Developing a sustainable model that improves access to high-quality care

Monday, 8 April, 2019

Q&A with Dr. Githinji Gitahi, CEO Amref Health Africa and Henk Siebren de Jong, Chief of International Markets, Philips

No company, NGO or government body alone can solve the many healthcare challenges facing communities around the world. But working together, I’m convinced they can develop the solutions needed to improve healthcare access and help lay the path to achieving universal health coverage (UHC) by 2030.

That’s why I’m excited about the Partnership for Primary Care Philips joined last year, together with Makueni County government, Amref Health Africa and the Dutch development bank FMO. The program, which kicked off in July 2018 with a one-year feasibility study in Makueni County, aims to strengthen primary care by building a financially sustainable model that improves access to high-quality care. The World Health Organization and others stress the critical role primary care must play in order to achieve UHC, so I’m eager to see the results of the study.

In simple terms, Makueni County is responsible for policy, provision of healthcare professionals and drugs and supplies, Amref is taking the lead in training health workers and managing facilities, FMO is providing catalytic financing and financing expertise, while Philips is providing health system infrastructure and medical equipment.

But we didn’t just jump into the partnership on a whim. Philips and Amref have been working together for six years. The trust we’ve built up over that time has set the foundation for this partnership. Dr. Githinji Gitahi, CEO of Amref Health Africa and co-chair of UHC2030, has played a central role in building that foundation. With the feasibility study well underway, and World Health Day on April 7, I took the opportunity to get his take on the Partnership for Primary Care.

Henk Siebren de Jong: Makueni County has close to a million residents. The population is up against a host of healthcare challenges. How would you describe the situation on the ground?

Dr. Dr. Githinji Gitahi: Before focusing on Makueni County, let me give you the context of the overall primary healthcare in the country. The primary care system in Kenya is not efficient and not able to serve the needs of its growing population. The system is often challenged by a lack of sustainable funding, poorly-equipped facilities, erratic supply chains, and a shortage of healthcare professionals.

This is also the case in Makueni County. Over 60% of the population lives below the poverty line, on less than $1 a day. Although the county government made significant investments in extending and improving its primary care system, most primary care facilities are not fully functional due to gaps in infrastructure and staff. Next to this, people need to bridge long distances before they reach a health facility. Too often at the facilities, they face a choice between sub-standard public care, costly and inaccessible private care, or traditional healers. Some patients don’t even seek the necessary care because of the time it takes or the costs involved. And very often, people do not know when and which health facility they should visit for the care they need.

Sadly, it’s a familiar story but the model we are now testing is addressing many of these issues. As part of the program, Amref Health Africa is offering capacity building, health worker training and other capabilities. How does this work in practice?

In this program, we train all levels of health workers – community health workers, nurses, clinical officers and managers of health facilities. All of this to ensure that people are referred to the right facility at the right time, and that whenever people visit a health facility they receive the right care.

An assessment of the three facilities in Makueni helped us determine what type of knowledge could be improved among the health workers in those facilities. All health workers have received training on these specific improvement areas. We have also trained around 60 community health workers. They bridge the gap between communities and the formal health system, a crucial role for a well-functioning system. After being trained, they are enrolled to our interactive mobile learning solution Leap, where they can improve their knowledge and skills and get support whenever needed.

It sounds straightforward and yet the shortage of trained staff is a reality for many communities. Let me ask you about the Partnership for Primary Care. Why do you think it has so much potential?

Improving healthcare in Africa requires strong partnerships that leverage the unique skills and resources of governments, civil society and the private sector alike. In the Partnership for Primary Care, which has the potential to be the first public-private partnership for primary care after the scale up, we combine the power of the private sector with the reach of the public sector. For example, the private sector can potentially have enormous impact in increasing business investments and developing scalable market-based approaches, while civil society organizations can ensure that those investments actually benefit communities and deliver quality services.

The program itself is effective because we tackle the entire health system by improving the demand and supply side of care and by focusing on financial sustainability. In order to really improve the system, you need to tackle these three areas. This way, we make the primary healthcare system more robust and stronger without actually changing it. We make primary healthcare available for everyone in a financially sustainable way while maintaining leadership of the public sector role of government as duty bearer.

I want to hasten to add that access of care is just as important as the quality of care. This project is just as much about access as it is about the quality of care being provided.

How has the local community responded to this program?

So far, we’ve learned that the community is positive about the changes. People see the facilities and the supply of healthcare have improved. So we see changes on the demand side in the clinics and there is more activity – more patients are being treated, more women deliver their babies in the clinics instead of delivering at their homes.

Health is a basic human right. Everyone should have access to essential health services without financial hardship. This is at the core of what we do as Amref. And this is also what we focus on in this program – building a sustainable model that improves the quality of care and leverages the national health insurance. Furthermore, we focus on the mobilization of domestic resources. This is critical because we see donor funding declining and healthcare costs rising. I’m really eager to see how the study continues to develop.

How do you think the model being implemented in Makueni County can be applied in other areas in Kenya and around the world?

To be honest, what we are doing here in Makueni is not rocket science. We bring proven solutions together that improve the demand and supply side of care. We explore whether there is synergy when combining this. And we focus on health insurance to make sure it financially sustains. At the end of this feasibility study in Makueni, we will deliver a blueprint showing what works, what doesn’t work, that, after contextualization can be used by everyone.

This article was first published HERE by PHILIPS on 4 April 2019.