Scaling heart health in Kenya
Access Afya is proud to secure scale-up funding from Boehringer Ingelheim for its transformative NCD program, set to reach 250,000 people in Kenya by the end of 2020.
Access Afya, a primary health innovation company providing an end-to-end model for primary care tailored for urban informal settlements, won first prize at a Boehringer Ingelheim pitch event earlier this month in Germany. Together, Access Afya and Boehringer Ingelheim will continue to deliver quality access to health services for patients living with diabetes and hypertension in informal settlements.
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Our non-communicable disease (NCD) program has already achieved world class outcomes, delivering real value for patients. In Kenya, where around 80% of the population is uninsured, NCDs are growing in prevalence. [1] NCDs account for 27% of all deaths in Kenya while more than 50% of hospital admissions and over 55% of hospital deaths are attributable to NCDs. [2]
The modern healthcare operating system for emerging economies.
We at Access Afya believe that a high-tech, high touch model for delivering healthcare can revolutionize global access. Our belief is that Kenya can leapfrog developed health systems by creating value-based, outcomes focused healthcare models for those who need it the most.
Digital health tools, telemedicine and point of care diagnostics combined with a network of community based access points creates a highly functional system for care that is less expensive and more patient-centric than the status quo. It is this unique and proven approach that secured the continued investment by Boehringer Ingelheim.
Akiba ya Roho: Save your Heart
Akiba ya Roho, which means ‘save your heart’, is a co-creation product of Access Afya and Boehringer Ingelheim that is creating NCD centres of excellence across Kenya.
This model combines retail pharmacies, clinics, telemedicine, and digital tools for health providers to deliver health consultations, lab work and medication as a low cost.
The Akiba ya Roho patient journey is divided into three stages: awareness and screening, diagnosis and conversion, and adherence to treatment and outcomes.
NCDs: low awareness, silent killer
Awareness is a key challenge in the communities that we serve. 55% of people we screened for NCDs had never had their blood pressure checked - and yet 11% of them had high BP; 82% never had sugars checked yet 2% had elevated blood sugar. 80% of those with elevated blood pressure and/or sugar were unaware that they might have a non-communicable disease.
Access Afya has served 12,000 to date with information on diabetes and hypertension, providing educational materials and screening in their facilities, at events such as football games, and at roving pop-up clinics. The technology model implemented in the program provides field agents and pharmacies with a platform that they can use to evaluate risk factors, collect essential data and provide a risk score that enables them to refer patients.
Unique approach to diagnosis & conversion
In Access Afya, all patients screened with elevated blood pressure and blood sugars are followed through a clearly outlined process by clinical teams. We have developed a behavioral approach to SMS that nudges patients through their care pathways ensuring that they follow-up when needed.
A number of innovations have been integrated into the model to drive cost savings and efficiencies including telemedicine consultations with specialists, mobile phone based ECG and automated prescription refills.
The conversion stage makes our work at Access Afya unique compared to large-scale screening programs we have seen. Despite the recommendation by the World Health Organization for the integration of NCD care management in primary health care settings, there is very little evidence base for provision of care in resource poor settings such as the informal settlements in Kenya. [3] This lack of health related data leads to inappropriate and unrealistic allocation of healthcare resources by both public and private sector which inevitably means that silent diseases such as hypertension and diabetes are overlooked. This can lead to severe and end stage complications of these diseases that come at a substantially greater cost to the individual and the health sector.
Global leader in medication adherence
In the clinical setting, adherence to medication is a key contributor to achieve control. Our current self-reported ability to adhere to medication is higher than the global average. [4]
Public information on health outcomes for NCD patients in the developing world is difficult to find, so we are working to change that by sharing our findings.
Our patients on average saw reductions of 6mm Hb SBP and 10mm Hg DBP, meaning that ⅕ moved out of clinical hypertension consistently for three months over one-year and most saw reductions in blood pressure. Our clinical management helped to reduce cholesterol levels by 15% with an average drop in cholesterol levels of 38 mg/dl. The average HBA1C dropped 1.56% meaning our program helped most patients achieve glycemic control. Despite the challenges brought about by the determinants of health affecting the communities we serve, we have been able to achieve comparable results to the average 8 to 10 mm Hg DBP decreases reported in a meta analysis of 208 antihypertensive clinical trials covering over 94k people in the United States (5).
Our experience underpins the need for investment by government to be placed in prevention and early management of hypertension and diabetes among low income earners. We advocate for the inclusion of diabetes and hypertension into the National Hospital Insurance Fund’s service package, as currently patients must pay out of pocket for expenses related to chronic conditions. We believe that with adequate health financing, clinical results achieved by our patients would look even better.
Affordable, local healthcare with proven results
The global NCD problem is often defined by unnecessary death, complications and suffering, so we believe programs should be held accountable to achieving the clinical results that prevent these things. Our high tech operating system and network of community based access points means we can maintain our keen focus on clinical outcomes while ensuring patient welfare remains paramount. Thanks to the ongoing support of Boehringer Ingelheim, we can now also continue to create NCD centres of excellence across Kenya to support patients living with diabetes and hypertension in informal settlements.
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References
1. Kenya National Bureau of Statistics (KNBS), & Ministry of Devolution and National Planning (2018). Kenya Integrated Household Budget Survey 2015-2016. Retrieved April 03 2019, from file: http://statistics.knbs.or.ke/nada/index.php/catalog/88
2. World Health Organization (WHO). (2014). Noncommunicable Diseases (NCD) Country profiles. Retrieved October 16, 2017 from http://www.who.int/nmh/countries/ken_en.pdf?ua=1
3. Sobry et.al. (2013) Caseload, management and treatment outcomes of patients with hypertension and/or diabetes mellitus in a primary health care programme in an informal setting.
4. Abegaz, T.M., Shehab, A., Gebreyohannes, E.A., Bhagavathula, A.S., & Elnour, A. A. (2017). Non Adherence to Antihypertensive drugs. Medicine, 96(4). Accessed online: https://doi.org/10.1097/MD.0000000000005641
5. Paz et. al. (2016) Treatment efficacy of anti-hypertensive drugs in monotherapy or combination. Accessed online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5265817/