Intergrated public health care model ppp case study in kenya
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Transcript of 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?