Maisha Meds: Jessica Vernon on the Value of Open Communication in Funder Relationships

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Carolyn Robinson: Could you please introduce yourself and tell me about your work?

Jessica Vernon: I’m Jessica Vernon, CEO of Maisha Meds, a medical doctor by training and a background in economics. I worked in Western Kenya prior to medical school. I wanted to stay involved and after medical school, went back to start Maisha Meds. At Maisha Meds, we work with small pharmacies, clinics, and drug shops to help improve the quality of care they deliver to patients. We started with certain disease areas that are the highest priority and highest impact. Malaria, family planning, HIV, maternal health, and eyeglasses are the five we have a core focus on.

We first design business management solutions to help pharmacies manage their business. Through that, we get very good data on exactly what they do. Using that data, we design programs to help improve uptake of certain high-impact health products and the quality of care that’s being delivered. We then package the data and insights for a variety of different groups to help them with their own decision-making. 

Carolyn Robinson: What would you say is distinctive about Maisha Meds that others aren’t doing in this space?

Jessica Vernon: There’s a few things that are distinctive. One is that we use technology to improve the quality of care at these private facilities. We build something that looks and feels a bit like health insurance, but it is paid for by global health funders and governments to enable access to better quality care. We build really good technology that sits at the intersection between the provider and the patient.

I would say the fact that our focus on the private sector is actually fairly unique. There’s a lot of different groups working on improving public health, but they usually work through the government facilities and health systems. Through the work I had been doing prior to medical school, we decided to focus on the private sector because there were so few groups helping to improve quality of care there. It seemed like the biggest point of leverage that we could be providing. About half of patients in all of these markets are purchasing their healthcare through the private sector.

Carolyn Robinson: What communities do you serve specifically, and how do these communities benefit?

Jessica Vernon: We work currently with close to 5,000 facilities. This includes pharmacies, clinics, and drug shops across four countries: Kenya, Uganda, Tanzania, and Nigeria. We’re operating at a national level scale in most of these countries. We don’t work with every facility in every country, but we do have a facility or a partner in most of the bigger towns or villages across East Africa. Nigeria is massive, so we are focusing on a few different states where we have worked with the state government to be building programs.

Carolyn Robinson: Could you share an example that illustrates the impact of your work?

Jessica Vernon: We’ve run, at this point, four different randomized control trials that show that we have between a 4x, so 400% to 700%, increase in the use of clinical decision support and quality care protocols. For malaria, for example, we make sure that a patient receives a malaria test before treatment. Quality assured treatment if the test is positive and then no malaria treatment if the test is negative.

Our intervention increases the use of malaria rapid tests before treatment by 4x. It’s 33 percentage points, or a 4x increase, over baseline and increases the use of quality-assured treatment in cases of positive tests. It has been the only study to show a decrease in using malaria treatment if the test is negative. With the support of the Gates Foundation and USAID, we have scaled that to over a million patients accessing malaria care through our network across these countries.

We have scaled that to over a million patients accessing malaria care through our network.

– Jessica Vernon

Carolyn Robinson: Would you say there’s something specific about your approach that led to that success?

Jessica Vernon: The fact that it’s technology-enabled and it delivers an incentive that acts like health insurance to provide that behavioral nudge. We also provide stock management solutions, so the ability to make sure the inventory is in stock at any given pharmacy we work with to enable access.

Carolyn Robinson: What surprised you about the support you’ve received and turned out to be an effective catalyst to grow and operate sustainably?

Jessica Vernon: We’ve received funding for the various randomized control trials we’ve done, but had the sense of what the business model was going to look like at scale during the RCT process. When both Gates and USAID Development Innovation Ventures supported the study for the malaria program, it was with this eye toward what a scale-up would look like in partnership with governments and other global health funders.

They were brought into the process at the start to make sure it was being designed in a way that would be appropriate for their support in the future. Having a really strong conduit between the mid-stage testing of a particular intervention, and then what the vision for scale actually looks like, is really important.

Carolyn Robinson: What role does trust play in your relationship with funders?

Jessica Vernon: It’s huge. The [funder] relationships we’ve had the longest, and that have helped us to grow the most, are the ones where there’s a really strong sense of sharing in both directions. In these relationships, we’re able to share what our constraints or barriers are, and they’re able to share what their perception of our work is, in a way that improves things on both sides.

Carolyn Robinson: Are there any bold shifts in funding needed to strengthen the voices of those closest to the problem?

Jessica Vernon: As we’ve thought about how to unlock additional funding or our own path to scale, one of the challenges we’ve come across is, a lot of times, funding is locked in more traditional models. There’s all these mechanisms that already exist and the money has to be funneled through standard relationships to then get to the innovators. It’s in five layers of somebody doing something and contracting something. It’s under those layers because the awards are small enough that it would be not cost-effective to do those directly.

One of our value propositions for both malaria and HIV is we can deliver care for significantly less than the status quo being paid right now. But if you bury that under these layers of overhead that already exist, you don’t necessarily get the cost savings because you still have all those layers. It’s just an additional cost instead of saying actually, if we just contract with you directly, we can save all of that overhead.

One of the things we’ve been advocating for with Global Fund is to be able to contract with us directly to get to the patient care piece, rather than having it sit under all these other contracting entities. In order for them to be able to do that, and in order for us to feel like this makes sense, having it structured as an outcomes fund where we get paid for every patient we see, rather than kind of getting paid one lump sum to do a bunch of work, is definitely our preferred path.

Being able to pre-fill several years’ worth of funding – so we say, not only can we plan for this year, but we can plan for next year and support a million additional patients or two million additional patients – really helps us get to that really strong pathway to scale. Without that, you have these stops and starts that cost everybody a lot more money.

It would ultimately be cheaper to pre-fund and commit to a certain outcomes type approach rather than saying, for the next six months, we’ll fund your overall program design, but we’re not going to commit to a two-year period, but also we’ll give you more money in that six-month period. That’s not ideal for us. I don’t think it’s ideal for the funder either.

Carolyn Robinson: What support did you receive from Rippleworks?

Jessica Vernon: We received a talent grant for $500,000 to support a few different things related to recruiting and exchanges between our country offices. We’re still under consideration for the standard award, but they had wanted to see a few additional. We received a grant for the Talent Works. We have received three different projects at this point that we’ve partnered with Rippleworks on. Then they gave us a $500,000 grant just for talent-related things.

We’ve done the standard projects using somebody with significant expertise and had them plug in on something that has no funding attached. Because of one of the projects we were working on, Rippleworks considered us for a specialized grant. It’s not unrestricted, but it’s very focused on people.

It’s a $500,000 talent award where they give $500,000 to help improve your people operations, your HR, or how the team is managed. We use that for what we call a global collaboration pathway, where we have exchanges between our country offices. We send people to different offices to help them understand the context, like sending Nigerian employees to Tanzania and vice versa, to understand how operations should be in each country.

We send people to different offices to help them understand the context.

– Jessica Vernon

Carolyn Robinson: Tell me a little bit more about how that all worked. What was the impact? What did you learn from that and how did Rippleworks help you develop those skills in your staff?

Jessica Vernon: They did a wonderful job of giving us the ability to propose whatever would be useful for our team. I believe we spent a little bit of the funding on a couple of people within our people operations department, so helping just build out the capacity to do a lot of our HR well. With the remaining funds, we have a quarterly application process where anybody from the team can apply and say, I want to learn how this sales process is done in this other country, or I want to share my knowledge with them.

We pick three or four people per time, and then send them all somewhere to be able to build that strong collaboration across offices. We also used it for a learning and development budget for lots of the team. People could propose things they wanted to get skills in, and then we would pay for courses and other things to help them.

Carolyn Robinson: This kind of the talent grant, does it differ from other kinds of support you’ve experienced with other funders?

Jessica Vernon: Yes, this is the only time we’ve ever received anything like this, and it’s been great.

Carolyn Robinson: Is there anything that could improve the talent studio in the future?

Jessica Vernon: No. It’s been really catalytic and great for the team to be able to go to other places. It has really streamlined how we do things and share knowledge across countries. The big question as we’re close to reaching the end of this period, how do we sustain this given that no other funder is willing to fund things like this. It’s proven to be such a value add to our team that we’re trying to decide whether we build it into our overhead for overall projects, or if we just do a reduced version of it to keep it going in future.

Carolyn Robinson: What do you think funders don’t understand about capacity building that would be useful for them to know more about?

Jessica Vernon: This talent-type work goes hand in hand with unrestricted funding, where if you’re looking to build an organization as a whole, you’re looking to build everything about how that organization delivers. Being able to really improve the capacity of the team helps reinforce that objective.

Whereas I feel like most funders are so focused on the particular delivery of the particular project, and getting it done and moving on to the next project, they don’t necessarily care who or how it’s done. They just want to have the output. There’s no incentive for them to invest in the long-term process and they almost disincentivize teams they fund to do things like that as well.

Carolyn Robinson: What would you say have been the biggest challenges in the funding support you’ve received?

Jessica Vernon: We have 95% restricted funding. We get almost no unrestricted funding, which is generally okay for us because we tend to work in healthcare verticals. The funding landscape is set up so that the verticals are almost like a prerequisite to getting a type of funding. You only get malaria funding or you only get family planning or whatnot.

It means that we have to build a really strong value proposition within a particular disease area or vertical. It also means that it’s constantly a little bit chaotic internally around whether we will be able to fund a particular program. Even if we have the full organizational budget funded, if there’s a particular malaria program in a specific country we don’t have funded, even if it does make sense to do it, we don’t necessarily have the funding to make that happen.

Carolyn Robinson: What changes in received funding would you like to see – just getting more unrestricted funding or other things that would help you scale your operation?

Jessica Vernon: Outcomes funding effectively operates as unrestricted funding because once you hit a target and it’s recognized as revenue, it becomes unrestricted so you can effectively use it for whatever you want to.

Carolyn Robinson: What advice would you give to other funders who want to help social ventures be more successful?

Jessica Vernon: One of the things I’ve found most useful is when a funder has a very clear idea of what we’re solving together, and they are along on that vision and journey. This should be how all of this works, but it tends to not be. Part of why we work with certain funders so well is that they see the long-term goal and they see what the organization will look like at scale almost before I do. Then they’re willing to help us on that journey.

With a lot of funders, the biggest challenge, even if they’re unrestricted, is they only fund Community Health Worker (CHW) programs or a certain type of intervention. They’ll fund the whole organization to do this program or intervention which actually restricts the whole organization, not just their funding. A lot of them don’t have this sense of what success looks like five or 10 years out. Because they’re not bought into your organization’s vision, they’re not helping shape it or giving advice for successful growth.

Carolyn Robinson: How is the USAID situation impacting your work? 

Jessica Vernon: There are two pieces to it. We had committed contracts that were already contracted and underway. We had expected those would continue as business as usual. One is to scale our malaria work, a $5 million award, and one is to support electrification and solar panels in private facilities in several countries. The second award, the electrification one, was canceled as of last week. I guess it’s now under the temporary restraining order, the TRO. It’s not clear what’s going to happen with that one.

The DIV one was co-funded by Gates. We’re still operating under the umbrella of the Gates Foundation, but with a lot less clarity around what the long-term funding landscape will look like. We had about $3 million worth of new funding that was in the process of being contracted and was supposed to support operations and additional scale this year. That all just disappeared. It’s gone.

As the leader of this team, we are in a much better spot than the majority of groups that get USAID funding. But it’s hard to make decisions for the future without more clarity. I would like to have enough information to make decisions on whether we should be trying to downsize or whether we should be shifting some of our operations. Because everybody’s in a holding pattern, it’s a bit hard to do that right now.

Carolyn Robinson: Talking about trust, how does this impact trust in American government funders? 

Jessica Vernon: My big lesson from this is how to get the best sort of funding for contracting for this sort of work. If we were to build an outcome spender for malaria going forward, our pitch would be: Get the money up front, build the outcomes fund, and have it sitting there in escrow. For example, the deliverable for USAID would be an outcomes fund so in theory, the funding wouldn’t be subject to a stop work order because the work is to set up this outcomes fund. Also having it be blended finance so that you have some Gates money in the pot, and some Global Fund money, and some USAID money, so you can use other pots of money in the meantime if things like this do get paused.

Carolyn Robinson: Everybody learns as much from things that don’t work as from things that do. Can you describe something you tried that didn’t work and the lessons you learned? 

Jessica Vernon: We constantly have things that don’t work, but we just keep working at them until they do. The two I would point to that have been the most recent ones are: we started an eyeglasses program with funding from the LIF (Livelihood Impact Fund). For the first six to eight months, it didn’t work. We were getting very low uptake and we weren’t seeing that the program was going to be able to hit its numbers. We kept iterating on the payments model, the value proposition, how we train pharmacies, and how we did marketing to customers, and finally, got to a place where it is now working quite well.

We had a digital wallet of health savings products that was funded by Gates Foundation that went through a similar process. It was about a year and a half of us saying this thing isn’t working before finally finding the thing that would make it work. It clicked into place and now is working fairly well.

On the operational side, you just have to keep going at it. On the funding side is where a lot more of our learnings are. For example, we have all of these programs. We’ve validated and done randomized control trials, shown that they can work, and usually, have a funder who will help us scale.

For whatever reason, the family planning program we designed and implemented, and had a really strong randomized control trial, did the best of all of our programs. But for some reason, we haven’t been able to find a funder or a partner who is interested in scaling this work. It’s languishing not because the operational side of it can’t work, but because there’s something on the political economy of family planning, the funding side, that’s just not working out for us. That’s the biggest lesson: you need somebody to buy in, to be the payer at scale, for this stuff to move.

Carolyn Robinson: Could you talk more about other funding models you’ve encountered that made it difficult for you?

Jessica Vernon: Actually the HIV program we’re now building is a great example of this. When a group of organizations perceives that there’s a lot of money in an idea, everybody wants in. It makes it really crowded and difficult to all work together. HIV has traditionally been the most well-funded of any disease area in this part of the world. You have a lot of these big bureaucratic traditional groups that are the ones leading the charge in this space.

The Kenyan government and the Afro Resource Center had, for years, wanted to build an HIV treatment program that uses community pharmacies. It would effectively cost $10 to deliver care, versus the $50 or more it currently costs to deliver that same care. In theory, it should be a very straightforward thing to do. We have the largest network of pharmacies in Kenya.

We have validated over and over again that these sorts of programs work. We should have been the obvious partner from the start, but because you have these legacy groups that have much better relationships with ministries of health and can navigate the bureaucracy a bit better than we can, we just were not finding a way in. Even though it should have been clear to at least try us to see what the cost structure and uptake would look like versus these others. Then the day after the stop work orders happened, three weeks ago now, all of those institutional funder legacy organizations effectively went away or stopped being able to work.

The Ministry of Health called us up and said, can you be in Naivasha tomorrow? We need to start work on Monday, so can you make this happen? We were like, cool. We’ve been waiting a year to do this. Of course, you tell us to jump and we’ll say how high. Effectively, in the time period that these other guys were all under a stop work order, we were able to scramble and get something in place. Now, ideally, we have a letter of support from the Ministry of Health that they want to scale this based on results across Kenya if the results are great.

Carolyn Robinson: Are there requirements with funders that are helpful, or do you work best when the funder just leaves all the details to you? What’s your preferred operating dynamic with funders?

Jessica Vernon: I like monthly touchpoints or quarterly touchpoints. I feel it creates this narrative over time that they understand a bit more. I tend to find the funders we work with see a bigger picture than we do. They see there’s this other organization or there’s this other pot of money and they’re thinking about their five-year strategy and whatnot. If you’re able to position yourself well, it turns into something really catalytic for the long term. They’re much more bought in and able to help you along your journey if there’s a regular touchpoint.

I tend to find the funders we work with see a bigger picture than we do.

– Jessica Vernon

Carolyn Robinson: Looking at Rippleworks in particular, are there gaps in how they approach their capacity building? 

Jessica Vernon: This funding has been just incredible. To be very clear, all of it has been a positive. We are one of the only organizations they first gave the talent money to and then were considering for the larger award. Everybody else had the larger award first and then were considered for the talent grant.

What it ended up meaning though was they felt like they understood us better than they actually did when they were considering us for the larger award. There are all these nuances to the model that you don’t need to necessarily know in order to decide whether to do a talent grant. It might have made more sense to do diligence on both of them at the same time so that it became really clear that there were probably still areas where they needed more information, or where they didn’t fully understand the model or approach. That being said, everything else has just been wonderful.

Carolyn Robinson: Is there anything you’d like funders to better understand in order to help ventures like yours operate? 

Jessica Vernon: The one thing that was surprising to me, we’re about close to eight years into this journey, and we’re just starting to get more and more institutional, blue chip funders and partners working with us. Early on, one of my biggest lessons was I figured we would just get an endorsement from some funder, and that would be that. In the first two to three years of an organization of our size, a lot of what was needed was a leap of faith from somebody. In the early years, each year we would fall a little bit short on some fundraising piece.

Being able to have somebody in the background who could say actually, this is going to turn into something really interesting, and an additional $100,000, will be the difference between whether this happens or not. Being able to take that journey with us is probably the only reason we still exist.

Carolyn Robinson: Speaking of scaling, you’re in Kenya, Uganda, Tanzania, and Nigeria. Any other countries you’re considering expanding to? 

Jessica Vernon: We’re always considering. Our tech is on the Google Play Store, so anybody anywhere can download and start using it to run their business. We get good data. We have pharmacies that use the software in South Africa, Zambia, Zimbabwe, and a few other places. We’re always thinking about whether there’s a light-touch approach we can use to continue expanding beyond where we are now.

Ultimately, in order to scale nationally in a country, you need boots on the ground to make that happen. We always have one more country in mind. We chose the current countries in which we’re operating because they have a mix of malaria, burden of disease, HIV, and family planning needs, and a really strong, robust private sector.

The next set of countries are a little bit less clear-cut. We could do Democratic Republic of the Congo for malaria, or Zambia for HIV, but neither one is the right fit for the other focus areas and each one has its own downsides. Until we have that clear-cut case for ourselves of why we would pick another country, we have decided to stick with these ones. For a little while, we actually had Ethiopian operations as well, but the private sector there was not large enough for that to make sense.

Carolyn Robinson: Do you think about expanding globally?

Jessica Vernon: We do. When thinking about expanding in Asia, I expect that the tech there is so much better that someone will outcompete us before we really figure out what we’re doing there. That’s been my hesitation there. Latin America would be interesting as well. Right now, we’re trying to get as big and as robust as possible in our four countries of operation, and then we’ll think about the next set.

Carolyn Robinson: Do you have all the staff that you need?

Jessica Vernon: Yes. We have about 160 people. It’s a mix of operations people, product, tech, data, and business development. It’s a very culturally interesting team with 12 different nationalities represented. There are a lot of different people working in each of those skill sets who have fairly different personalities and ways of approaching problems. It’s an interesting melting pot.

Two or three years ago, we really invested in recruiting and finding the right people who could help us really scale the organization. Because of that, we are in a really good spot right now. It’s unfortunate that we have to be in this pause period because we were ready to just go and support millions in the next year or two. That was a big learning, that our focus on recruiting would pay off in the long-term in ways that I didn’t fully anticipate at the time.

Carolyn Robinson: During this pause period, are other funders that are not associated with the US government jumping in to support? 

Jessica Vernon: With this question around pause, we’re asking how do we redirect so that we’re still providing things that are needed but also not quite as aligned with US government objectives. There are a lot of funders thinking about what to do, but everyday things are changing.

This has caused them to move a little bit more slowly than they would’ve. We got a lot of interest like, what would you do if I wanted to support this thing? Not necessarily people saying, oh, yes, let me open my pocketbooks. I want to make sure I’m supporting this for the next year or whatnot.

Carolyn Robinson: How much of your time and energy has to go into funding, fundraising, and overseeing funding versus other operational needs? Is there any way to make that a little easier for you?

Jessica Vernon: As an organization gets bigger, the CEO is responsible for the fundraising. It is a truth of life that I am reconciling for myself. It’s not necessarily where I thrive or enjoy spending the majority of my time, but that is the role I signed up for at this point with the size that we are in. 

I do think, when you have a really savvy or smart funder, you end up spending a lot of time deep in debates around service delivery or cost-effectiveness, which are themselves interesting conversations. If there were ways of having that sense of “this is a good idea” or “there’s a five-year commitment in here,” it would allow us to really redirect some of our resources to things that would potentially help us be sustainable, better, and more cost-effective at scale.

Carolyn Robinson: Looking at Maisha Meds in particular, what are the top three things you would say you need to unlock your ability to grow, sustain, and expand?

Jessica Vernon: Right now, we’re in such an uncertain period in terms of the future of global health funding that it makes it difficult. Right now, it’s difficult not just for the ones who are at risk, like USAID and Global Fund, but for everybody else because they don’t yet have clarity on where their capital will be best used. Everybody’s in a holding pattern until some of this gets figured out.

More certainty is the thing that’s needed, first and foremost, but I don’t know how we get that. Once we have that certainty, it’ll become clear where the gaps are and where others should be filling in. As we spend a lot of time getting advice from different groups, we’re anticipating it’s going to be at least six to 12 months before anything becomes clear. I would like to see more funders being able to work within that uncertainty, and the crowd and the support that’s needed in the meantime.

Carolyn Robinson: Thank you, Jessica.

Carolyn Robinson led Solutions Journalism Network’s broadcast initiatives for many years. She is an experienced television producer/reporter for global news media such as CNN, BBC, and Al Jazeera. As an international media development consultant, she has trained local journalists and directed media programs in two dozen countries around the world.

* This interview has been edited and condensed.

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