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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.

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.

References:

http://www.newyorker.com/magazine/2013/07/29/slow-ideas?currentPage=1

 

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?