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Slow Ideas in Health

by Access Afya

Slow Ideas in Health

“In our era of electronic communications, we’ve come to expect that important innovations will spread quickly.” An article published last year in the New Yorker, Slow Ideas, argues that this is not always the case. Unlike trends on social media that spread and die just as quickly, social change that sticks moves slowly. Changing the norm takes time.

Some innovations spread quicker than others; this can be because of resistance and skepticism, it takes time to change behaviours to form habits, and a vested interest and tangible benefits in the innovation by all parties is needed.

Vomiting, diarrhea, and worms are common in children of informal settlements in Nairobi. One cause for these problems is poor hygiene practices. Hygiene is an ‘invisible’ problem with physical manifestations. A solution to poor hygiene is hand washing.

Access Afya is running a Healthy Schools program, which combines primary care with hygiene and nutrition interventions in private schools in the informal settlements near Access Afya clinics. One of the tools the program is introducing to improve hygiene in the schools is hand washing.

Infographic on the Healthy Schools Program

Infographic on the Healthy Schools Program

Handwashing has been shown to be the single most effective intervention to reduce diarrhoea in children. The process of implementing hand washing was a lesson in this concept of ‘slow’ ideas, changing behaviours and creating new norms. Introducing hand washing, what was originally thought to be a quick solution to hygiene, became a month long process. Signs, a song, and the hand washing station sitting near the bathroom became reminders for the children and the teachers. However it was only through having staff at the school full-time reminding children to wash their hands before each meal, after playing and after the toilet that saw the habit form.

Josephine, a Clinical Officer for the Healthy Schools Program teaching children handwashing

Josephine, a Clinical Officer for the Healthy Schools Program, teaching children handwashing

Diffusion of behaviours like hand washing ‘is essentially a social process.’ Incentives and rewards can only go so far. What is needed is the human element. For people to model the behaviour, persuade others why this change is necessary, and become actors of the change itself. We found this to be true through having  key community members and the children buy into the behaviour and convince others of its necessity.

At the beginning there was some resistance from both teachers and children. It was more work; it took more time out of other activities. The benefit to the teachers was not immediate. However, after one month the children are remembering to wash their hands on their own.

One of the hopes of introducing hand washing into the Healthy Schools program is so the habit will transfer from school to the children’s home. This habit diffusion has already begun with children asking parents for more soap at home as they want to wash their hands. This is how it starts. Big ideas calling for habit change often take time. This is slow change so that it sticks.



Success Story Series – Paul “Pop” Oduor

by Access Afya

Walking down the road, the smell of sweet mangoes wafts in the air. Just inside the window of Paul “Pop’s” juice stand, orange mango juice drips down Pop’s hand as he stands using a spoon to scoop the mango out of its green skin, plopping it into a bucket of water. He disappears behind the curtain, emerging with a blender. His juice stand, where he sells orange, passion and mango fruits and juice, is just a few doors down from the Access Afya clinic.

Before the Access Afya clinic came to Kisii Village, Paul would take his daughter when she was sick to the hospital. When his daughter got sick again earlier this year, he consulted with Access Afya staff about her stomach pain. “The people that work there are my friends. They consulted me and told me to bring her in.”

When he came to Access Afya with his three-year-old daughter to visit the clinic for the first time he noticed the staff. “They were friendly. The nurses and doctors were perfect; they know what they are doing,” Paul says. The clinician was able to treat his daughter. The treatment helped her not only to feel better but also to be more comfortable in the classroom. He says, “She is good in school; she’s doing okay there.”

Paul Pop

Pop is an advocate for Access Afya because of the quality care for individuals, like his daughter, but also because of Access Afya’s impact in Kisii Village. “It is really community work. It’s the only clinic in the surrounding area,” Paul says.

Even though he has since moved out of Kisii Village, Paul continues to use the Access Afya clinic. “Since then [taking my daughter to Access Afya], I never took my daughter back to the hospital.” He only asks Access Afya to expand their work so that they can employ more people from the community.

McDonald’s hasn’t reached Kenya, but has the ‘McDonald’s of Health Care’?

by Access Afya

What is a micro-clinic?

Why does Access Afya think they can have an impact in informal settlements?

Is there something wrong with hospitals and other clinics?

These are questions often posed to Access Afya. A recent article in Forbes has explored the area of ‘McDonald’s style health care’, and by this, we don’t mean offering fries with every visit. McDonald’s have managed to franchise the burger and fries industry, ensuring across the globe if you visit a McDonald’s you get the same service, clean toilets, and the trademark “Would you like fries with that?” value add service.

In a health setting this would mean accessible, technology driven locations focusing on standardized clinical protocols and pricing, customer service, centralized supply chains, continual staff education, and community education.

'Would you like fries with that?'

‘Would you like fries with that?’

While Forbes discusses the business case for franchised clinics in USA: “The holy grail is a replicable Golden Arches-style model that puts a branded urgent care shop on every corner–and that’s what smart money has been chasing in a long list of deals over the last few years.”, Access Afya is exploring a similar model in Kenya.

Health care in Kenya is often a last resort. Hospitals are full, far from informal settlements, staff are often underqualified and medicines are at risk of being fake, out of date, or out of stock. Access Afya micro-clinics are situated where the customer base lives – in the informal settlements. They are around 15 ft x 15 ft, offering a consultation room, laboratory for common tests, chemist and waiting room. This means we can get a branded clinic on every block, just like Safaricom or CocaCola has done in this market. By using a retail style community model for healthcare we save our clients time but also enable earlier care conversations.

The retail clinic model needed to be adapted to the local market. This meant investing in outreach and community education. Outreaches in the community include deworming drives, family planning education and nutrition interventions. If we can reach the community at the onset of illness and foster positive health changes, their costs are lowered and preventative care can keep them out of the hospitals.

Access Afya runs two micro-clinics in Nairobi and plans to be an eight clinic chain by the end of next year.

References and further reading:

Forbes: Drive-thru health care: How McDonald’s inspired an urgent care gold rush

Forbes: How not to fix US health care: Copy the Cheesecake Factory

New Yorker: Big Med: Restaurant chains have managed to combine quality control, cost control, and innovation. Can health care?





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



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



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.