Intergrated public health care model ppp case study in kenya

A Case Study – A Case Study – Integrated Primary Health Integrated Primary Health

Care in East Africa Care in East Africa

The EAAG Givers’ Lounge 30 March 2012

Dr. Michaela Mantel Aga Khan Foundation/Aga Khan

University

A model developed by the A model developed by the Aga Khan University East Africa and the Aga Khan University East Africa and the University of California, San FranciscoUniversity of California, San Francisco

Aga Khan Development NetworkAga Khan Development Network

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The AKDN Integrated Health System The AKDN Integrated Health System in East Africa – proposed settingsin East Africa – proposed settings

Core provision Sustainable health services of high quality

at primary, secondary and tertiary level in East Africa

Most care offered in AKDN-assets 8-10 clusters in the entire EAC to serve

large number of patients with full continuum of care at highest standards

Income pyramid

Wealthy

Destitute

Middle class

Aspiring

Struggling

Poor

Access expansion • Target is a small number of geographically

defined populations with patients across the wealth spectrum

• Provide select types of care and partner with government/mission assets to complete offering

• Focus on selected districts and demonstrate how to improve access and quality in a sustainable way

Integrated Primary Health Care Integrated Primary Health Care Start-Up Project Start-Up Project

(IPHC S’UP) (IPHC S’UP)

Aga Khan University East AfricaAga Khan University East AfricaUniversity of California, San FranciscoUniversity of California, San FranciscoAga Khan FoundationAga Khan Foundation

June 2011-May 2012

Objectives Objectives

To develop an IPHC model that

◦ recommends effective mechanisms for partnership between district health systems and higher education institutions and

◦ identifies social innovations to increase access to high-quality primary health care services in resource poor, rural East African communities with focus on maternal. Newborn, and child health (MNCH)

Planning grant for proposal development and Resource identification and mobilization for

testing of the IPHC model in selected geographical area(s).

The PartnersThe Partners

Kaloleni District, Coast Province, Kenya

Aga Khan University (AKU)

University of California, San Francisco (UCSF)

Community Health Department, Aga Khan Health Service-Kenya

Aga Khan Foundation

What we didWhat we did

Signing agreement with the Provincial Govt.

Community engagement exercise

Health facility assessment/mapping

Capacity building (district & AKDN internally)

Social innovation workshop and internet research

The nursing alumni conference

E-health training and health system workshop

Testing the role of family medicine doctor in a district health system

Workshop with nurses/midwives

Building a partnership with the Kaloleni District Health Management and the Hospital teams

Kenyan women on the way to the clinicKenyan women on the way to the clinic

The three delays in maternal careThe three delays in maternal care

Delay to seek care

Delay to reach care Delay to receive care

Distance to Health Center (HC)Delay in recognizing danger signsLack of community knowledge of the link between improved maternal and newborn outcomes and a skilled attendant at deliveryLack of maternal decision making power (men as main decision makers)Concern over costs of health care accessCultural beliefs of delivering at home Perceived poor quality of health care

Insufficient money for transportLack of means of transportImpassable roadsLack of communication between communities, and first facility level and referral levelLack of community engagement in local transport solutions

Lack of capacity of health facility staffInsufficient linkages between health facility staff and the Community Health Workers (CHWs) Insufficient materials, medications and equipmentPoor motivation of health staff and inadequate attitudePoor quality of care and inappropriate case management

What we learnedWhat we learned

We learned about

How to engage the communities to identify gaps and barriers in MNCH

Community demands and priorities Engagement with community leadership and importance of

participatory approaches in planning and monitoring Health workers needs for capacity building and effective

methodologies for training /mentoring District management needs including the need for

community based HMIS Strategies that have high potential to enhance community

health, primary health care and referral system Cost-effective interventions and innovations (e.g.mobile

technology), franchising, output-based approach and other good practice models

We also learned about structures and processes that are essential to meet the universities’ needs in terms of education and research relevant to local health systems .

District Hospital (4)

Health Centres (3)

Aga Khan University Hospital

Other Aga Khan HealthServices Hospitals

Community Clinics

Dispensaries (2)

Community Units (1)

National (6)Provincial (5)

Referral

AKDN Multi- sector input

AKDN Integrated Health System in Partnership with the Public Health System

Source: Dr. Armstrong, AKU/FHS

Ministry of Health

Education

ResearchServices

CommunityMembers become resilient, self sustaining and newly informed consumers in an emerging

market while experiencing improved quality of life through a Multi Input Area Development approach

Aga KhanHospitals

Aga KhanCommunity

Clinics

AKU/UCSF

External Resources

Bi-lateralDonors

Global Initiatives

International Foundations

AKDN Multi-sector input

Quality

Impact

Relevance

Access

Core Principals

Accountability

Transparency

Sustainability

Resilience

Values

Provincial Government

District Hospital&

District Health Management Team

Primary Health Care

PartnershipCritical Inputs

Innovations, tools and other resources

Community Health Workers

Integrated Primary Health Care Partnership Model

Local NGOs

Local NGOs

AKDNAKDN

Envisaged IPHC partnership programmeEnvisaged IPHC partnership programme

Partnership Model (AKU/UCSF/Local Govt. & AKDN/other):

EducationResearchServices

Critical Inputs from external resources (resource mobilization)

Monitoring and evaluation – documentation and dissemination – informing/influencing policy

Initial focus on MNCH

Model of an open concept: changing focus according to changing needs and priorities; e.g. NCD, environmental health; even beyond HEALTH

Next steps:Developing a AKU/UCSF partnership proposal for testing an IPHC programme in a selected district (Kaloleni District) for a period of three yearsResource mobilization to support to the partnership model to provide ‘Critical Inputs’

Our visionOur vision

To create an IPHC partnership model that

contributes to the health of communities in resource poor areas through community engagement, improved access to quality care, and strengthening health systems

offer students unparalleled access to divergent communities

provide faculty a unique opportunity to apply for research funding to undertake multidisciplinary, multi-sectoral research enabling AKU-UCSF / AKDN to design innovative, locally applicable, globally relevant solutions

Develops education programmes relevant to local needs and utilizing locally applicable modern technologies to build multi-sector capacities addressing the current inequity in health and education

Can bridge communities across three continents (AKDN focal regions)

We believe that we can make a difference! PARTNERSHIP

Critical inputs: examplesCritical inputs: examples

Community based solutions and innovations

Training and mentoring of community health workers

Increasing systainability of CHW system e.g. through small enterprise development

Franchising of community midwifery services

Voucher system for maternal services

Birth planning and preparedness (savings for transport)

Resilience and positive deviance approach

Support tools

Material and learning tools Communication systems Infrastructure improvements e-health system

◦ e-learning◦ tele-medicine◦ m-health◦ Information systems

Local media Support to training and

capacity building Support to alumni networks Technical assistance to

develop tools and innovations

Asanteni Sana Asanteni Sana Thank youThank you

Comments?Comments?

Questions? Questions?