1. A Case Study –
Integrated Primary Health
Care in East Africa
A model developed by the
Aga Khan University East Africa and the
University of California, San Francisco
The EAAG Givers’ Lounge 30 March 2012
Dr. Michaela Mantel
Aga Khan Foundation/Aga Khan University

2. Aga Khan Development Network
2

3. The AKDN Integrated Health System
in East Africa – proposed settings
Income pyramid
Core provision
 Sustainable health services of high quality
Wealthy at primary, secondary and tertiary level in
East Africa
 Most care offered in AKDN-assets
Middle class  8-10 clusters in the entire EAC to serve
large number of patients with full
continuum of care at highest standards
Aspiring
Access expansion
• Target is a small number of geographically
defined populations with patients across
Struggling
the wealth spectrum
• Provide select types of care and partner
with government/mission assets to
Poor complete offering
• Focus on selected districts and
demonstrate how to improve access and
Destitute
quality in a sustainable way
3

5. Integrated Primary Health Care
Start-Up Project
(IPHC S’UP)
Aga Khan University East Africa
University of California, San Francisco
Aga Khan Foundation
June 2011-May 2012

6.  To develop an IPHC model that
◦ recommends effective mechanisms for partnership
between district health systems and higher
education institutions and
◦ identifies social innovations to increase access to
high-quality primary health care services in
resource poor, rural East African communities with
focus on maternal. Newborn, and child health
(MNCH)
 Planning grant for proposal development and
 Resource identification and mobilization for
testing of the IPHC model in selected
geographical area(s).
Objectives

7.  Kaloleni District,
Coast Province,
Kenya
 Aga Khan University
(AKU)
 University of
California, San
Francisco (UCSF)
 Community Health
Department, Aga
Khan Health Service-
Kenya
 Aga Khan Foundation
The Partners

8.  Signing agreement with the
Provincial Govt.
 Community engagement
exercise
 Health facility
assessment/mapping
 Capacity building (district &
AKDN internally)
 Social innovation workshop
and internet research
 The nursing alumni
conference
 E-health training and health
system workshop
Kenyan women on the way to the clinic  Testing the role of family
medicine doctor in a district
health system
 Workshop with
nurses/midwives
 Building a partnership
with the Kaloleni District
Health Management and
What we did the Hospital teams

9. Delay to seek care Delay to reach care Delay to receive care
Distance to Health Insufficient money for Lack of capacity of health
Center (HC) transport facility staff
Delay in recognizing Lack of means of Insufficient linkages
danger signs transport between health facility
Lack of community Impassable roads staff and the Community
knowledge of the link Lack of communication Health Workers (CHWs)
between improved between communities, Insufficient materials,
maternal and newborn and first facility level medications and
outcomes and a skilled and referral level equipment
attendant at delivery Lack of community Poor motivation of health
Lack of maternal engagement in local staff and inadequate
decision making power transport solutions attitude
(men as main decision Poor quality of care and
makers) inappropriate case
Concern over costs of management
health care access
Cultural beliefs of
delivering at home
Perceived poor quality
of health care
The three delays in maternal care

10. We learned about
 How to engage the communities to identify gaps and
barriers in MNCH
 Community demands and priorities
 Engagement with community leadership and importance of
participatory approaches in planning and monitoring
 Health workers needs for capacity building and effective
methodologies for training /mentoring
 District management needs including the need for
community based HMIS
 Strategies that have high potential to enhance community
health, primary health care and referral system
 Cost-effective interventions and innovations (e.g.mobile
technology), franchising, output-based approach and other
good practice models
 We also learned about structures and processes that are
essential to meet the universities’ needs in terms of
education and research relevant to local health systems .
What we learned

11. AKDN Integrated Health System in Partnership with
the Public Health System
Aga Khan
University
Hospital National (6)
Provincial (5)
Other Aga Khan Health Referral
Services Hospitals
District Hospital
(4)
Community Clinics Health Centres (3)
Dispensaries (2)
Community Units (1)
AKDN
Multi- sector input
Source: Dr. Armstrong,

12. Integrated Primary Health Care Partnership Model
Ministry of
Health
AKDN External
Resources
Core Principals Partnership
Critical Inputs Values
s Innovations, tools and other
Quality ion rc h ice
AKU/UCSF u cat esea Serv resources Accountability
Ed R
Bi-lateral
Provincial Donors
Impact Government Transparency
Global
Aga Khan Initiatives
Relevance District Hospital
Hospitals Sustainability
&
District Health Management
Team International
Access
Foundations Resilience
Aga Khan
Community Primary Health Care
Clinics Local
NGOs
Community Health
Workers
AKDN Multi-sector input
Community
Members become resilient, self sustaining and newly informed consumers in an emerging
market while experiencing improved quality of life through a Multi Input Area Development
approach

13. Partnership Model
(AKU/UCSF/Local Govt. & AKDN/other):
Education
Research
Services
 Critical Inputs from external resources (resource
mobilization)
 Monitoring and evaluation – documentation and
dissemination – informing/influencing policy
 Initial focus on MNCH
 Model of an open concept: changing focus according
to changing needs and priorities; e.g. NCD,
environmental health; even beyond HEALTH
Envisaged IPHC partnership programme

14. Next steps:
Developing a AKU/UCSF partnership proposal for testing an IPHC
programme in a selected district (Kaloleni District) for a period of
three years
Resource mobilization to support to the partnership model to
provide ‘Critical Inputs’

15. We believe that we can make a difference!
PARTNERSHIP
To create an IPHC partnership model
that
 contributes to the health of
communities in resource poor areas
through community engagement,
improved access to quality care, and
strengthening health systems
 offer students unparalleled access
to divergent communities
 provide faculty a unique
opportunity to apply for research
funding to undertake multidisciplinary,
multi-sectoral research enabling AKU-
UCSF / AKDN to design innovative,
locally applicable, globally relevant
solutions
 Develops education programmes
relevant to local needs and utilizing
locally applicable modern
technologies to build multi-sector
capacities addressing the current
inequity in health and education
 Can bridge communities across three
continents (AKDN focal regions)
Our vision

16. Community based solutions  Support tools
and innovations
 Training and mentoring of  Material and learning tools
community health workers  Communication systems
 Increasing systainability of  Infrastructure improvements
CHW system e.g. through  e-health system
small enterprise ◦ e-learning
development ◦ tele-medicine
 Franchising of community ◦ m-health
midwifery services ◦ Information systems
 Voucher system for maternal  Local media
services  Support to training and
 Birth planning and capacity building
preparedness (savings for  Support to alumni networks
transport)  Technical assistance to
 Resilience and positive develop tools and
deviance approach innovations
Critical inputs: examples

17. Comments?
Questions?
Asanteni Sana
Thank you