Jacaranda Health: Nick Pearson on How Funders Can Help Ventures Focus on What Matters Most

Jessica Kantor: Please introduce yourself and tell me about your work.

Nick Pearson: My name is Nick Pearson, and I’m one of the co-executive directors of Jacaranda Health. Jacaranda Health is a nonprofit that focuses on improving health outcomes for moms and babies. We work in the maternal health space. Our headquarters is in Nairobi, Kenya. We work primarily in Kenya, now in a few other Sub-Saharan African countries. Our approach is really about working with government partners in the public health sectors in countries like Kenya and addressing some of what we see as the key gaps in quality of care, access to care that improves outcomes for mothers and babies.

For example, we deploy a handful of products and platforms that address what are high leverage in addressing key gaps. We have a digital health platform called PROMPTS that connects mothers to care, gives them a voice in the health system, and helps them navigate care as they’re going through their pregnancies and the baby’s first year and a half of life. We also have a nurse mentorship program that focuses on improving skills and quality of care in facilities when moms come in to deliver their babies so that those skill gaps and practice gaps are addressed in the government health system.

We’ve also evolved based on the reach and the amount of data that we collect across the populations that we serve. We have a data platform called Pulse that synthesizes some of the input and insights and experience of care in the health system from both the moms that we work with as well as the frontline providers to provide useful insights for governments partners – such as opportunities for improving more equitable allocation of resources, and quality improvement.

We’ve been around for 14 years, and the work that we’ve been doing in the public sector has been in the last nine years. We are currently working across about half of Kenya. We’ve reached about 3 million mothers with our digital health platform. We work in hundreds of some of the busiest health facilities in Kenya and work with about half of the county governments. Then we also are expanding. We have an office in Ghana, and we’re piloting with partners in Nigeria and Eswatini as well.

Jessica Kantor: How are you measuring impact? 

Nick Pearson: We have a pretty strong data and technology team, and a monitoring and evaluation team as well. What we’re looking at primarily is a combination of key behavior changes. Things that are relating to health-seeking behavior, moms getting into care for more prenatal and postnatal visits, coming in to facilities for skilled deliveries, uptake of postpartum family planning, and so forth – as well as behavior and skills on the side of frontline providers, ie. improved nurse knowledge and performance and those kinds of things.

Those are what I would call more proximal indicators and are the ones that are most straightforward for us to measure. They’re also all behaviors that have been linked in the literature to better health outcomes. We’re also, as part of our North Star, looking at how we measure improved outcomes for mothers and babies though that’s harder to measure in the health system. At this point, we have strong research around behavioral indicators, and anecdotal evidence around health outcomes.  But we’re looking to be able to quantify some of the reductions in newborn mortality complication rates among mothers in pregnancy and delivery. 

Jessica Kantor: Do you have an example that illustrates the impact of your work?

Nick Pearson: We have seen improvements in prenatal and postnatal care-seeking among mothers. We’ve done randomized control trials as well with external academic partners. I don’t have the numbers at the tip of my tongue, but [we’ve seen a] 20% to 25% increase in prenatal care, seeking postnatal care, seeking a doubling of postpartum family planning uptake among mothers.

We’ve seen consistently that nurses are performing at 80% or 90% of the skills that we want them to be able to maintain post-training and mentorship and sustaining that over time. We’ve seen a lot of measurable impact in some of the key things that we’re measuring. We’ve also seen, on a more local basis, reductions in newborn mortality and in some of the facilities where we’re working more closely with the counties to track over time.

Jessica Kantor: Are you doing any self-reported tracking, or is it all through the organizations that you’re working alongside and your tech platform?

Nick Pearson: Both. We have internal monitor and evaluation, which ends up being a mix of things like leveraging real-time data from our tech platforms and what moms are reporting. Then, we do more deliberate periodic M&E (Monitoring & Evaluation). For example, like surveys, skills evaluations, et cetera. The kinds of things that you can say at a particular point of time, hey, nurses are doing better. Moms are reporting changing their behaviors, et cetera. On top of that, we also do these periodic external evaluations with academic partners that are more academically robust as well. We’re triangulating on it from a variety of different directions.

Jessica Kantor: Thinking about the support that you’ve received, what’s something that surprised you and turned out to be really helpful for you to scale?

Nick Pearson: We haven’t yet had funding from Rippleowrks. We’ve had some of the technical assistance where they place experts with us, and so we had a really good experience with them. They matched us with someone who worked at Square in San Francisco. He provided some pro bono support over a period of months to help us advise. Rippleworks has both the pro bono project support and the capital support. This was the former.

This was several years back when we were just building out our technical capabilities. One of the interesting things about Jacaranda is that we’ve developed a really strong African-led technology team that’s on the cutting edge of a lot of what’s going on in the AI (Artificial Intelligence) and large language model space here on the subcontinent.

At this point now, it’s like guys like Google and Meta and OpenAI are coming to us to partner on insights around how do you leverage the power of some of their tools and platforms to improve efficiencies, improve quality, et cetera? We use AI heavily now, at this point, on the backend of our digital health platform to engage with moms so that we can answer 12,000 questions a day and get moms to care in a timely way and that kind of thing.

To get started with that, obviously, we were coming as an organization that did not have tech in our DNA in the early days. We were coming more as a health system player who knew how to partner with the government, how to do great clinical things, how to build programs, how to deploy them, but not large language models or natural language processing.

We realized that our digital health platform, PROMPTS, the SMS (Short Message Service) platform that we deploy across half of the country, needed more of that. Rippleworks came to us back in, I want to say it was 2020, and linked us up with a data expert who helped us navigate the early steps of what we needed to do to start working with, this was pre-LLM (Large Language Model), at first it was natural language processing, but how to start building out that capacity in-house and how to test it, how to iterate on it. That was an extremely effective engagement.

We’ve gone back several times to that. When we’ve communicated with folks from the Rippleworks’ team, it was really catalytic in a lot of ways because it helped put us on a path towards this in-house technical capability that I think a lot of organizations are struggling with right now. 

Jessica Kantor: How does Rippleworks’ process of deciding what capacity-building support to provide differ from what you’ve experienced previously? 

Nick Pearson: I wouldn’t necessarily say this is unique to Rippleworks, but I do think they’ve gotten very effective at it and are real pioneers in the space. It’s their approach to co-defining what the needs are and then hunting for the right person to fill that technical gap. Sometimes technical assistance programs come to you more like: we’ve got a technical assistance solution, can we provide it to you? Over the dozen years that I’ve been doing this, we’ve received a lot of different kinds of technical assistance from various well-meaning funders and partners. More often than not, except in a very narrow range of projects, it’s one size fits all approach. 

Any good or useful technical assistance requires some customization to fit the actual needs of the organization. I feel like Rippleworks did and I assume does, still do that well where they were like, hey, what do you need? Where’s the gap? Here are some suggestions of what the opportunities might look like, and then let’s collectively hunt for someone who could be a good fit to help you navigate that challenge. The Rippleworks technical assistance we received was actually catalytic in helping launch our early AI work, which is now central to our impact model. 

Jessica Kantor: Do you recognize any other kind of gaps in this model?

Nick Pearson: The success of it depends on a couple of things, like both the quality of the fit and placement, the level of engagement of the technical assistance person who’s also got a job, and the amount of time and bandwidth that the organization has to work on it. If any three of those things fail, then you end up with underwhelming project output. Even if Rippleworks’ has found a great technical volunteer, if the organization that’s receiving the technical assistance doesn’t have the bandwidth to put it into action, then it’s going to sit on a shelf somewhere or not result in a good outcome.

I think that’s the challenge with that. It’s the only good way to do technical assistance, but it relies on good people on the Rippleworks end to find the right fit. My observation is that the team there is sophisticated at helping to tease out what the needs are.

Jessica Kantor: In terms of the different types of support you’ve received from different funders, what’s something that surprised you and turned out to be really helpful to scale?

Nick Pearson: Speaking in terms of investment, honestly, I think a degree of flexibility is always good. Unrestricted funding, multi-year funding, those are always good. I don’t know if I would ever say that any of that surprises me because we are fortunate in having some good funders and supporters. The DNA of different funding organizations is always going to be different, for example the Gates Foundation is always going to do restricted grants with detailed project plans that they want to be involved in.

That’s less fun than just getting an unrestricted million dollars from someone. But it’s just the way they do business, and so it’s what comes along with the amounts of money that they provide.

The funders I see as the best ones have managed to straddle. There are funders where they just write you a check, and then it’s hands-off. That’s nice just because you’re busy and you appreciate the flexibility, the unrestricted money.

But some of the best funders are more than that. They are the ones that provide funds and some measure of accountability. Not necessarily to a rigid set of targets but because they understand and appreciate the journey of a social entrepreneur and the flexibility that you need to bring to bear when your strategy is evolving. 

A good funder will just continue to nudge you and force you to think hard about what matters. In other words, what’s your North Star? Are you achieving what you said you would? At the same time, they have enough awareness and knowledge of what it’s like on the other side of the table to recognize that sometimes you have to adapt those targets and plans.

What’s your North Star?

Nick Pearson

Like any good scaling plan, a funding plan or grant agreement is not a straight path. You need a living document that accommodates the twists and turns in the market and your evolving team, your funding landscape, the technology, and all of those things. You have to be constantly pivoting to a certain degree.

Jessica Kantor: What role does trust play in your relationship with funders? 

Nick Pearson: The matter of trust works in both directions.  Sometimes there’s this reductive notion that trust-based philanthropy is just giving a grant and then backing off and letting people do their thing after you’ve done some good diligence. To a certain extent, that’s true, but sometimes it ignores the fact that accountability is valuable—I don’t know, if I had money, I would want to make sure that someone was doing the work and using it well, and a little bit of accountability can be good for trust too. It means you care about the mission of the organization.

The cultivation of trust is bidirectional and requires both for there to be some respect from the recipient side that the funder understands you and your context. In other words, have they walked in your shoes or have they been on the other side of the table. That’s always a trust builder that it’s not just the philanthropist in their ivory tower or whatever the expression is. From a funder’s perspective, that may not be something to cultivate, as much as something to hire for – i.e. hiring staff who have been entrepreneurs and implementers themselves and understand the context.

The other thing is the ability, and I think some funders do this well, to maintain a dialogue over time with your partner that engenders trust. It’s not as simple as just being like, I don’t know what you do, but I trust you. I think it’s more believable and builds a stronger relationship over time if you can add value with your perspective and ask tough questions, but at the same time not do it in a gotcha kind of way. In other words, it’s not about that you trust that those questions are not coming from a place of mistrust or a place of trying to prove you wrong.

The challenging bit is the actual execution of the work that you do. Fundraising is hard, but the execution of delivering a service and building a successful organization is super hard – and occasional failure goes with the territory. If a funder gives you too much grief, and that tends not to build trust. 

In summary, I do think there’s some middle ground where it’s not as simple as just providing money and not asking any questions, but the dialogue itself can be trust-building in its own way as long as it’s coming from a place of good intentions. 

Jessica Kantor: What shifts are needed in the funding landscape to center the voices of those that are closest to the problem?

Nick Pearson: I know this is important to Rippleworks, and I’m conscious that I’m speaking as someone who is not particularly proximal to the problem my team works on – we work on maternal health in Africa and I’m an American male. Having said that – existentially, as an organization, Jacaranda Health is very much a Kenyan organization. My co-executive director, Cynthia Kahumbura is Kenyan, our leadership team is mostly Kenyan. Our staff is almost exclusively Kenyan. We spend a lot of time with the end users that we work with, both the county governments, the frontline providers, and the mothers whose journey we’re accompanying.

I feel like, across the landscape, funders are doing a better job sourcing deals and funding opportunities from more local organizations, which takes a lot of work. Because a lot of times, a local, smaller, Kenyan-led organization that doesn’t have a footprint in the States doesn’t have the social networks or fiscal mechanisms that you’re used to seeing as a funder. There may be language barriers. They may not have some of the same cultural ties and things like that.

Bridging that takes some effort on the part of funders. I think the funders that we work with who do it well, do it by establishing a presence or hiring people who are from that context. In other words, having investment managers who are in or from East Africa as part of their team so they can take a step in the direction of understanding and also appreciate that they’re looking for deals and partnerships that are more locally led. I do feel there’s been a shift in the landscape in the last 10 years in a positive way. 

How to do it better, though? As I said, it feels like funders are taking steps in the right direction. It’s a journey because it requires both being intentional and finding deals, building networks, but also sometimes helping build capacity in smaller organizations. Some of the funders that have done it well have also invested in building capacity. Some of it is just translational capacity, i.e., the ability to put your stuff in spreadsheets or decks or whatever looks appropriate for a US-based funder. 

It’s the investment in deal finding and sourcing. It’s having a team that understands and even represents, or for that matter, I think most effectively of all is to have a footprint in those countries where you’re looking to build those relationships. I’ve seen a couple of organizations do that well and effectively…is the Draper Richards Kaplan Foundation or ELMA Philanthropies or Dovetail Philanthropies. They all have offices in East Africa with some great folks who are working to build a pipeline more robustly locally. 

Jessica Kantor: Tell me about your funding journey.

Nick Pearson: Most of our funding is from private philanthropies. That’s just where we’ve ended up finding our groove in terms of fundraising. We don’t have a lot of individual donors. We’ve had a little bit of USAID (United States Agency for International Development) funding in the past. It’s mostly a mix of technical foundations that are interested in health systems or technology and family foundations or other unrestricted funders.

The journey’s been growing from small to bigger over time. For a number of years, we were a sub-$1 million organization working lean and scrappy for small grants. Now we probably have a $10 million budget and a portfolio of funding partners who are pretty sophisticated – Gates, Mulago, CIFF, Google, ELMA, Dovetail, Pfizer, Agency Fund, etc.

Jessica Kantor: How did you get to that groove of private funding?

Nick Pearson: It’s just a better match for our DNA as an organization. We’re pretty technical and nerdy in the sense that we are very systems-oriented, tech-oriented, clinically-oriented and like building deep relationships with health systems partners and local governments. Like, let’s talk about how we address health systems with these solutions that are scalable and sustainable. That resonates with slightly more sophisticated funders and more deliberate and technical funders. That’s just been the capability we’ve built in-house.

We tend to have funding from individual funders; high-net-worth individuals, or grassroots retail funding  – since takes a different tooling as an organization. You need to have those fundraising teams in place, and that was never really our board or our leadership team’s vibe. We just weren’t particularly good or comfortable doing that stuff. We’ve been more successful with grant proposals, working closely with donor partners who want to roll up their sleeves and partners with us on addressing these systemic challenges.

Jessica Kantor: What have been some of the biggest challenges in the support that you’ve received?

Nick Pearson: Our funding is partly unrestricted but mostly restricted, so a lot of our larger funders are restricted funders, and so you end up creating a jigsaw puzzle of funds. In an ideal world, you would have an organizational strategy and then bring a bunch of people to the table and say, give me a million dollars each for several years. You’re funding this strategy, and here’s the goal we can achieve collectively. Then you guys are all at the table and helping us out – a coalition of the willing.

That rarely plays out with nonprofits. In other words, you get the Gates Foundation or some technical foundation who says, I want to fund this program, or I want to answer this question, or I want you to be in this geography. There’s a financial exercise to try and make all the pieces fit together. It’s like, we have our organizational budget and our targets as a goal. How do we Tetris maneuver all these different funders together to support the broad objective?

But inevitably, different people get excited about different things that you do. We have some funders that come in, like Google, who are amazing and supportive of some of the new AI technology that we’re working on. You have some funders that are interested in health systems research. There’s some who are more about scale and impact. Each of those brings different expectations to the table, so that’s one of the biggest challenges when you’re creating a portfolio of funder partners. I think effective organizations do a good job pulling together like-minded people.

Effective organizations do a good job pulling together like-minded people.

Nick Pearson

I think that the challenge at the leadership level of a nonprofit when you have big ambitious goals is to make sure that the funding doesn’t pull you away from your mission, that you’re not chasing money just for the sake of money, that you’re not creating obligations that distract your team from executing on the most important things. 

Jessica Kantor: What do you think of words like “taking risk” and “dignity” when you are talking about support? 

Nick Pearson: I think good organizational leaders can stand up and turn down money as necessary. This gets to the dignity point. Candidly, I have not met many disrespectful funders. The funding and philanthropic community is pretty sensitive to the fact that they’re asking a lot. They’re giving a lot, but they’re also asking a lot, and they respect your position. They have their own opinions to varying degrees about how their money should be spent, but in a lot of cases, they’re entitled to that.

Good organizational leaders can stand up and turn down money as necessary.

Nick Pearson

The question of dignity is important, but I also don’t feel like there’s a pressure to make undignified decisions that much. I don’t feel like it’s like we’ve had to make too many ethical choices and be like, you’re asking us to do something existentially wrong or demeaning to us or our clientele.

It’s more a matter of being able to say, you’ve got money, but you want it to do something that’s not our area of focus. We’re going to say no to it as a result of that. Not that we don’t love you or don’t want to take your money, but it’s going to distract us from our core purpose. Most funders are respectful of that.

The question of risk is an interesting one. Different organizations have different risk profiles, and so do different funders. You can have a conversation with two different funders looking at your organizational strategy, and one says, be bold, go to a bunch of new countries as fast as possible, and that’s how you’re going to learn and grow as fast as you can. Another who’s like, hey, be smart. Really focus on your core geography and do a great job on that.

Those are risk questions. The funders’ level of risk tolerance or their sense of what a good organizational strategy is, they often have different opinions about that that are informed by their own lived experience. It differs, and so you can get pulled in different directions around how aggressive to grow, or how conservative to be, or how focused on a particular population versus a scale. Those variables are different for different funders and the degree of importance that they accord to them.

Jessica Kantor: What advice would you give to funders who want to help social ventures be successful? 

Nick Pearson: I think the notion of providing unrestricted multi-year support with a good relationship that’s not just unleashing money, but also involved in thoughtful conversations, and to some extent technical assistance over time, is really powerful. You need both the time horizon of slightly longer grants, and then you also need the flexibility to be able to pivot, grow, and adapt as an organization. You need that kind of flexibility in the funding and continuity.

Jessica Kantor: What are the top three things that you need to unlock your ability to scale and sustain your organization?

Nick Pearson: There are some model-dependent questions, so we’re in the process of getting traction with what it looks like to replicate our tech platform in new countries. There’s just a bunch of questions about, how does it work? Does it work when it’s not us deploying it? Does it work when we deploy it through a partner? We’re figuring out what replication looks in new geographies through partners.

I think that’s actually not uncommon. A lot of us get really good at doing things well ourselves, maybe in partnership with the government, or whenever you get to a certain scale, you look at new geographies. The only way practically to scale as a nonprofit is not to just keep adding staff because, ultimately, that’s going to be unsustainable. You’ll reach a point where you can’t continue to fundraise to make that happen, so you need to work through partners to scale.

In addition to figuring out replication and adaptation, the other piece that will unlock scale is figuring out government buy-in and cost share, which gets at the sustainability piece. I know this is the million-dollar question for a lot of organizations, which is okay. Yes, philanthropy is funding this now. What’s your long game? Who’s going to pay for it over time? Is this something that the government should be paying for, et cetera?

We’ve been very deliberate about that and have made a lot of headway in terms of getting the government to cost-share elements of our program. That’s a long journey in the sense that 50% is only 50%. We need to continue to work. It’s like, how can the telecoms unlock zero-rating of their SMSs? How do we work with partners to bring other resources to bear? That’s another piece that is going to unlock scale is figuring out the sustainability bit.  And obviously, more money, but that goes without saying. 

Jessica Kantor: Are you able to describe something that you or the organization tried that didn’t work but you learned from?

Nick Pearson: I mentioned in the early days we started as an organization that was delivering private sector maternity care. We were setting up maternity hospitals and delivering care through those hospitals. We realized that we were doing a great job at that, and there were a lot of insights that could be replicated in the public sector.

If we wanted to follow our impact North Star, we needed to be working in the public sector, which is where most of the moms were delivering. There just wasn’t a scalable path through the kind of private sector, so we spun that venture out, and now the nonprofit is focused exclusively on working in government health systems to reach the most moms. That was an interesting learning journey kind of thing. That venture is still going. They just opened up their fourth maternity hospital now, but it’s small in terms of total scale compared to where we are now across half of the country.

What we found with our nurse mentorship program, which does training for frontline nurses, is that it was very effective on an individual level, but as we scaled it, we found when we were doing some impact evaluations that even though we had been able to measure at a kind of a individual trainee level, that the skills and capacity went up to a significant degree, and that it was sustained over time and the government loved it and was cost sharing it. All the signals were good, and it was scaling in the right way.

But on doing our evaluation, we learned that there was so much turnover in the government facilities, nurse transfers, that we often didn’t have a critical mass of trained nurses on the maternity wards at any given time, and so that the quality of care at the facility level, which is what was important for a mom coming in and delivering her baby, wasn’t improving to the degree that we had assumed it would extrapolating from the individual training gains that we saw.

In other words, we weren’t getting enough penetration because nurses were getting transferred out of the facility or rotating into different areas. That required a big reflection on how we adapt the model to accommodate that fact? Now we’ve pivoted more towards a cohort-based training model where we’re tracking across all the nurses in the facility rather than just on an individual basis so that there’s a little more of a buddy system.

We’ll be measuring the success of that soon, but it’s a good example of the fact that even as you do smart design, and rigorously test, and iterate – still, scale brings some unexpected externalities and you have to continuously adapt to achieve impact. 

Jessica Kantor: Very interesting. Wonderful. Thank you.

Jessica Kantor is an independent journalist specializing in health, human rights, and social impact. Her work can be found in Fast Company, Healthcare Quarterly, Innately Science, and others, and she has been a Solutions Insights Lab interviewer since 2023. Additionally, she provides communications strategy to nonprofits and INGOs who are working on the Sustainable Development Goals. She is a living kidney donor based in Los Angeles.

* This interview has been edited and condensed.

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