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Paying Off

by Access Afya

Below is an excerpt from an article I wrote that was just published on NextBillion Health Care: “Health Centers Paying Off in Kenyan Slums: Access Afya’s award winning model is based on empowering clients.” This recognition comes at a great time, as we celebrate the first month of our second micro-clinic, welcome three new team members, and experience one of our busiest months so far! -Melissa, CEO, Access Afya

Access Afya is redefining the care system for Nairobi’s urban slums. Our clients often do not have safe access to quality primary care. This means they frequently buy medicine over the counter from unlicensed, unsafe chemists. This is usually not the right treatment, and self-medication is creating a growing problem of antibiotic resistance in Kenya. Our micro-clinic model is lean: two shifts of two people run the facility, which is open 10 hours a day, seven days a week. It is designed for efficiency, fitting essential primary care services into an average plot size in the slums, which ranges from 100 to 200 square feet.

Despite common narratives about unwillingness to pay at the base of the pyramid, our pilot clinic has over 1,000 clients and has earned more than $4,500 in its first year. Patients pay an average of about $4 each, depending on which service they use. Monthly revenue increased over 150 percent in 12 months, and both sites are covering between 70-80 percent of their operating costs in 2014. With increasing word-of-mouth referrals, better marketing and branding materials, and sustained community outreach, we aim to have all four sites (current and planned) self-sustaining by the end of the year.

Building a business model is related to – but not the same as – building a business. Access Afya is growing a team of Kenyans passionate about improving the health sector. Our end goal is empowered clients who understand themselves, their bodies and how to mitigate risk. We use a few strategies to do this, including community outreach and marketing, partnerships with the public sector for priority care delivery, small, efficient micro-clinics and qualified health professionals.

- Read the full post on Next Billion!-

Survey experice at the Mukuru slums

by Access Afya

My name is Mary and I am a consultant at Access Afya Kenya. Access Afya is based at Kisii Village, an area within one of the Nairobi slums. We provide reliable health care services to low-income communities within the slums through a micro-clinic model that is using health technologies. Having a high population in the slums, there is a lot of demand from the communities for quality health care.  Access Afya is looking forward to opening a second mini-clinic within Mukuru. Therefore, we have been involved in a lot of field surveys to try and select the best location for it, in terms of highest demand for health care services from the communities.

 

Having an experience at Mukuru should be on everyone’s to do list!! Almost everything you come across is interesting; you end up turning your head to almost everything. From the kids playing all sorts of games, construction going on, women selling all sorts of different Kenyan foods to the friendly community members you pass across. Funny enough everyone says “hey” and they are concerned of how your day is going alone, even though this is rare in most other estates within Nairobi.

Some of the Access Afya team at Kisii Village

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Dommy, the Community Health Coordinator, and I head out to different areas within the Mukuru slums to do needs assessments with potential clients. The Mukuru slums are large- there is an estimated quarter to half a million people living there, but no one knows the exact figure. We grab the organization’s new iPad to ask questions and record feedback in the field using an offline app to enter answers and type notes.

As we make our way into Kayaba, it is very easy to point out groups of youth seated together. Dommy and I walk to them. They are very happy to see us. We begin by explaining why we are interested in talking to them, and all their faces light up. They all love the idea of a clinic within their locality. To explain further we remove the tablet from the bag so as to demonstrate exactly what kind of clinic we intend to bring. We flip around the photos that we had pre-loaded on the iPad showing our current clinic. It was amazing how they all come closer, and they all want to have a hold of it as they view the photos.

Respondents giving feedback

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Moving door-to-door, kiosk-to-kiosk as we interview women in both Mukuru Kayaba and Hazina, we are getting to learn so much from them. Once we have finished asking the questions, they all seem to have questions for us too. For instance how soon we intend to have a micro-clinic in the area, in case we have patients registering, will they get a registration card for it.

Two women from Hazina responding to the survey

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At the end of the day the survey to us was very educative, we learnt a lot from the communities concerning health related issues. Some responses were not surprising- the respondents echoed the need for more lab facilities, especially for stool testing given the poor sanitation services. Others demanded more comprehensive health, asking for health talks on nutrition and dentist services. Access Afya is working on putting together membership packages to include these things.

 

A lady sharing her story with Dommy

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We look forward to having a second micro-clinic in either of the sites. With time we hope to have several micro-clinics in the slums to ensure that quality health care is given to all people.

Diabetes: Not a popular word in Kenya

by Access Afya
diabetes

[Written by Kelly Thoma. Kelly is from Seattle, Washington and is currently in Kenya for the summer as a fellow with Access Afya.]

 

It seems he has three names: Anthony, Vincent, or Vinny. I’m still not quite sure what to call him but it seems like a lot of the patients feel comfortable calling him Vinny, which I see as a good sign.

vinnyVinny works at the Access Afya clinic in Kisii village as a clinical officer. Vinny and I started by talking about his history in the medical field. He graduated from Kenya Medical College at the Nairobi campus in 2009 and has been working in a hospital or clinic ever since. Vincent has worked at Partners for Health and Mbagathi District Hospital here in Nairobi, as well as medical camps in almost every region in Kenya.

I asked him what he thought were the serious medical conditions he encountered the most often in the clinic on a weekly basis- what were the big health issues for his patients? He told me that the serious health concerns he has for his population of patients is diabetes, as well as hypertension and cancer.

In an interview published this month, Executive Director Alex Chika Ezeh of African Population & Health Research Center, who is based out of Nairobi, was asked about public health trends across Africa. Ezeh pointed out how serious of an issue diabetes is and how it isn’t one of the main issues that is being addressed by health programs and organizations in contrast to issues receiving lots of attention and programming like Family Planning or HIV.

“There are few interventions aimed at improving adolescent health, which is a precursor to adult health…Current evidence suggests that most of the behavioral factors that affect NCDs risk originate in the early adolescent years. Therefore, addressing such factors will be important for sustained improvement in health in sub-Saharan Africa. Earlier diagnosis is also critical. Up to 80 percent of Africans with diabetes don’t know they have the disease—as a result, they suffer complications sooner and die earlier in life” said Ezeh.

So I asked Vinny: “Regarding diabetes, why is it such a big problem here and how do you change that in this community?” Vinny responded saying it comes down to two main areas for change to happen: Education and screenings. He told me that people here in the village do know what diabetes is, to a certain extent, and that there is a stigma that exists around the word. He frequently has patients showing the signs of diabetes and  asks if they will take the screening to find out if they have high blood sugar, not using the word diabetes as to not frighten a patient before they even get the results. The screening only costs 100 shillings which is a little over $1.00. However, the majority decline wanting to do it, saying to Vincent that they don’t have high blood sugar/diabetes and don’t need the screening. Vinny says that the lifestyle needs to change- there needs to be increased education on nutrition and physical activity and that people need to be willing to get screenings. Vinny couldn’t elaborate enough to me in on our conversation on the importance of someone’s diet as a key to good health. “Diet, diet, diet!”

Sometimes, a patient will agree to be screened for diabetes when he asks them. However, Vinny has never had a patient who has paid for a screening that has come back to work on their “high blood sugar” problem. Yes, you read that correctly: no one he has screened has ever come back to see the results and work on addressing their dangerous high blood sugar levels which are causing them health issues that they are coming to the clinic for.

I asked Vinny why this is? Is it because it is too expensive? But he told me it isn’t because of cost that they don’t come back- it’s a priorities issue. Diabetes is a denial issue here. People often don’t want to come work on it or get treatment for it until it is unbearable to live with. And even then, it is usually just a “band-aid” treatment that will only help the problem for a few days or weeks.

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For more information on diabetes in Kenya visit:

http://healthservices.uonbi.ac.ke/node/842

http://www.capitalfm.co.ke/news/2013/06/government-to-fight-diabetes-macharia/

http://dmi.or.ke/

Family Planning Methods: A Story of a Powerful Ripple Effect

by Access Afya
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[Written by Kelly Thoma. Kelly is a from Seattle, Washington and in currently in Kenya for the summer as a fellow with Access Afya.]

 

Stack-of-multi-colored-condomsCondoms are one of the first things you will see for sale when you walk up to the pharmacy window at the Access Afya clinic is Kisii village in Nairobi, Kenya.

And condoms are a great choice as a family planning method, especially because they play a very important role in preventing the spread of STIs. And I thought that condoms would be the most frequently used form of birth control for patients coming in and out of the clinic. I thought that the accessibility, low cost and user friendly attributes of condoms would make them more popular within a slum. I was surprised when I came to talk to Access Afya’s clinical officer about birth control methods that condoms hardly entered our conversation. When I asked about them, I learned that most young women coming to Access Afya for family planning visits were not actually using condoms.In fact, and again to my surprise, when I was talking with Joan it seemed that a traditional local birth control method consisting of a weekly dose of an herbal liquid drug was more commonly used than condoms.

(To learn more about this dangerous herbal contraceptive, which comes in liquid and pill form, check out the Kenyan government’s Pharmacy and Poisons Board notice advising people against this method of birth control: http://www.pharmacyboardkenya.org/index.php?id=25 )

Joan, the clinical officer at Access Afya, grew up in central Kenya in Kianyaga. Her grandmother was a nurse at a Provincial General Hospital. She described for me that she thinks her desire to be in the medical field was something sparked out of the family she grew up in. Joan, like myself, had never heard about this herbal liquid birth control until she had a woman in her late twenties come into the clinic just about a month after having joined Access Afya.

The woman in her late twenties, as Joan described her, came in with incredible pain especially in her abdomen, unusual heavy menstrual bleeding, vomiting, and swelling in her calves; she wasn’t coming in with the intention to talk about family planning. However this woman, (let us call her Sara for the sake of this story), thought that perhaps the reason she had been in so much pain over the last week was because of the herbal liquid drugs she had been taking. She had been using this method of family planning, as did her other close female friends, for the last two years. But this was the first time the pain was this bad and the bleeding was so intense. Evidently a few days before Sara came to Access Afya, she was visiting her hometown in a nearby city when the pain started. Sara went to a larger clinic in that city and they discharged her after giving her some simple painkillers, so Sara then came to the Access Afya clinic days later because the problem wasn’t resolved.

She came to ask Joan how to stop the pain, but also possibly with the intention of finding a way of not having to take this herbal birth control anymore. Joan asked her about this herbal liquid more, as Joan wasn’t familiar with it. Joan talked more with her and they decided that she would stop taking this traditional form of birth control for good. So Joan asked Sara if she would like to hear about modern birth control options. Sara was extremely open to the topic. They discussed four: injections, implants, IUDs and the daily pill. Joan described to me how an important part of her job is to discuss with each patient about the side effects and advantages of each method so that they can fully understand all the presented methods before trying to make a choice. Sara had never heard of IUDs or implants and Joan said she seemed interested, but ultimately decided to go with the daily pill. She did say she wanted to go home and talk with her husband about IUDs though, in case that was something they wanted in the future since her husband wasn’t aware of that option either. However, Joan’s main goal for that day was to make sure Sara didn’t continue to suffer from all the pains she came into the clinic with that day.

Joan treated Sara and they finished with Joan instructing her to come back in a week for a check-up. Sara also purchased her month’s birth control pills at the pharmacy at Access Afya as she was leaving. Birth Control pills for a month supply are sold at the Access Afya clinic for the affordable price of just 30 shillings, or roughly 50 cents.

A week later, Sara came to the clinic to meet with Joan for her check-up as instructed. Sara said the pain was gone and that the bleeding had stopped completely. Joan and her finished the appointment with Joan asking her to come back in a month for a check-up to see how she was doing with the birth control pill that Sara now took daily. When Sara came back a month later, everything was going well and Sara proceeded to bring a couple friends over the next week to have them meet with Joan to discuss the problems associated with the traditional herbal birth control that Sara previously used. Sara would bring friends and wait in the waiting area at the clinic for them until they had finished their appointment with Joan. Many of Sara’s friends switched from the traditional herbal method to a modern birth control method.

I liked this story because it is so simple and yet so important. It would be difficult to measure exactly how many lives Joan changed by meeting with Sara, because of the ripple effect it has had through Sara’s friends and now Sara’s friends who have passed on this information to their friends and so on. In my mind, I see a picture of this knowledge Joan passed onto Sara about the dangers of this herbal contraceptive and how many other safe methods that are available now as knowledge undulating across the slum, reaching more and more ears person by person, increasing its potential reach each day with each new person’s awareness.

Vote for Access Afya- Transforming Health Systems!

by Access Afya

Access Afya was selected as one of six finalists selected as gamechanging business models in Ashoka’s Transforming Health Systems challenge. We are excited to be part of this community of changemakers and gaining momentum towards expanding our impact.

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Vote for Access Afya today!

Vote for Access Afya today!