Innovations in health care access for Nairobi residents

Hilary Nicole Zainab Ervin, Nairobi Community Manager
Nairobi, 3 June 2015

Often staffed by individuals with limited knowledge of medical and diagnostic standards, the pill or chemist shops around Nairobi are places where individuals can obtain ad-hoc medical consultation and are sold pharmaceuticals.

Though Kenya has consistently improved the quality and scope of health care coverage across the country, many challenges remain. For example, since 1990 the nation's maternal mortality ratio has declined from 490 to 400 deaths per 100,000 live births as of 2013. Under-five mortality has also declined from 99 to 71 deaths per 1,000 births from 1990 to 2013. Yet, the greatest burden of disease, or disability-adjusted life years lost to premature mortality and disability, in 2012 remained those associated with maternal, neonatal, and nutritional causes.

Overall, Kenya has achieved significant success in reducing the number of deaths due to the HIV/AIDS virus. In 2000, roughly 384 individuals per 100,000 of the population died as a direct result of HIV/AIDS; by 2012 this rate had declined to 126 deaths per 100,000 of the population. However, the disease remains the leading cause of the death in the country, killing 58,000 individuals in 2013 alone.

Lack of access to affordable care, timely diagnostics, and quality health services for low-income individuals residing within informal settlements contributes significantly to the nation's overall disease burden. Working to address these challenges, and provide a comprehensive patient records collection and communication service, Access Afya has been working to scale its existing model to increase coverage for a greater number of slum residents.

Access Afya utilizes a social enterprise model of primary healthcare provision at its two existing clinics in the informal Nairobi communities of Kisii Village and Sinai (Jamaica) Village. The organization is a social business that establishes micro-clinics to provide individuals with an initial entry point into the formal healthcare system in a safe and affordable manner.

The clinics offer onsite consultation, diagnostics; electronic patient records maintenance and dispense medications. Patients pay for services and medications as well as having the option to buy related health and hygiene products. This revenue works to ensure sustainability of the direct medical services provided on-site and to keep the cost of accessing direct care low.

Lack of quality record-keeping has remained a consistent challenge to health care provision across the developing world. Many innovative health models and applications have been developed over the years to address this gap. Access Afya has built its own internal electronic patient management system that collects holistic and longitudinal patient data, which is then available to health care workers meeting with patients on site.

These mechanisms work to standardize practices and provide health care workers with critical information on patient medical histories that further inform the quality of medical care provided. The organization hopes to scale their current operations to include an additional six clinics by the end of 2015. Approaching medical care provision from a client-centered perspective and locating services in the communities where residents live will likely remain a critical component to increased quality of care and coverage as Kenya continues to develop.

Photo: Gates Foundation and Access Afya

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