Building Blocks

Everyone always asks me why I started a company. Journalists, investors, family members. “Were you scared?” They ask.

For a while I didn’t get it. Starting Access Afya seemed to me like the most obvious thing to do. Ten years on, with the knowledge of how hard it was and how long it took, I am starting to understand. 

Not one single a-ha moment 

So why did I do it? When I think about the years before I started Access Afya, I think about walking around interesting streets. It might not appear to logically lead to starting a digital health business in Africa.

I think about getting lost in Shanghai, captivated by eels and eggs in buckets on the ground and strings of lights and wet clothing drying. I went to Shanghai for an NYU course. I was studying Public Administration and leading some work around microfinance. Microfinance is a strategy for using social capital instead of assets to guarantee loans, opening up an entirely new base of creditworthy customers. In China I was learning about credit and investment options available to people, but I was really learning about how it felt to be in a fast changing city. 

Or I think about the Valley Arts District in Orange, New Jersey, going to Gamburgers and talking to the owner over a burger and coffee cake about how the neighborhood was changing. I was walking around Orange, New Jersey when I was working at Emerging Markets, a consulting firm building place-based investing strategies for the emerging markets of the United States. A place based approach looks at a community's comprehensive needs. It expects the overlap between housing, schooling, jobs and access to food and healthcare. My project was working with a corporate philanthropy on shifting from issue based philanthropy (“We fund the arts”, for example) to one that was centered around the comprehensive and overlapping needs of specific communities.

I learned about this approach and I was hooked. I had never felt satisfied when I thought I needed to pick a career specialized on one issue. I could focus on places instead. 

When I took the leap from this stimulating and fun lifestyle in the East Village to start my first business in Nairobi, Kenya, it wasn’t because of a singular “a-ha” moment but rather a series of experiences and decisions that made entrepreneurship the inevitable path for me. Before I had “the one idea” that formed the basis of my company’s business model, two things had become crystal clear to me:

1. Cities could be places of opportunity, but could also reinforce cycles of inequality.

This truth is felt especially acutely in the informal settlements where half of our global cities exist. In an increasingly urbanizing world, one of the most important challenges of our time is how we are going to formalize opportunities and the delivery of essential services in the world’s informal settlements. Kenya has a lot of these settlements, and I knew people and artists working inside of them.

2. “Micro” innovation applied elsewhere could similarly disrupt the delivery of other essential services.

I started to work on micro health partially because of how hard it was— I always loved a challenge. I saw how quickly technology was moving in the health sector, yet how technology adoption was happening at a glacial pace. 

The Neighborhood Health Model

Where we live impacts our health. It impacts what water we drink, what food we eat, how much green space and sunlight we see, what noises we hear in the night, how we move around and so much more. It is self-evident, yet our health system is not designed taking this into account. 

I started Access Afya to build a micro-health model for urban informal settlements. Neighborhood Health. Our first clinic was built to look like a grocery stall on a “high street” in Mukuru, Nairobi. People stopped by the window to chat with our team on their way home from work or school. Where we’ve come is not only creating a functional and friendly healthcare system that serves over 10,000 people every single month, but also a neighborhood institution. Our clinics are (mostly) solar powered. This means we have stable electricity, and our security lights are sometimes the only source of light at night in the slums. Boda Boda (motorcycle taxi) drivers come to park their bikes there when they are done with work, sometimes huddling under the lights waiting to find one more ride before ending the day.

The building blocks that got me there 

When I look backwards and unpack why entrepreneurship became the inevitable path for me I think it came down to the building blocks that I was using to build my approach to life. 

  • Curiosity. I was genuinely interested in how things worked. I was never bored. I saw every conversation as a chance to learn about some new corner of the world. Most of the first answers I got didn’t satisfy me. And what this led me to do was to--

  • Talk to people (a lot). When starting work on a place-based business plan I wanted to talk to business owners and people waiting for trains first. When in the Peace Corps I learned more from drinking cinnamon tea on rooftops than in any book about the Middle East. Why this led me to entrepreneurship was a--

  • Restlessness with the status quo. Place-based development wasn’t a project, it was an imperative. And it genuinely didn’t make sense to me that where someone is born should dictate their physical health. And I think why I turned that restlessness into a company was my tendency to focus on--

  • Design and mapping. It always made sense to me to draw and map information as a way of processing. It was only later that I learned how to use frameworks like human-centered design and systems change design. The map I made on the exposed brick wall of my East Village studio of the Kenyan health system, the technological forces changing it and the roadblocks holding things back was the first Access Afya business plan.

For me, starting a social company was ultimately a design challenge. We were designing what healthcare would look like if you started from scratch, unencumbered by legacy infrastructure and interests, and focused on the patient experience. For the first few months I sat, and I listened, and I took a lot of notes, and I drew, and redrew, what the perfect patient journey looked like. Doing this was my favorite part of being a Founder. 

And when I knew it was time to go 

This year I passed the Access Afya torch to a new CEO. After nine years, I was ready for the next design challenge, and honestly burning out. Seeing challenges in our neighborhoods that our business couldn’t work on has made me curious again, and is causing me to talk to a lot of new people during this transition. I’m starting to map out a new system and set of solutions, and hope I’ll be ready to write about that soon! 

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New directions and bigger questions: Digital for adolescent minds