Feature Startups

Saving lives – Lou Koboji´s health startup in South Sudan

STARTUP: Kajo-Keji Health Institute
The Kajo-Keji Institute is the first private not for profit health training institute established by South Sudanese.
PLACE: Kajo-Keji County, South Sudan
FUNDING:  Bootstrapping and permission of using NGO built infratructure with permission given by government of South Sudan with consultations of the Landlords.

In March 2012 Lou Louis Koboji left Uganda, a country he had lived in for 26 years as a refugee,  for a few weeks of work in his former home country – South Sudan.  Whilst there, he met a woman close to child birth in a Traditional Birth Attendant home state. He was surprised to hear that she chose to give birth at  home rather than go to the local health centre and that this was common amongst expectant mothers in South Sudan. The reason therefore was that the health centers did not have enough qualified health workers. After learning that the young woman had then died on the same day, he decided to dedicate himself to solving the problem of inadequate number of qualified health workers in South Sudan – which led to the founding of the Kajo-Keji Health Training Institute.

What is the origin of the Kajo-Keji Health Training Institute?

Lou Koboji: Before I founded the institute I was working in Uganda. When I finished my degree in biomedical laboratory technology at Makerere University in Uganda on a scholarship from Windle Trust Uganda (Formally Hugh Pilkington Charitable Trust-HPCT-UK), I had a very good job in Arua District, Uganda. But at the same time I did not forget my roots and my country South Sudan. In 2012, South Sudan Older Peoples Organsation (SSOPO), offered me HIV/AIDS consultancy and I got a real opportunity to see my home, South Sudan, after 26 years of refugee life in Uganda.
There, in a County call Terekeka, I met Kiden (RIP). She was a pregnant woman who was expecting to give birth. Like in many countries, I expected her to be in a Health Centre, being attended to by midwife. But this was not the case in South Sudan. She was being attended to by a TBA, a traditional birth attendant. Kiden did not make it, she died in the process of giving birth to new live and later I realized that Kiden was just one of the many pregnant women dying every day in South Sudan.

Kiden’s death would have been preventable if enough medically trained health workers had been there to attend to her.
Later, after further enquiries in the Ministry of Health South Sudan and looking at data I realised that South Sudan had the highest maternal mortality in the whole world (2,054 per 100,000 live births with 16 women dying daily due to pregnancy related complications).
I continued with my consultancy in Upper Nile in South Sudan and soon I came across cases of guinea worm. Guinea worm is almost eradicated in Uganda and other countries in the world. So again, I asked “What is happening here?” and I saw that another big challenge was the Neglected Tropical Disease (NTDs) in South Sudan. 90% of the global NTDs burden in South Sudan ops alone leave a high under five infant mortality. And then I said that I will come back and we will build this country by improving health care.

How did you implement your idea?
Lou Koboji: I went back to Uganda and I made a very difficult and hard decision – being a young man and also leaving my good employment. I said I need to come back, contribute towards improving health care in South Sudan. I resigned my job in Uganda I went back to South Sudan.

I made a very difficult and hard decision – being a young man and also leaving my good employment.

All this was what motivated me to start improving health care in South Sudan. Next came the administrative step. I went from office to office and it took me 9 months to organize things. After the 9 months we were accepted and the institute was duly registered and recognized in South Sudan Then we went to get staff and finally in January 2014 we started the first class. We started with 60 students and currently now we have 208 students.

What does your work mean to you?
Lou Koboji: The KKHTI means a lot to me because when I went to school and my speciality in school was to save lives. And now I also am working in the line of saving lives and teaching people to learn and save lives also. I am achieving my goal of saving lives. 
What is so special is that we work locally but with a national perspective. We have students from the whole country – we take 5 from each of the 10 states.

How many people are working within the Institute?
Lou Koboji: We have 23 full time staff. There are 2 Medical Officers and we have Clinical Officers. We have Laboratory Technologists. We have nursing officers. We have one finance assistant, who does the finance managing. Then we have human resource management. We have a driver that delivers food and we have support staff made up out of 4 cooks, 2 cleaners, and 2 security guards.

How do you find the other professionals working for the institute?
Lou Koboji: We advertise for them in South Sudan and when people apply we interview them with the help of the ministry of health and then we offer them a position. Now what mostly happens is that we have to attract people to come and work. So we go out and source for people, particularly in Uganda. Most of the senior staff now we have to source from Uganda as we would not be able to get them in South Sudan . So we have one year contracts with them and they come and teach for one year or they can terminate their contract with the notice of 1 month if they feel uncomfortable.

What are the 3 main challenges you have encountered for your startup?
Lou Koboji: The main challenge when we started up was the infrastructural room. Classrooms, administration, labs, library, rooms for the students to sleep in and stay. So the limited space capacity of the infrastructure was the problem.
The infrastructure that we are using right now was previously constructed by Norwegian People Aid (NPA) to help the community train Aanimal health workers during the war.
The infrastructure that we are using right now was previously constructed in 2003 by Norwegian People Aid (NPA) to help the community train animal health workers 2003 to help the community during the war. So when peace came this structure was abandoned in 2008 due to funding challenges . So we went into negotiation and since what we are doing is also helping the whole country the government finally allowed us to use the infrastructure. That was the first challenge, which still is a challenge as we talk now.
The second challenge is the inflation in this country. When we started $1 USD was equivalent to 4 South Sudanese Pounds (SSP). So when we pay 2000 SSP to the cleaner it was like we are paying them $ 500 USD, which was pretty good.
 Right now, $ 1 USD is 25 SSP. So when we pay 2000 SSP this is like we are giving this person about $ 80 USD. When we started, because the inflation was not so high, we were able to recruit and retain more staff. The inflation is due to the geo-political situation in this country and it has affected us.
So the third challenge is connected with the inflation as it has affected us and led to poor staff retention. Especially those specialised staff like the medical officer.

How do you handle the stress entailed with the startup?
Lou Koboji: Here in South Sudan we rely on our resilience. It is very hard to answer this question precisely. But when we struggle, resilience helps with the stress. 
Number two, what we are doing is for the national interest of this country. So from time to time, where we see necessary, we work with the government so that they can advise us. But they do not have physical or finances contributions but advisory.

What are the things you hope for in the future and how do you hope to achieve these?
Lou Koboji: Firstly, we plan to expand space capacity by constructing classrooms, hostels and demonstration lab. I am happy to let you know that at this moment we have already secured funding for the construction of a classroom from Segal Family Foundation, a US based foundation. The next thing we need are funding for the library and the demonstration lab.

Our next big thing after this is to graduate 90 students annually.This year we are graduating 50 as we have only 50 students. There are 2 courses so next year the second course will be able to graduate also. There also are 50 in that course, so in total we would be looking at 90 to 100 students.

Then, the other thing that we are looking at is that we should be able to improve health care in South Sudan in two ways.

Then, the other thing that we are looking at is that we should be able to improve health care in South Sudan in two ways. First our graduates will treat patients in the private and public, second as part of the training requirement we will continue with our supervised treatment of patients by our students and offer community based health education and services.

Where will your students be working after graduating?
Lou Koboji: The students are being sent by their development partners. Particular students are bonded and when they graduate, they are supposed to go back to where they were sent from. They go back with additional knowledge, Skills and positive attitude that will improve the health care of the people there. Then we also have students who fund themselves. When they finish they need to find clinics, placement in South Sudan. Given the low number of health workers in South Sudan, we only have around 120 physicians in whole South Sudan, so there is job market for them, both in private and governmental areas. But most of our current students are already bonded and will go back to where they were sent from.

How did you finance the founding of the KKHTI?
Lou Koboji: First of I funded it from my savings. When I ran that consultancy I was given some money and used the savings. I used those savings to get it started, buy office equipment, computers, develop the website etc. 
Then the second one is that we used NGO (NPA) property.

Can you make a living from running the KKHTI?
Lou Koboji: Yes, I can make a living. 
To me as an individual including rent, it can go to 417 SSP per day, about $14 USD per day, as is here in Kajo-Kejii. But it can go up to about $ 23 USD per day in other cities. If I am to talk here about my family it can go up to 500 SSP per day, which is about $ 20 USD per day. This includes transport, which is purely public transport, moderate rent. We don’t have insurance and our cost for health care is moderate and low as it has been subsidised with the support of the NGOs that are in South Sudan.

And finally, what are 3 things you think your startup will need next?
Lou Koboji: Firstly, capacity expansion. We have been supported by Segal Family Foundation and other good friends of KKHTI  to construct one block of 4 classroom. Everything is as planned but still we need to expand our capacity in terms of demonstration laboratory and library. In terms of finance we are looking for $ 120,000 USD for both the demonstration laboratory and library. This will improve the quality of instructions in the class. The second thing is staff retention. Due to the current economic situation, there is high staff turn over cause of inflation. We are looking for $ 90,000 USD per annum to help us top up salary for our 23 staff so we can continue to retain them. Similar institutions like KKHTI are now paying their staff in dollar, hence attracting staff and retaining them. We believe we can also retain staff if we top up their salary.

However, this is a short time solution for the inflation period till 2018 when the government will go to elections and hopefully will stabilize after the elections.

Then the third thing we are looking at is in services training of tutor. We are looking for funds to hire specialists from around the world that can build the capacity of the staff on site mentorship, coaching and training for at least 2 weeks biannually. This will help keep the tutors updated and also be able to meet international standards. The estimated cost is $ 10,000 USD per year.
So in total we are looking at a total of $ 220,000 USD for this year.

Information on South Sudan
In 2011 a referendum led to South Sudan becoming one of the newest countries in the world. However, despite having gained independence from Sudan, the young nation has been struggling with political conflicts and a state of civil war.
As a consequence of this, the already weak healthcare system of the country has been neglected, leaving the population without the needed direly medical care.
Dr. Lou Loui Kobojii has made it his goal, to change the healthcare situation by founding the Kajo-Keji Health Training Institute in 2013.
Capital: Dschuba
Size: 619.000 to 644.000 km²
Population: 11.3 Million
Human Development Index: Rank 169
BIP per capita: $ 1,120 USD (IWF)
Form of government: republic
Independency: 2011

If you would like to contact Dr. Kobojii, have some questions or ideas, you can send us an email and we will put you in contact with him or you can contact the institute directy under info@kajokejihealthtraining.org.

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