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Improving care through digital health

by Access Afya

In the developed world, there are 3 physicians for every 1,000 people and 4.9 beds for 1,000 people. Here in Kenya, those numbers drop dramatically to just 0.2 physicians and 1.3 beds per 1,000 people.

At Access Afya, we believe in combining the power of technology with skilled, supported, emotionally intelligent people to improve both the cost and quality of care in the developing world so that we can reach more people with the health infrastructure that we have today.

Using a team-based care model, standardization, and digital infrastructure and tools, we have driven the price point of a visit to an Access Afya clinic down to under $4.00 while maintaining our 30% profit margin. In October, Melissa and Eric spoke in San Diego and Singapore about Access Afya’s data-driven approach to providing better care.

 

Melissa at DigiMed2017: Digital health in Kenya is all about creation, not disruption.

 

Dr. Eric at HIMSS AsiaPac17: Collaboration, coordination and co-creation to improve the patient experience.

 

Access Afya Updates

  • We launched two pharmacies in the second half of this year, completing the link between our field programs and clinics. In month one pharmacies saw 900 people and they are getting busier. 196 of those people used us for promotive health, such as family planning and water purification. 87 accessed rapid diagnostics. Each day eight people were refered to Access Afya Clinics for further care. Our vision is simple: like our clinics, our pharmacies promote positive health.

 

  • 11,000 patients were screened for diabetes and hypertension risk through Akiba ya Roho, our co-creation project with Boehringer Ingelheim, Ashoka and PharmAccess Foundation. We found 13% needed to be referred to our clinics for further testing and treatment, 80% of those referred did not know about their conditions prior to Access Afya, and 100% had a positive experience with our team.

 

  • We have a new corporate partnership with Heineken Africa Foundation to launch a mobile maternal and child health clinic, sharing essential devices such as ultrasound with multiple communities. Look for an update on this early next year!

 

Get Involved.

  • Help us make our mobile maternal child health clinic a success! We are looking for a radiologist to help with remote quality assurance, a fellow skilled in project management to spend a few months with us, and devices for self-monitoring high-risk pregnancies to test.
  • Did you enjoy this update? Share it with a friend!
  • “Like” us on Access Afya and post your No Shave Movember photos. We’re donating 5 shillings to cancer research for every new like in November.

 

Thanks!

Melissa and the Access Afya Team

Pioneering Health Financing Solutions

by Access Afya

Judia Waithera has three children but she spends most of her time looking after only one, Nancy. The four-year-old suffers from cerebral palsy and the slightest fever gives her violent convulsions.

Before Access Afya opened a clinic in her neighborhood, Judia had to spend endless hours waiting in hospitals only to get conflicting advice from doctors who didn’t know Nancy’s history. Now, she can get her daughter the attention she deserves from a clinician who she trusts.

Still, Nancy’s medication can cost up to $10 a week – that’s about a week’s wages for Judia. And she is not alone. Many of Kenya’s poor citizens struggle to pay for medication or lab tests, which often leads to dangerous practices like self-prescribing or postponing treatment.

This is why Access Afya has partnered with Sasa Finance to launch an innovative health care micro-financing initiative. Now, Judia can get an instant loan to buy her daughter’s medication, which she then repays in small installments by working as a housemaid. “I am so grateful,” says the 36-year-old mother, “I don’t know what I would do without this.”

The system is fast and intuitive. For only $0.30, our patients can take out a loan of up to $5.00. They then have a month to repay at their convenience, via their mobile phones. Since the start of the program in September 2016, we have issued 534 loans.

The Challenge

The issue of healthcare financing is a controversial one – especially in underserved communities. Experts have rightly pointed out the risk of indebting already vulnerable families or potentially inhibiting customers from seeking medical care if they have not repaid a loan.

But those fears do not negate the vast need for health financing for millions of people around the world. So Access Afya is taking the lead in testing the micro-loan model. As a tech-savvy company, we believe in learning by doing and we think that the success of small-scale financing in other industries shows the potential benefits of this service for healthcare.

Our Solution

We have chosen Sasa Finance as our partner because they are committed to building better products for the base of the pyramid and have a deep understanding of the Kenyan market. What’s more, they are willing to handle repayment, which means our customers don’t fear returning to Access Afya, even if they have a pending balance.

Offering financing options is a way to reward our patients’ loyalty and collect precious data that will help Access Afya better understand cash flows in the communities we serve.

We believe this is not a new behavior for our clients. Micro-loans happen informally through personal networks anyway. Credit is in fact not so different from savings for disadvantaged families. Instead of saving small amounts in order to pay for the service in the future, our micro-loan allows them to afford the treatment as soon they need it and then save up to repay it.

Mercy Sasa Loan

Next Steps

To be sure, this is just the initial stage and we are still a long way away from identifying the perfect health care-financing model. So far, the loans have a 53 percent repayment rate – which Sasa acknowledges is high given the newness of the market and the lack of collateral, but should be improved.

Our customer care representative, Georginah Ndanu, is currently interviewing many of the patients who didn’t repay the loan. Thanks to their feedback, we are already tweaking our approach to clarify the terms of service, improve the follow-up process and provide incentives for repayment.

By December 2017 we will have gathered information on 1074 of users and will be able to draw broader conclusions on the behaviors of Kenya’s poorest urban communities and the feasibility of this innovative financing solution.

We want this data to serve not only Access Afya but all other players trying to expand health care options in underserved communities. As our CEO Melissa Menke puts it, “the potential benefits of health-financing are too great for us not take risks.”

2016 Annual Report

by Melissa Menke

We had a busy start to 2017 and will share more on that soon. It is going to include an exciting update on clinic performance and highlight some of the new technologies and partnerships we have been testing out.

For now, we would like to invite all of our followers and supports to check out our annual report. It was great to sit back and reflect on how far we came last year.

Patrick in action

2016 Year in Review

by Melissa Menke

 

Access Afya opened our doors to our first patients in December 2012. We had big plans then. We came a long way but we were tackling some really tough problems. We were trying to sell primary health care, something people do not necessarily want, in slums, where people have extremely limited income to spend on anything, we were trying to up the bar for quality in our clinics and field programs while maintaining a sustainable model. A lot of people thought we were crazy. But we kept at it and we’ve proven most of what we set out to do. Our new phase is all about growth.

2016 was big for us. We grew our team, expanded our chain of clinics, and developed new models to get quality healthcare to the people.

 

Kiambiu Clinic Launch

Ribbon cutting with the Kamkunji County CHV Coordinator and the Chief at the clinic launch party.

Love at Sixth Site

 The road to Kiambiu was a long and winding one. We evaluated six different slums in Nairobi asking questions to residents such as:

  • Where do you usually go when you feel sick or want to talk to a doctor?

  • How long does it take you to get there?

  • What is the average monthly rent in this community?

We also surveyed other clinics, chemists and went mystery shopping to conduct a few quality checks on the surrounding facilities.

The Kiambiu community stuck out to us for many reasons. There were really no other clinics or chemists close to the plot that we chose. The Community Health Volunteers (CHVs) welcomed us with open arms. The government facilities welcomed the help to serve a dense and underserved population. The location near to the Gikomba Market and Industrial area signaled people living here had some small incomes.

After selecting the Kiambiu community we spent six months evaluating clinic design and build options, setting up, recruiting, and marketing. We opened our doors to our patients December 2016.

Healthy Schools

The Healthy Schools program brings care directly to children in schools through a nurse with a mobile care kit, creating a new and proactive health paradigm.

This year, Healthy Schools saw over 800 children in ten schools. We developed a new model of selling directly to donors, meaning entire schools could benefit from the program. In contrast to a direct to parent sale, we saw really exciting impact benefits when full schools were covered. The number of children needing check-ups dropped from 70% to 48% over a four-month term and parents reported better hygiene at home. They also saved a lot of money.

Healthy Factories

Healthy Factories joins Healthy Schools as our second field health program. We run on-site check-ups, screenings, testing, treatment and health talks for our factory partners, and they can also refer work related injuries to our clinics.

We signed on six factories covering over 1,400 workers this year. We have seen that employees and supervisors like coming to Access Afya for care because it is easier than other options, saves them time and money so they can get back to work faster, and they like the follow-up and aftercare we offer for injuries.

Below, our team runs a pop-up clinic at a local recycling company.

Team

We brought on a strong team to run our third clinic. We welcomed a new Clinical Officer Edwin. Edwin works closely with two Clinic Assistants Annalice and Mercy, who come from the Kiambiu community.

We also brought on a new lead Clinical Officer for the Kisii Village Clinic, Reuben, and a reliever, Fridah, rotating between our sites.

This month we are excited to welcome Eric, our Technology Director, who will be spearheading our work to be the most data driven health company in Kenya.

We also started working with Spire last quarter to provide custom training and professional development to our team members.

“Do you know how many clinics I’ve passed just to come here? When the doctor treats me, I get well. That’s why I keep coming back when I have a problem.”   #testimonialtuesday   Like us on facebook for more testimonials!

Special Thanks

We have had a lot of support to get where we are.

 Nadeem and the Anthemis team were generous with their talents and networks and advised us on talent, contracts, and generally talked through the gamut of start-up issues as they came.

Dr. Ravi Komatireddy joined us as our Digital Health Advisor and has been helping the team structure and use our data, with a lot of compassion for what we are doing.

Avanti Architecture volunteered their time and expertise to develop a model for a clinic in a container and a fixed concrete structure.

Thanks to our new funders that came on this year: Child Relief Foundation, PharmAccess Foundation, Moondance Foundation, and Insaan.

Looking Forward

This year we have more growth in the pipeline. We are learning from our third clinic and crafting our expansion roadmap for future sites. This roadmap includes expansion of our clinics and our field programs so we can continue to bring quality, low-cost healthcare to more people in Kenya in innovative and sustainable ways.

We have a model that works and we are starting to grow it. We are finding new ways to grow it faster. Patients like it and it works. We’ll be raising money again this year to expand our work and need ideas and introductions from people like you to keep growing.

Thanks for your continued support!

Melissa

Founder, Access Afya

 

Through My Eyes: Access Afya Communications Fellow

by Access Afya

This month I  joined Access Afya as the new Communications Fellow! It’s been a month of “I am a communications fellow with Access Afya” to my friends and family. But, mentions of Access Afya are  accompanied with so many questions; “What’s Access Afya?” “A Social Enterprise, what’s that?” “How is Access Afya different?” I found that in my excitement of telling others about my new fellowship, many did not understand what we actually do as a health care social enterprise. So I starting telling people that our values: “At Access Afya, we believe every patient should feel cared about and understand what they are getting” makes us unique, fresh, and different from the norm.

Being new at Access Afya is very exciting. I went through orientation and handover with the former communications fellow and met the team at the head office and planned to visit the clinic staff later in two different villages of Mukuru Slum. The one thing that stood out while familiarising myself with the teams, programs and protocols was the emphasis on the patient: care should always be patient centered, our care teams and processes stand out against the competition, and we work to  provide a welcoming, comfortable, and friendly atmosphere for our patients.

I am a sociology major and I am interested in observation and research. The emphasis on patient centered protocols for the clinics was captive to confirmable objectivity. I needed to do a research with a clear baseline, to see what makes the organisation different and unique from other health care companies. I decided to visit the clinic staff to familiarise myself with the location and community but I decided that I was going to do it as a patient, rather than introducing myself as the new fellow. I wanted to experience Access Afya through the patient’s eyes.

I had my directions that I located on the website but also I wanted to try to get to the clinic from the main bus stage by asking the locals. I wanted to let the signposts for both clinics guide me. I also intended to call Access Afya and ask for direction; more than once.

First, I visited the Kisii Village clinic. I took a bus to South B. I alighted and asked for directions to Access Afya. I was pretty impressed that 11 out of the 13 people in Kisii Village that I asked for directions knew clinic location. With Sinai Village, only one person had no idea how to direct me. Interestingly, when I called the organization at both clinics after ‘getting the directions wrong’, they asked me if it would be okay if they called me instead and gave me a precise detailed direction. That was amazing! The signposts were also descriptive in terms of direction and distance. I did all that; the calling and asking the locals, for research purposes but the signs were enough to get me there.

I finally saw it. A small, blue and white clinic; similar to the colors used on the signposts. The clinic has clean white blue patterned tile, smells like spirits, antiseptic, giving an assuring hygienic scent. The clinic is small and has a waiting bay, a pharmacy that is right near the door; two other rooms for lab and consultation. . I was welcomed by a smiling receptionist who had a tablet in her hand. I found one patient in the waiting area and one just leaving the consultation room for the pharmacy. I really wondered why the patients weren’t  holding any paper for reference. I am so used to being sent to the Lab or Pharmacy or the consultation room with my documents! This, was all new and strange to me. I was asked for my bio data and they impressively noticed that I was a new patient and asked me how I found out about the clinic as she filled in the details.

I used my first name and surname. Then I realised they were using technology on my first stop at Kisii Clinic and my records would be in the system, it would be hard to visit Sinai with the same intent. To avoid getting caught’ I used a different name in Sinai Clinic.

I was then taken to the consultation room, had a sit down with the doctor, explained how I felt (gave out all the signs and symptoms of Malaria; I seriously hadn’t thought that bit out calculatingly!). He wrote some things on a tablet, had a chat with me about the possibilities of what was ailing me, excused himself and came back shortly after and explained what kind of test he was doing. A rapid test was done, and shortly he came back with the results; a negative malaria test. At the Sinai Clinic I was explained to, the possibility that I could be ailing on something other than Malaria because of my persistent tummy ache(a detail I added to Kisii clinics’ symptoms) and so, an intense lab test (stool test) was done in Sinai. This was also, unsurprisingly, negative.

The doctor addressed the headache concern, by giving me painkillers and advised me to come back, if it persisted. The medication was pretty cheap. He asked me to come back for a check up, the following week because I mentioned that I had a condition that needed regular check up. That was quick! The receptionist then asked me to confirm with her what date my check up was and wished me a good day as I left just as another patient got in; for consultation. No wonder, there was no queue!! I thought to myself as I left. I left the clinic smiling.

Then I finally let both clinics know that I am a new member of the team. They were surprised for a few seconds and welcomed me to the team just as warmly as they had when I was a patient in the clinics!  I went back to work in the head office satisfied. The one thing that caught me off guard was getting a call from Access Afya customer care 2 days later to check my progress. This made my heart smile because I had never received a call from any facility to check on me after a visit. Being an Access Afya patient made me feel a sense of relief and actually made me feel cared for. The fact that my tests and medication was explained to me gave me assurance that I would be okay! Overall, it was an experience, I’d go back to!