A 360 - Population Services Kenya

A360

The global prevalence of all leading chronic non-communicable diseases is increasing, with the majority occurring in developing countries and projected to increase substantially over the next two decades. AstraZeneca’s ambition is to meet the needs of millions of patients across Africa and contribute to meeting the WHO target of reducing premature cardiovascular deaths by 25% by 2025.

PS Kenya has implemented 24 months of a private sector model in Astrazeneca’s HHA project that seeks to improve knowledge and awareness on hypertension, improve the competence of those offering hypertension services and increase access to affordable and quality antihypertensive medications. This project has been implemented through the Tunza Family Health Network, a social franchise of private providers, who offer primary health care services and serves the low-income population.

The program is targeted to Kioko, who represents the at risk population. He is a male aged 30years and above lives in a high population settlement in Nairobi or its outskirts. Kioko is married with two children and is employed in a local school. He indulges in social activities like “nyama choma” and social drinking that make him at risk of hypertension. He fears losing his job and health is not top of his mind, until a family member gets sick and usually visits a chemist to get drugs. Kioko has very poor health seeking behavior compared to his female counterpart. The program also sought to reach males and females equally.

The program, first of its scale in Africa, has made substantive gains in the sector and through the private sector lenses, share the following learnings:

Over
3.5
Million

Blood pressure screenings at the community or health facility

Over
4,000

Trained health care workers:CHVs, doctors, nurses, pharmacists

Over
500

Over 500 facilities activated in Africa

The program, first of its scale in Africa, has made substantive gains in the sector and through the private sector lenses, share the following learnings:

Patient Awareness of hypertension

It takes a long time for a patient to acknowledge and actively manage their condition on their own; even after discovery. This is influenced by the asymptomatic nature of the disease and Health not being a key priority ~ Kenyans are faced with other front of mind challenges e.g feeding their family and paying the school fees.

Private sector learning. There is need for:

Long term, integrated social behaviour change communications and interventions to address different stages of the patient pathway. This acknowledges that the path to behaviour change is not linear and there is need to invest in operational research to determine the barriers to adopting hypertensive care along the journey.
A myriad of demand creation activities are necessary to create awareness to the general population. Implementing “Kioko” specific activities e.g work place outreaches are key to managing males and females equally. Medical camps / outreaches with a clinician on board to administer treatment on site are preferred because of their high ability to link patients to treatment;
The program demonstrated high linkage rates when the “Reach, screen and treat” – Medical camps with clinicians on board approach was implemented; increasing aggregate linkage rates from 28% to 52.7% within demonstration and extension phases respectively.
High calibre CHVs to complement the private sector cadre of clients. CHVs require a rigorous recruitment and capacity building process covering messaging and M&E. They also require support supervision to ensure high quality sessions are being conducted.
Incentives to motivating front line workers to following up patients screened and found to have elevated blood pressure. The project demonstrated an increased linkage of up to 113% by applying monetary incentives.

Patient management of hypertension

There is no cure for hypertension. Treatment can start with lifestyle modification and progress through different medicine offerings. Until a patient is fully aware and understands the need to proactively manage their condition, they are unlikely to turn up to clinic without prompting.

Project learnings

Active quality assurance and provision of HTN capacity building activities in addition to task shifting of hypertensive care to nurses for hypertension will support the increasing number of Kenyan adults to accessing hypertension treatment. 74% of the project sites were operated by nurse.
Development of appropriate monitoring tools to enable collection of client level data to ensure accountability of all people screened through to diagnosis and adherence. This level of data enabled follow ups to be conducted along the patient pathway. Due to the volumes of data, the program had 5 dedicated staff to ensure monthly reporting is achieved.
There is need for providers to access and use monitoring data to manage patients; informing management and retention strategies such as provider initiated follow up (text, calls) and MOPC clinics to manage patients. PS Kenya would analyse and share monthly data with the providers to inform progress; focussing on addressing lost to follow ups, to ensure adherence and better health outcomes.
Private providers require business support on financial management, supply chain management and customer care as key skills needed for a successful private practice. Top Care nursing home, after receiving business support, set out to improve hypertension service within their clinic, focussing on implementing MOPC clinics once a week in addition to investing equipment and other operational changes. After a duration of three months, the clinic demonstrated astronomical profits of over 1000%.
Anecdotal information informs that patients prefer not to be put on drugs at first; due to many reasons including perceived fear of expense of the drugs, in addition to fear of being on drugs for the rest of their lives.

Supply Chain Management.

Following the development of the MOH Hypertension protocol, sites may be short of medicines interfering with the management of hypertension, even though patients can afford them.