned licences, an inspection takes place yearly and attention is paid to compliance with the regulations and overall cleanliness.

NHIF

The National Hospital Insurance Fund is the national health insurance where many Kenyans take out insurance. Membership fees are linked to income and costs vary between at least 150 and 1,700 shillings per month (EUR 1.20 euro to EUR 16). These mandatory costs are deducted from salaries. As some Kenyans work in the informal economy, not everyone is insured with NHIF.

The following costs are covered by NHIF health insurance:

Outpatient care, including:

Appointment with doctor or nurse;

Blood test;

Medication;

Family planning;

Physiotherapy.

Inpatient care, including:

Hospitalisation costs;

Nursing charges;

Medication;

Surgery costs.

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Maternity care, including:

Check-ups during pregnancy;

Delivery (including Caesarean section);

Family planning.

The HWHC is currently in the process of becoming affiliated with the NHIF as a hospital. Once this is finalised, this would mean that patients affiliated with the NHIF will be compensated for their insurance costs if they join the HWHC. This group is currently visiting other hospitals because, otherwise, they would have to pay the bill themselves since the HWHC is not yet affiliated with the NHIF. The NHIF inspection has already taken place and the HWHC is currently awaiting approval.

Planning

The initiators expect that it will take about 8 to 12 weeks to implement the business plan. During the first phase, the current floor plan will need to be updated, first by an architect, and after this has been done, the construction of the maternity ward can start. During the construction of the clinic, equipment needs to be purchased. The delivery time of this equipment might affect the total duration of the project. Finally, the maternity ward will need to be set up.

Focal areas

The following aspects are crucial to the successful implementation of the business plan:

Attracting competent personnel. The success of the clinic largely depends on the personnel. The question is whether the allocated salary budget will be enough to attract this kind of personnel.

The financial and administrative organisation: the accounting department and administration are currently weak points at the WWC. Since the organisation is growing, this aspect will be increasingly important with regard to possible NHIF status and the accompanying administrative duties. The importance of a proper administration was discussed during the project trip.

Legal & fiscal compliance: for the successful operation of the clinic, it must comply with all fiscal and legal requirements. As a clinic, the HWHC will also draw the attention of several government agencies. One specific point that should be taken into consideration is payment of the minimum wage to specific occupational groups.

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Financial model

This part of the business plan describes the expected investments and provides insight into the cost structure of the HWHC. A complete overview of the financial model can be found in the attachment to the business model.

Investment

The total expected investment in the HWHC is KES 7,974,543.00 (EUR 86,580). All investments will take place within one year and the initiators do not expect any additional investments to be needed in the five consecutive years. The table below provides insight into the investment and the two most important entries: construction costs and investments for medical equipment. The overview is based on actual quotes.

The exchange rate in the model below is KES 100 for EUR 1, which is a conservative exchange rate.

Investment Costs in KES Costs in EUR

Construction costs 3.538.457 35.384,60

Interior Setup 748.693 7.486,90

Medical Equipment 3.492.720 34.927,20

Beds and furniture 683.430 6.834,30

Human Resources 60.060 600,60

Registration fees 110.000 1.100,-

Marketing 24.613 246,10

Inventory (to sell) 24.613 246,10

Inventory (to start up) 251.240 2.512,40

Total 7.974.543 86.580,-

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Human Resources

The tables below provides an overview of HR. HR is the most important debit entry of the HWHC and plays a crucial role in the clinic’s success. The salaries are average numbers from Kenya. The nursing staff can perform nursing as well as midwife activities. An FTE in Kenya consists of 6 days a week and 8 hours a day. Two scenarios are described in the tables below. The maximal capacity scenario is based on the maximum number of deliveries that the clinic can handle. The minimal capacity scenario is based on the minimal availability during 24/7 operation of the clinic. The security guard is hired via an external party and costs KES 20,000 (EUR 200) per month for 24/7 security.

Max. capacity scenario:

Min. capacity scenario:

24/7 open FTE Average Total

per month Comments

Management 0.5 50.000 25.000 Management of Watoto Wema - average 50% involved

Nurse 7 40.000 280.000 4 during the day and 3 during the evening and night

Sonographer 0.5 56.000 28.000 8 hour a day - 5 days a week

Gynaecologist 0.2 300.000 60.000 One day a week - only for check-ups once a day (no deliveries)

Admin & Finance 1 25.000 25.000

Watchman 1 20.000 20.000

Cook 1 12.000 12.000

Cleaner 2 12.000 24.000 Healthy environment

Total 13 515.000 474.000

24/7 open FTE Average Total

per month Comments

Management 0.5 50.000 25.000 Takes care of finance & admin

Nurse 4 40.000 280.000 Minimum requirement for 24/7 operarion in 4 nurses

Sonographer 0.2 56.000 28.000 1 day a week

Gynaecologist 0 300.000 - Not needed in minimal capacity scenario

Admin & Finance 0 25.000 - Not needed/can be done by Watoto Wema staff/management

Watchman 1 20.000 20.000

Cook 1 12.000 12.000

Cleaner 1 12.000 24.000 Healthy environment

Total 8 515.000 240.200

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Financial projections

The model below provides insight into the expected financial projections for the next 5 years. The model consists of a minimal capacity scenario for years 1 and 2 and is based on an occupancy rate of 20% (year 1) and 40% (year 2). In year 5, the model assumes an occupancy rate of 85%. The model takes into account a financial construction in which 25% consists of a loan with a 5% interest rate and a grace period of one year on both the interest and principal. 75% of the public sector borrowing requirement is a donation.

Year 1 Year 2 Year 3 Year 4 Year 5

Medical revenues 4,275,300 8,550,600 12,825,900 17,101,200 18,170,025 Non-medical revenues 125,000 143,750 165,313 190,109 218,626 Total revenue 4,400,300 8,694,350 12,991,213 17,291,309 18,388,651 Medical costs 553,400 1,106,800 1,660,200 2,213,600 2,351,950 Non-medical costs 86,300 99,245 114,132 104,560 120,244 Total costs 639,700 1,206,045 1,774,332 2,318,160 2,472,194 Gross profit 3,760,600 7,488,305 11,216,881 14,973,149 15,916,457 Gross profit margin 85% 86% 86% 87% 87% Human resources 2,882,400 2,882,400 2,882,400 5,688,000 5,688,000 Administrative costs 88,006 173,887 259,824 345,826 367,773 Sales & marketing costs 220,015 434,718 649,561 864,565 919,433 Operational costs 220,015 434,718 649,561 864,565 919,433 Dep. & amortisation Operating profit 350,164 3,562,583 6,775,535 7,210,192 8,021,819 Operating profit margin 8% 41% 52% 42% 44% Financing fees - 92,775 66,580 40,385 14,189 Profit before tax 350,164 3,469,808 6,708,955 7,169,807 8,007,629 Taxes 1,040,942 2,012,687 2,150,942 2,402,289 Net profit 350,164 2,428,865 4,696,269 5,018,865 5,605,341 Net profit margin 8% 28% 36% 29% 30% Cash flow

350,164

2,428,865

4,696,269

5,018,865

5,605,341

Reimbursement

-

-523,908

-523,908

-523,908

-523,908

Reinvestment

Balance 350,164 1,904,957 4,172,360 4,494,957 5,081,432 Cumulative balance 2,255,121 6,427,481 10,922,438 16,003,870

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Conclusion

My personal conclusion is that the HWHC is a project with considerable potential. The initiators have shown that the WWC has proven to be a successful project. The projects are run with a great deal of joy, enthusiasm and commitment and this is subsequently expressed in happy orphans and the fact that the WWC is able to successfully attract funding from contributors time and time again. Thanks to the HWHC, the initiators get the opportunity to diversify income and therefore become less dependent on external financiers. In this way, the WWC and HWHC are frontrunners of sustainable development aid. With the proper financial and intrinsic support of external financiers, the HWHC can grow into a successful clinic that profits from both a financial and social return. From personal experience, I have seen that healthcare in Kenya is not very well-developed and lags behind compared the country’s economic growth. This is especially the case when it comes to care of pregnant women, as they are a vulnerable group in Kenya. The HWHC can make a difference by providing a place where women can be taken care of in a respectable and safe manner.

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References

https://www.cia.gov/library/publications/the-world-factbook/geos/ke.html

http://knoema.com/WBPS2014Jul/poverty-and-inequality-statistics-july-2014?country=1000780- kenya

http://www.unicef.org/kenya/overview_4616.html

http://data.worldbank.org/country/kenya

http://www.businesstoday.co.ke/news/opinion-and-analysis/1429074876/kenyas-middle-class- illusion

http://blog.iese.edu/africa/2014/10/15/kenyas-middle-class-and-economic-growth/

http://aphrc.org/wp-content/uploads/2014/08/NCSS2-FINAL-Report.pdf