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Our Approach to User Experience Design

by Access Afya

Melissa is CEO of Access Afya, a chain of low-cost micro-clinics in Nairobi, Kenya. Melissa spoke at Digital Health Week 2014 in Singapore on the organisation’s user experience design framework, and how it takes a forefront in Access Afya’s technology development strategy. 

At Access Afya, we always start by thinking about our users. When designing a better healthcare experience, we started by talking to potential patients before building our clinics or selecting our services. Now that we are focused on establishing scalable technology systems for information management, analytics, clinical learning, and patient engagement we remain committed to focusing on user needs and experiences first. As articulated in a recent Forbes article, technology for the sake of invention is worth nothing. Technology starting with the goals of end-users improves lives.

Our technology strategy is to implement technology solutions in a modular way, focusing on the largest business pain point, solving that, and learning what works and what needs to be improved on still. Our sales system, which this post focuses on, is one example of a challenge we used technology to help solve.

Tackling Challenges

This simple diagram shows key areas to consider when tackling a new challenge. The business goals are important, the specific requirements of the type of information we are managing are important, but the user needs- that right corner, is what we lead with. It is this emphasis on user experience that makes our system strategy unique as compared to many healthcare technologies.

Mike ProfileAs a company we used to waste a lot of time recording sales and managing our inventory levels. This is Mike. Mike works as a pharmacy technician at our Kisii Village clinic. He communicates treatment plans to patients, explains the importance of appropriate medication, and oversees the pharmacy quality processes. Mike used to spend a lot of time checking various sources of stock information. He would even waste time on visual checks. Mike is one example of the users that we designed our sales system for.

We observed and evaluated various user groups at the clinics that interact with sales and stock and analysed their current operations, pain points, skill levels, and attitudes towards technology.

From here we still examined those other two circles; business needs and information attributes. Some business constraints included low bandwidth and heightened risk of theft. Some information attributes included a large inventory necessary for primary care, and multiple physical locations with centralised ordering and pricing.

We considered not just business constraints, but also values and vision. Our technology systems must fit within this values framework:

  • The patient is our client and their experience fuels our company
  • Our health workers are our team members and the systems must empower them to do their jobs
  • We generate the data we can learn from
  • Maintain scalability as a goal

After collecting needs, desires, skill, attitudes, and articulating values we were ready to select software and hardware that met our needs. For software, we have implemented and adapted shopify. This is an existing point of sale and ecommerce software with a track record of customers, venture funding, and a support and development team. We did not have to reinvent the wheel, just creatively adapt it to our context.

AA Shopify

For example, the images are all pictures taken at our clinic of the exact brands and packing on medication and hygiene products that we do stock. Instead of colour options or sizes, the item variants show different brands that have the same active ingredient. The item tags reflect product type or top sellers. The system works online, offline, and will be able to add new sites quickly. The game-like interface was intuitive, and the clinical team picked up the system in a matter of minutes. This was really important given that we do not have a full-time technology training and enforcement team. And with our approach, hopefully we won’t need one.

AA Old POS

The above image might look familiar to anyone that has visited a coffee shop in New York or San Francisco recently, but it is certainly not status quo for sales systems yet. As a contrast, the image on the left here shows the experience of selling through quickbooks, the system that we used when we first set up operations.

 

Traditional POS

AA POS

Our hardware also looked quite different because of our context. While the ipad is normally selected for its appealing interface, and has elegant, sleek hardware to match, we took that interface and locked it inside of a locally made box that was intentionally bulky, signalling that the tool was immobile.

An essential component of our technology strategy is to evaluate how any new device or system will live within Access Afya’s operations, and even the Kenya healthcare system. The humans in the organisation and the operational processes must support the technology, and a successful technology installation will support the humans in the organisation, and the operational processes. This partnership between frontline workers, operations, and technology systems is ultimately what will make any new technology improve business and health outcomes.

References and Further Reading:

Read more about Digital Healthcare Week

Forbes, “5 Things Preventing Technology Adoption in Health Care.” 

Digital Health Week, Personal Connected Health Track

Meeting the neighbours – Alex Onkundi

by Access Afya

Alex leans on his forearms, his head sticking out of a rectangular window. He is standing to chat with a group of men outside on the street. Sitting behind Alex is a large green clothed pool table in the centre of the room. He runs a billiard hall, where a game costs 20 shillings (0.22 USD).  He spends most of his day here in the billiard hall, a local hangout for neighbours and community members. Throughout the day, Alex can be seen peering out his window, chatting with those that pass by or sitting inside in his chair watching and interacting with customers as they play pool.

Alex’s business is located in Mukuru and his home is nearby, where he stays with his wife and a three-year-old daughter. His daughter is often nervous about visiting doctors. Alex used to take his daughter to a clinic in his village. Then a friend, Dommy, a community health worker for Access Afya, talked with Alex about our services and he decided to try the clinic when his daughter got sick.

Alex relaxes in his pool hall

Alex relaxes in his pool hall

He describes his first visit to the  clinic with his daughter as positive. “My first impression was it is a safe zone and warm. My daughter felt at home. She wasn’t nervous.”

Alex liked the consultation that he had with the doctor. At first, he questioned the doctor about the medications prescribed. “To be transparent, when I was given the meds I thought that it was a bit expensive. But the doctor said it’s the one that will work. I bought them and it worked.”

With friends and neighbours often coming in for a game of pool, he tells them about Access Afya’s services if he sees they are having problems. Alex recalls a recent referral. “A friend went to another clinic to get a dressing for an injury. Three days later, there was no change. So I told her to go to Access Afya. She went and now she is improving.”

Alex says he will continue to use the clinic himself, saying, “I will go there if there is a condition that is not good.” He also will continue to tell his friends, family, and customers about Access Afya because “the services are good, we like it [Access Afya].”

 

The changing face of healthcare

by Access Afya

The health care industry has traditionally been one of cures and treatments. You seek healthcare when you are sick, when you are in pain, or when you are pregnant. If health care were far from you, if it took hours to get to a clinic, and then hours of waiting to be treated, would you still go? Or would you try home remedies, ask your local ‘witch doctor’, or ask your priest to pray for you instead?

In Kenya, there are many tribes that are used to asking local healers for health advice, using traditional cures or ignoring their ailments as professional health care is too far away, too expensive, or too intimidating. A key example is the use of traditional birth attendants (TBAs). They deliver around 30% of babies in the West of Kenya, as they are highly regarded community members. However they don’t have the medical training to correctly deal with any problems during childbirth. Deliveries by TBA’s are shown to have a far higher mortality rate than those delivered by a skilled attendant (those with medical training). In 2013, the Government began offering free deliveries in public hospitals, but some women still choose to use a TBA instead. One woman has said, “I avoid going to public hospitals because the services are poor and the nurses are very rude.”1

To increase access to health care in rural areas, First Lady Kenyatta launched a new chain of mobile clinics, Beyond Zero. The clinics aim to improve access to health care for mothers and children including immunisations. They are being rolled out to counties based on HIV, maternal and child health indicators, but aim to ultimately support all counties.

Amref Health Africa has piloted a model using discarded shipping containers in Northern Kenya to bring healthcare to nomadic tribes. Research had shown only 7.9% of Turkana mothers had access to a skilled birth attendant, resulting in one in five children dying before their fifth birthday.  The mobile clinics have halved the distance from the tribes to healthcare, meaning more mothers can seek professional care instead of relying on local Emuron (traditional diviners who request an animal is slaughtered and brought as a gift in return for healing).

Vincent, Clinical Director, checking a child in Access Afya's Kisii Clinic

Vincent, Clinical Director, checking a child in Access Afya’s Kisii Clinic

Access Afya’s micro-clinics bring healthcare into informal settlements, in a non-intimidating way. They are staffed with local community health workers who grew up in the community. They offer cures and treatments, but also advice and a friendly chat.  Last week KEMRI CDC visited Access Afya’s Kisii Village Clinic (Mukuru), as they kept hearing about Access Afya as the key choice for women in the area to visit for family planning and maternal health.

As more innovative healthcare interventions join the market, we hope to see a healthier Kenya! Healthcare should be about the patients, not about the industry. It is not about one key solution, but rather partners working together, educating the population on the importance of good health and making healthcare accessible.

 

References:

  1. http://www.womendeliver.org/updates/entry/despite-newly-free-deliveries-in-kenya-some-mothers-opt-for-traditional-bir

What does our community think of us? – We asked Florence ‘Auntie’ Nelinda

by Access Afya
Kisii Clinic and Florence's Shop next door

Bananas hanging on rope twirl above piles of oranges, onions, and avocados. Through the bananas and a pile of bundled spinach, Florence ‘Auntie’ Nelina stands behind a wire barred window inside her home. Her fruit and vegetable shop sits just outside her home on the street. She wakes up at 5 am each day to catch a ‘matatu’ (small 14 seater van) to the market, a fifteen minute bus ride away,  to buy fresh fruits and vegetables to stock her stand. Her fruit and vegetable shop sits just next  door to one of Access Afya’s clinics, making Access Afya’s staff some of her best customers.

Florence at the window to her shop

Florence at the window to her shop

As a neighbour of the Access Afya’s Kisii Village clinic and ‘Auntie’ to Access Afya staff, Florence was aware of Access Afya’s before there was a clinic. “When they were looking for a place to build it, I advised them to do it here, at the location next door. It is a good location because I have stayed here for ten years; I know the area very well,” she says.

Florence was inclined to work with and support Access Afya because “they know how to treat people well.” More so, Florence says, “when we see something from Europeans, we trust it more because we think it’s not corrupt.”

Florence noted ways in which Access Afya is different from other clinics and chemists in the area, “Access Afya is not after money, they are wanting to help more. Other clinics are very serious – they just want money, money, money. With Access Afya, you are welcomed first.” Feeling comfortable with clinical staff is important to Florence. “They know how to welcome patients and treat them well.”

Florence likes the layout of the Access Afya clinic because it creates a more personal, private environment for patients. “There is a doctor talking with you in a private room, not through a window. I may have private issues and can’t talk outside with the chemist,” she says.

With the Access Afya clinic Florence says, ‘People even from far away are coming from what they have heard.” She tells us that what people traveling have heard is the treatment of patients and trust one can build with the doctor. People are also coming for the original medications that are always in stock. “Chemists are not very active with painkillers. They don’t have a lot and maybe they are out of something,” she says.

For many like Florence having the clinic close by helps, “we don’t go far, it’s very near.” Whenever there is an illness or health issue in the family, Florence goes to Access Afya. She takes her children to the clinic for treatment when she sees problems, when they have a cough or seem sick. Florence likes that the medicines work right away to help her children feel better faster.

Living next door to Access Afya has advantages other than health care. Florence is always on duty working at her stand – welcoming and speaking with community members and patients during the day as they come and go from the clinic. Even at night Florence says, “I feel like Access Afya’s security when the clinic is closed.”
“We haven’t seen anything like it,”  she says about the Access Afya clinic. “They have everything, even injections.” She only asks Access Afya to expand their lab services so they can help more people and not refer them to hospitals for such services.

Improving maternal and child health through micro-clinics

by Access Afya

A health talk was being given to young pregnant women on nutrition and safe sex in Mukuru informal settlement, in south Nairobi. Being a Community Health Worker from the area, Domianah Mwikali heard about the talk  and wanted to go to speak to the group about using condoms and the risks of HIV.  “There are so many challenges for pregnant women in the slums,” she says.

After the talk, Domianah met one of the organisers, Melissa Menke, who asked Domianah to join the health talks as a speaker. Later, Melissa came to Domianah with the idea  to build clinics in the village, calling them Access Afya (Afya meaning health in Swahili). Domianah loved the idea and helped to find locations. Domianah saw the need for accessible, quality clinics for people in her community, especially mothers and their children.

Domianah smiling as she poses for a photograph in her community. Boland, Jaclyn 2014

Domianah smiling as she poses for a photograph in her community. Boland, Jaclyn 2014

“Back then, the health centres were so far. Women would just have babies and wouldn’t go back again,” Domianah explains. “With my first child, Nunu (now seven years old), I used to spend the whole day at the government facility. The nurses in those health centres don’t treat you well. There is no courtesy; they sometimes speak badly to you. You find most women stop taking their children after nine months (after the last immunisation). Even me, I stopped. Instead of giving good advice, they accuse you. So many women fear going and lose hope.”

More so than the treatment at the facilities, there were problems with medications. “Most of the people in the slums go to the health centre, they get free treatment but they are being told which drugs to go buy.  So they come back to the slums and just go to the chemists. They feel like they have wasted time and energy going to the government clinic just to come back and buy these bad drugs.”

Now with Access Afya’s clinic located in Kisii Village, operating since November 2012, Domianah has seen a difference in the community.  Access Afya’s clinics offer consultations including antenatal care, immunisations, lab tests, and a pharmacy with original medications.

Women are coming for antenatal care during pregnancy and bringing their children after they deliver for immunisations. Domianah notes, “Our records show that lots of children are coming here. The children they are so many, more than the adults.” “They want to come here, even though it’s not free. They pay little but they come and pay because of the good services. They feel it is not expensive, it is worth paying to be treated well,” Domianah says. “They like coming because it is nearby. There are no queues, they get right in to see the nurse.”

Some people will use the public hospitals and come to Access Afya for the medication. “We ask them to come in and pay for a consultation before we give them the drugs. Most of the people who usually come to our clinics, they get the original drugs. You don’t see them going somewhere else after they come here.”

Access Afya has even had a positive impact on Domianah’s family. Comparing her experience with her first child in the public facility to her experience at Access Afya with her second child, Ramon (4 months old), she says Access Afya has treated her very well. “With my second child, Ramon, I come to Access Afya every month. I came even when I was pregnant for my antenatal care and I was treated well. It’s much easier to come here; it’s near and I get good advice. I feel like a good, caring mother when I come. I never forget to come for the check-up for my baby and I will continue to take him here. Even my whole family comes here to be treated.”

In addition to working at Access Afya, Domianah works in the community as a Community Health Worker, educating women and sex workers about safe sex practices, HIV, and gender-based violence.