Expanding primary care access in South Africa

Tebogo Maimela’s 80-year-old grandmother has never seen a doctor. Tebogo, herself a nurse,  grew up in a rural village in South Africa, about 300 kilometres from where she runs her own primary care clinic in Gauteng. There were only two clinics for every three villages where she grew up, all run by nurses. “We are carrying out the healthcare system in South Africa,” she says.

In 2022, after a decade of working in public health, Tebogo opened her own primary care clinic, as part of the Unjani Clinic Network, which is funded to empower female African nurses to own and operate primary care clinics, helping to build a sustainable network of care in areas of great need. “I had reached my level of growth and learning, and wanted to be in a different setting, but still in patient care,” she says. “I wanted to be an entrepreneur by opening a clinic.” 

The need for more primary care facilities in South Africa is “overwhelming,” Tebogo says, particularly for women. Government clinics are only open from 8 am to 4 pm —primary working hours— and even those who can take time off from a job without being penalised must line up at 4 am to be seen, a time when it is risky for a woman to wait outside a city clinic in the dark. “It’s difficult for working mothers to access healthcare,” Tebogo says. It’s also hard for the many immigrants to the city, who are usually not accepted at government clinics and turned away when they cannot produce a passport or identification. 

Instead, Tebogo’s clinic is open after usual working hours and on weekends. It’s affordable and patients are not asked about immigration status. “We’re a clinic of last resort,” she says. While the clinic is open to both men and women, 90% of her clients are women and children. In other clinics, young women are often stigmatised for asking for contraceptives, but Tebogo offers them a safe space for their medical needs.  

“We are not judgmental, which means that the young lady will come back to us with other problems,” she says. “When you win that young woman over at the first visit, you win them for life.” Those women will be more likely to get prenatal check-ups and take preventive measures to avoid unwanted pregnancies, STDs and HIV. They are also more likely to be screened for breast cancer and other diseases because they trust the nurses at the clinic.

Roche is there as a funder to help make it possible for nurses like Tebogo to be able to open her clinic and make sure the fees are affordable to most people. “Unjani Clinics NPC literally helped set up the clinic, getting the structure and the medications ready, so you just have to come in with your clinical skills.” Unjani Clinics NPC, which supports over 220 care settings in South Africa, also provides business and administrative support in running the clinic.

Tebogo’s clinic is also unusual in that it has an advanced breast cancer diagnostic machine, a wireless ultrasound imaging machine. The partnership with Roche and Unjani will also enable breast cancer awareness creation and education. South Africa has one of the highest rates of mortality from breast cancer. “It’s lack of access to care, lack of knowledge and delay in getting treatment,” she says.

With the portable breast cancer screening tool, nurses can diagnose diseases easily and early. When they do find evidence of cancer, a referral network allows patients to be seen by a specialist right away.

“Before, we saw a patient whose treatment had been delayed for three years because she couldn’t get an appointment with a specialist, and couldn’t get transportation to that clinic,” says Tebogo. “We not only do early diagnosis, but we provide transportation from their homes for treatment.”

Tebogo’s clinic sees about 1,000 patients per month, many of whom would otherwise have delayed medical care or would have simply gone without.

Tebogo is proud to have removed barriers in healthcare by becoming a nurse-owner of a business and is inspired by the women in her life. “I always look at my grandmother, who never had an education, but ran an informal business to support her family.” Her family gives her the strength she needs to work long hours every day. “When you go out in the world and try to make a difference, sometimes you come home broken, and they literally hold my hands.”

Inspired by her mom, Tebogo’s daughter dreams of becoming a doctor. Tebogo hopes that in the future, because of efforts like hers, there will be greater inclusion for women throughout South Africa — in employment, allowances for pregnancy at work, decision-making, and every aspect of society.

She has another hope. “I’d like to open a clinic in the village I came from, and give back to the people there,” Tebogo says.  “I’m grateful to have the opportunity to do what I love and make an impact on people’s lives.”