Good Enough to Run It. Too Poor to Own It?

By Tam Goldsmith

Unjani helps nurses become clinic owners, asking whether franchising puts too much weight on who has the money.

Unjani Clinics is helping South African nurses move from treating patients to owning the clinics they run. It raises an awkward question for franchising: are we choosing the best people to own businesses, or simply the people with enough money to buy them?

Franchising likes to sell the idea that it creates entrepreneurs. There is an awkward catch, though. In many systems, you need a substantial amount of money before anyone gets particularly interested in how good an entrepreneur you might be.

South Africa’s Unjani Clinics turns that around. It starts with professional nurses who already know how to care for patients and understand the communities they serve, then provides a structured route towards running and ultimately owning a clinic. Unjani Clinics NPC supplies infrastructure, systems, training and ongoing support during that process.

It is important to be clear about what Unjani is. This is a social-franchise model operated through a non-profit company, rather than a conventional commercial franchise selling territories to investors. That distinction is important because the funding structure is precisely what makes the model so interesting.

We May Be Using Money to Choose the Wrong People

Having enough capital to buy a franchise proves one thing rather conclusively: you have access to enough capital to buy a franchise. It does not prove that you can manage staff, retain customers, control costs or run the business better than somebody who cannot afford the entry price.

That distinction becomes difficult to ignore with Unjani. Its candidates are professional nurses who must have the appropriate primary healthcare qualification. They also research their proposed communities and present a business case, because clinical ability alone does not guarantee that a clinic will work commercially.

Unjani says its site-selection process examines population, demographics, disease profiles, existing healthcare facilities and, crucially, whether people in the community can afford the service. These are private clinics charging patients for treatment, so good intentions cannot rescue a location without enough paying demand.

The interesting part is what happens when Unjani finds the right nurse in the right community. Instead of asking her to arrive with enough money to fund the entire clinic herself, the organisation has built financing around getting that operator into business.

That is almost the reverse of conventional franchise recruitment, and it deserves more attention.

The Clinic Costs More Than the Nurse Is Asked to Find

Unjani currently puts the investment required in a clinic at roughly R1.2 million to R1.35 million per professional nurse, depending on the infrastructure format. That includes the clinic infrastructure and equipment, operational support and costs incurred by Unjani Clinics NPC.

Its first 90 clinics were fully grant-funded. The organisation later introduced blended finance combining grant and loan funding, with participating nurses repaying the loan element during a five-year enterprise-development period.

The current model is built around that five-year journey towards ownership. Unjani Clinics NPC says it also provides operational donations during the first 24 months while patient numbers build towards break-even.

This is where the comparison with ordinary franchising becomes uncomfortable. Plenty of experienced managers spend years running somebody else’s franchise unit successfully but could never meet the financial requirements to buy one themselves. The industry can trust somebody with staff, stock, customers and daily operations while simultaneously deciding they are too poor to own the business they know how to run.

There are perfectly sensible reasons franchisors require capital. New businesses need working capital, lenders need security and franchisors cannot simply absorb the cost every time somebody wants a territory. Unjani can structure things differently because it is a non-profit public benefit organisation supported by funders and donors whose objectives include social impact.

That means a fast-food chain cannot simply copy the model on Monday morning. It does not mean the question disappears.

Ownership Without Support Would Be a Cruel Gift

Putting a clinic into somebody’s hands and wishing them luck would not constitute empowerment. It would simply transfer the risk.

Unjani’s nurses may understand primary healthcare, but owning a clinic requires another set of skills. Cash flow, stock, compliance, staffing, marketing and financial reporting still need to be managed, while the clinic has to attract enough paying patients to remain sustainable.

The network provides coaching, mentoring, procurement and logistics support alongside its systems and technology. Nurses retain responsibility for operating their clinics while developing the commercial skills required to become independent owner-operators.

That support matters because Unjani is trying to solve two problems at once. It wants affordable private primary healthcare in communities where access can be difficult, while also creating businesses owned by the black women nurses operating them.

Those goals only survive if the clinics work financially. A clinic that cannot cover its costs eventually stops helping anybody.

This Is Already Much Bigger Than an Experiment

Unjani is no longer a handful of pilot clinics. Its current website says the network has more than 290 care settings across South Africa, built around an owner-operator model serving underserved communities.

The network provides primary healthcare that includes diagnosis and treatment of common ailments, family planning, antenatal care, chronic disease management, HIV counselling and testing, and wellness screening. Its clinics sit between two realities familiar to millions of South Africans: an overburdened public system and private healthcare that many households cannot comfortably afford.

That makes local ownership more than a nice addition to the story. The nurse operating the clinic has a financial interest in whether patients return, whether costs are controlled and whether the business survives. She also brings professional experience and knowledge of the community into the operation.

The franchise structure then handles things that would be expensive or difficult for every independent nurse to recreate alone. Systems, procurement, branding, training, technology and business support can be organised across the network while the individual clinic remains locally operated.

For anyone interested in franchising, that should sound familiar. The unusual part is who the system was designed to put into ownership.

Perhaps Franchising Should Stop Confusing Wealth With Ability

There is an uncomfortable possibility here. Franchising may be excluding some of its best potential operators before they ever reach the interview.

The industry understandably worries about undercapitalised franchisees. Running out of cash can destroy an otherwise viable business, so lowering financial requirements simply to sell more franchises would be irresponsible. The answer cannot be pretending capital does not matter.

But there is a difference between ensuring a business is adequately funded and insisting the operator personally arrives with all the wealth required to fund it.

Unjani demonstrates that difference rather well. Its model still needs capital; a clinic requires more than R1 million of investment. What changes is where that capital comes from and how the eventual owner reaches ownership.

That should interest commercial franchisors, particularly those struggling to recruit capable operators. An experienced store manager, technician, therapist or other employee may already understand the customers and the operation better than an outside investor. What they may lack is the balance sheet needed to buy the opportunity.

Franchisors do not need to become charities to do something about that. Staged ownership, employee-to-franchisee programmes, partnerships with specialist lenders and financing structures for proven operators are all worth examining.

If somebody is good enough to run your business for you but can never afford the chance to own one, perhaps the problem is not entirely with the candidate.

What We Can Learn From This

Franchisors should be careful about using personal wealth as a shortcut for franchisee quality. Unjani shows how professional expertise and local knowledge can be identified first, with funding and business support then structured around getting capable operators towards ownership. Conventional franchisors cannot simply reproduce a donor-supported social-franchise model, but they can build clearer routes for proven employees and operators who lack substantial personal capital. As franchise investments become more expensive, brands that find responsible ways to back capable people may discover owners their competitors never considered.

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