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Access Afya In 2015 : Healthy Schools and More !

by Access Afya

Dear Friends,

It’s 2015, and Access Afya is back with several exciting updates!
The start of this year has kept us busy indeed. Our Sinai-village clinic turned a year old (drum roll, please) and is getting busier every month.

In particular, however, we made significant strides with our Healthy Schools program. As of March, Healthy Schools enrolled 300 students, with 93 new students joining just over the last month!

“Having a doctor at the school is a plus. Kids get into different things all the time and knowing that if they fall ill they can get assistance is a good feeling or just getting a phone call on my kid’s health is awesome! I will pay the 100 shilling just for feedback on my kids health.” – A Healthy Schools mother

About Healthy Schools:
To recap – our Healthy Schools program brings healthcare directly into schools surrounding our clinics, providing basic healthcare products, services, and education to students. With the consent of the parent(s), students are given a health check-up and deworming with results communicated to parents through text-messages and phone calls. If students need additional treatment, tests, or medication they are referred to our clinic.
Last year Healthy Schools had over 100 students enrolled in the program. This year, we have started in a new school. The school, All Nation, is located near our clinic along the main road leading into the Mukuru slum.

“I am very happy with the program. Life is fast and sometimes you can miss something especially with girls. So it’s good to have someone to chat with in case there is a problem.” – Single father of 2 daughters in the program

At All Nation:
Integrating health and education, particularly for school-going children in informal settlements and whose families migrate often, acts as more than just a safety net to keep in school. It also helps them to concentrate better, learn more effectively and perform specific skill-based tasks.

“The program is great because no one else is doing this. My kid was excited after being seen. It’s different and I hope we will see change with their performance as well.” –Mother

At All Nation, 92 students went through an initial screening. 68% of these were referred for additional treatment, tests, or medication.
The top reasons for referral include: skin conditions, respiratory tract infections, and abdominal pain. Other reasons for referral included eye problems, tooth decay, and malnutrition.

  • Treatment: Of those that were referred, just over 50% visited the Access Afya clinic for treatment and/or medication prescribed by the doctor.
  • Follow-up: Of those who had conditions, less than 25% still needed follow-up or are still on treatment for the same condition identified in the check-up.
  • Nutrition: With the basic check-up we also screen children to see if they are following the growth and development for their age. Of the 92 screened, only one child was found to be moderately malnourished.
  •  We also dewormed over 50% of the students at the school and educated them on what worms are, how they can get them, and why it is important to be dewormed. One parent even told us that the dewormers worked as they saw the result in the toilet later that night!

Feedback:
“The program is great because no one else is doing this. My kid was excited after being seen. It’s different and I hope we will see change with their performance as well.” –Mother

The overwhelmingly positive feedback from the parents of our ‘Healthy Schoolers’ has been encouraging for Access Afya. Their commitment is reflected in their willingness to pay for the quality care that is provided to their children at All Nation. Additionally, they have been unanimously appreciative of the effort put into follow up – via a call or SMS – to keep them abridge of their childrens’ health status and needs.

“This program is just amazing! Getting a call on your kid’s health is so awesome and makes me happy. I want the same attention. What about me? Any programs for me?” –Father

Next steps:
We have been diligently following up with the students even through their break! We can’t wait for all the students to return to Nairobi and back to Healthy Schools for the check-up in May ☺

 

Healthy Schools Coordinator, Dhahabu,busy at work!

Healthy Schools Coordinator, Dhahabu,busy at work.

‘Mangoes cause Malaria’ and other Malaria-Myths…Debunked!

by Access Afya
Mangoes in Nairobi (picture credit: Zordfiles)

Mangoes in Nairobi
(picture credit: Zordfiles)

The rains are here and how?! The deluge of rain has brought with it another round of dangerous misconceptions about the prevalence, causes and symptoms of malaria in Kenya.

Scope of Malaria:

According to Population Services International, over 70 per cent of Kenya’s population are at risk of malaria, 75 per cent of whom live in rural areas. Malaria is most certainly a major health problem in Kenya – one that disproportionately impacts the poor, pregnant women and children under five, due to lack of adequate housing structures, access to medication and to quality care.

It is crucial, then, to be able to correctly identify and treat this illness. Access Afya is here to highlight what these myths are, and debunk them for you!

Top five myths:

Myth 1: Mangoes cause malaria
Debunked: Eating mangoes, ripe or unripe, does not cause malaria. It is commonly believed that consuming mangoes can cause malaria, because when mangoes ripen during the rains, they fall from the trees. And when they drop, they rot. Rotten mangoes, especially during the rains, can be breeding ground for mosquitoes. However, the consumption of mangoes does during the rains or otherwise, does not cause malaria.

Myth 2: The occurrence of flooding causes malaria
Debunked: Mosquitoes breed in places of stagnant water. Therefor, the rains are mistakenly believed to be harbingers of malaria. While malaria is more frequent during the rains, and consequently, in a time where flooding is rampant, the occurrence of flooding does not cause malaria.

It is important to note that flooding can increase the transmission of diseases cholera and malaria. However, Malaria can happen throughout the year, and is not only a ‘rain-disease’.

Myth 3: Nairobi is a high-risk malaria region
Debunked: Malaria is not present in all parts of Kenya, but is a problem in Western, Coast, Nyanza, parts of Eastern and North Rift. Some communities suffer with malaria all year round and others just have breakouts from time to time. Nairobi, however, is a low-risk region.

Myth 4: Excessive sweating means you have Malaria
Debunked: There are two kinds of malaria – (i) Uncomplicated malaria and (ii) Severe malaria.

While having the ‘sweats’ is a symptom of uncomplicated malaria, it is only one of several other symptoms that occur together. A patient with malaria presents a combination of symptoms such as, fever, chills, nausea and vomiting, general malaise, headaches, body-aches, elevated temperatures etc.

In countries where malaria is frequent, residents often recognize the symptoms as malaria and treat themselves without seeking diagnostic confirmation (“presumptive treatment”). This is usually why people believe falsely that if they are sweating excessively, they have malaria.

Myth 5: The cold brings or pushes out Malaria.
Debunked: In keeping with the point above, people also presume that the cold can push out Malaria. In Kenya especially, the temperature drops during the rains, which are followed immediately by cold. Both seasons see a rise in general influenza, because of a temperature change. Often, symptoms of a common cold are mistaken as symptoms of malaria.

If you are concerned about whether any of the symptoms you are experiencing are Malaria symptoms, then come in to Access Afya for a check-up, for a conversation to clarify and even just to say hello!

Access Afya 2014 Recap

by Access Afya

Dear Friends:

This year has been a big one for Access Afya. We opened a new clinic, started selling healthcare in the field, and grew our team.

We started the year with seven full-time people and our team has now grown to sixteen. We have welcomed Andy McBride as our COO and Margaret Kiplagat as our Talent Director. Andy brings his background in leadership development and business analysis to implement our strategy, and Margaret brings her decade experience in healthcare management to current and future talent development and ensuring patient engagement and experience.

We opened our second micro-clinic this year, which has seen over 1,000 patients. Our first clinic, called Kisii Village, has experienced 130% growth in revenue since January, and our new clinic, in Jamaica Village, has had revenue growth of 70% since it opened in March. At this rate, we project both of the clinics to be fully self-sustainable by mid-2015.

This year we started delivering healthcare directly in the community surrounding our clinics. Our Healthy Schools program is a really innovative way to reach the children in the slums by selling primary healthcare and wellness interventions directly to their schools. Each child in our program gets a daily healthy snack, a check-up once each term, and a health report card to take home. The participating schools get WASH interventions and education, teacher check-ups, and a deworming drive. The results are compelling: attendance increased from 69% to 96% and the need for clinical referrals reduced from 32% to 16% in the first school we worked with.

We have set goals for the next year. Some of our 2015 highlights will include:

  • Healthy Schools will grow to 700 children, which will bring it to full sustainability.
  • We will pilot healthcare products at our clinics, including membership cards and group chronic care.
  • We will develop two more field-based care sales offerings similar to our work with schools.
  • We will open two new micro-clinics at the end by the year.

To do this we will need your continued support.

  • We are hiring a Medical Director, and a Client Acquisition Lead and would love your recommendations!
  • We are looking for experts in impact analysis to work with us on measuring and communicating our impact.

On behalf of the entire Access Afya team, we wish everyone continued success in 2015!

Sincerely,

Melissa Menke
Founder and Director, Access Afya

*Access Afya has partnered with donor-advised fund SharedImpact, meaning donors in the US, UK, and Hong Kong can give tax-efficiently and conveniently. Click here to donate today!

Team picture at a community clean up, a regular part of our marketing.

Team picture at a community clean up, a regular part of our marketing.

 

 

 

 

 

 

 

 

 

 

 

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].”