Sanford Health expands world clinic model

Sanford Health’s goal in Ghana is a big one:

“To be the No. 1 primary health care provider in the country.”

That’s according to Jim Slack, vice president of Sanford International Clinics, who is helping lead clinic development in the African nation and worldwide.

Sanford International Clinics was formed as part of T. Denny Sanford’s $400 million donation in 2007 with a mission to provide care to underserved populations worldwide. And while it started with pediatric clinics in the U.S., the organization’s eye has shifted to Africa.

In the past 60 days, Sanford has opened 12 clinics in Ghana, for a total of 17. The plan is to develop at least 300 clinics in the country.

It’s a venture that has brought Sanford into a new relationship with Global Health Corps., a New York-based nonprofit led and founded by Barbara Pierce Bush, daughter of former President George W. Bush.

“I’m very impressed and inspired by Sanford International Clinic’s commitment to working and supporting partner organizations, at every level, in the areas they work,” Bush said in an emailed response to questions.

“It’s truly wonderful to be supported by such an innovative and inspiring health care leader. There is a great deal of overlap between our work, so our relationship is a busy two-way street for sharing best practices, networks and insight.”

Global Health Corps., or GHC, was founded in 2009 to place professionals from Africa and the U.S. in yearlong paid fellowships to work with local organizations to improve health care access and outcomes. The organization plans to work with Sanford to develop health care professionals and identify and implement best practices in areas such as electronic medical records, supply change management, medication standardization and clinical education.

The two met through philanthropist T. Denny Sanford.

“Denny had a relationship with Laura and Barbara Bush and was aware of Barbara’s initiative,” Slack said. “The focus of that really looked to align with what we do with Sanford International Clinics. He brought us together.”

That was about a year ago, and the organizations started talking about what each was doing in Africa and what synergies might exist.

“For us, it was really quick to identify,” Slack said. “She’s got thought leaders and fellows and alumni she’s recruited from all over the world. She’s got top talent knocking at her door to be part of her program. Because of the depth of operations we’re building, it just lends to a great experience for these fellows to dig in and find meaningful projects.”

Bush, too, praises the new relationship.

“It’s not often that you find such a philosophical synergy in a partnership,” she said. “I think both of our organizations share that deep commitment to ensuring access to quality health care for everyone and the belief that where someone is born or lives should never dictate how healthy and empowered a life they can live.”

GHC counts 600 former fellows as alumni. They have worked in the U.S., Rwanda, Uganda, Malawi and Zambia. One of its first fellows has worked with Sanford in Ghana for years.

“We’re looking to take our model to other African countries,” Slack said. “So she brings us great wealth of knowledge from alumni who can help us prospect other countries to add to our model.”

Alumni from Rwanda and Uganda will work with Sanford to help with prospecting for future clinics “to understand the health care market and our model and does our model fit,” he said. “They already have a lot of relationships started with government officials.”

Growing in Ghana

The model Sanford is building in Ghana is one that could be replicated in other African nations, Slack said.

Sanford started working in the country in 2012. It’s about the physical size of the state of Minnesota and has a population of 26 million concentrated mostly in the southern portion of the country.

Sanford’s health care infrastructure involves a network of hub clinics staffed by medical professionals supplied by the government of Ghana. About half are newly built, and the others are renovated existing clinics. From there, Sanford runs fiber, builds wireless towers and sets up an intranet structure, so rural clinics can be connected to the hub.

Much of the health care expertise then can be delivered remotely through telehealth.

“It’s going to continue to grow and expand every month or couple months going forward,” Slack said. “We had a big breakthrough of establishing our first 12 (rural sites) just over the December-January time frame. We’re probably going to help set the telehealth strategy for the country, which is pretty good.”

Sanford pediatric expansion across U.S. less likely

On the technology side, Sanford also has worked with Sioux Falls-based electronic medical record software provider DocuTap since starting in Ghana four years ago.

“With time, we were able to migrate everything up to the cloud, and they’re actually running their electronic medical record from the cloud in West Africa,” said CEO Eric McDonald, who has visited the clinics. “It’s great to see them taking some of the best practices from western culture and applying what they can. I was really impressed by what they’ve done.”

The EMR and overall model have been “life changing” in Ghana in terms of providing care, McDonald said. Patients who used to wait three or four hours to be seen at a clinic have found that time cut dramatically.

The clinics deliver a range of primary and reproductive care to all ages. Patiently are treated regularly for malaria, respiratory tract infections, skin and wound infections, and high blood pressure.

“We see more women of childbearing age and children than any other population,” said Ann Mays, executive director of clinical health services.

Through a physician liaison program, Sanford has sent three physicians to the country each year over the past two years. Nurses also have gone, and Sanford is developing an exchange program that could expand the opportunity.

“So it could be laboratory, pharmacy, or it could be someone on the business side if it’s a value-add on both sides,” Mays said.

Sanford also has built a corporate structure in Ghana, with 20 staff members. That same model would be re-established in other African countries should Sanford expand.

“You just need to be there,” Slack said. “If you’re going to scale, you need boots on the ground.”

Kojo Benjamin Taylor is Sanford’s top executive in the country. While the public sector that manages the core of the preventative health system has done a good job of ensuring basic services in rural areas, gaps exist in providing “curative care,” he said.

“Sanford’s collaboration with the Ministry of Health is making remarkable progress in improving the health status of rural communities by effectively combining preventative and curative care in its business model,” he said.

The next hub clinic is planned for a northern region of Ghana, where a donor is helping fund a 100-bed hospital.

Much of the rest of the growth is supported through grants. Sanford has a relationship with a global organization, University Research Co. or URC. It was chosen to manage a $70 million grant in 2014 for the U.S. Agency for International Development, or USAID, that included $10 million to build and refurbish clinics in two regions of Ghana.

“We’ve reached an agreement where we’re going to lead the site selections and establishment of these clinic locations through their grant money,” Slack said.

Sanford ultimately will operate the clinics and has found sites for the first 10. In four years, the grant is expected to fund between 100 and 200 clinics.

The business model includes a patient-visit cost less than $7. Most health care in the world is subsidized by the government with residents paying on a sliding scale according to income. That can range from $2 to $16 in U.S. dollars annually for a mother and her children.

Sanford has been able to prove financial sustainability in its first five clinics and will work through how the model looks in remote locations.

“As we are able to prove the sustainability and build this model up, we plan to solidify that partnership with the government and continue to convert clinics,” Slack said.

Expansion in Asia, Europe

Sanford also is expanding its pediatric services in China.

A clinic in Kunming opened in the fall of 2014 as a partnership with YMCI Calmette Medical Investment & Management Co. Ltd., a state-owned company of the Yunnan provincial government.

“The relationship is going very well, and they’ve asked us to be expanding our pediatric clinic to be all the primary care pediatric services for the hospital we’re partnered with,” Slack said. “We were just doing a floor … but now they believe in the model and are going to convert their eight pediatricians to our care model.”

That will allow about 75,000 children to be seen annually, he said.

“We’re looking at expanding the relationship with our partner. They are looking to expand within the province, so we are having early discussions.”

The telehealth model from Ghana also might work in rural China, Slack said.

“We have had very early preliminary discussions with the government, and they’re very interested in exploring it.”

Growth in Europe for Sanford International Clinics has gone a different route. A new portal clinic is operational in Germany, supporting Sanford’s stem cell research efforts. The stem cell application is not approved by the Food and Drug Administration for use in U.S. patients but can be performed on Sanford patients in Germany.

“We ran about four patients through and have about six or eight more interested,” Slack said.

The hope is to start clinical trials and eventually offer the services in Sioux Falls – but the process can take years.

Not all Sanford’s international efforts have reached fruition, either.

After trying for years to establish a clinic in Ireland, “we just couldn’t get it across the line,” Slack said.

“The health care payer system couldn’t make the sustainability model work, so we couldn’t move forward. And that’s part of the learning.”