Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Important declaration again, that mask ana. So it's called the Standard Declaration of October 2018, which affirms the commitment to the one fundamental right of every human beings to the enjoyment of the highest attainable standard of health without distinction of any kind and reaffirms the commitment of the Alma Hot a core principle. So what is the kinds healthcare in Kenya? So it's basically dominantly accurate tive, what do you mean by, by curative approach? So, in a nutshell, it's whereby we have uh most uh most of our patient's, of course, you know, presenting at the referral hospital like Man Yuki, for example, on your, are you when it comes to like keep, yeah, those are the main big hospitals in like it. So you have patient's who have had undiagnosed hypertension and diagnosed diabetes, for example, um diagnosed tuberculosis, even HIV authorities such chronic diseases, but I've never been diagnosed before. So they just present to you at the emergency department with things like D K A, you know, strokes hypoglycemia, you know, uh arrhythmias, advanced malignancies and so forth other presenting with symptoms of advanced HIV disease not decks before. So of course, that is the current system that is the current system we have. And it's mainly because at the ground, at the household level, at the community level, we do not uh the the promoted and preventive aspect of healthcare is not, it's not been given the strength, the emphasis that it requires function. So you want basically have fragmented primary healthcare structures. Those are the dispensaries health centers that are not harmonized to be able to give the services from at the community level upwards. Uh Next. So, so now what we are doing at the primary healthcare level, uh we are trying to come up and organized healthcare in terms of levels and starting basically from the community level. And we have also come up with something called primary healthcare vital signs profile, of course, to be able to profile um what the background of a community, what communities do we have? What class do we have in terms of healthcare? So as you can see in that chat, you are able to see that our maternal mortality rate is about 383 in 100,000 people. The life expectancy for Kenyan understands at 66 years and your natural mortality 23,000 uh live babies, they're living. Of course, the the the poverty index standard 37%. And as you can see the N C D, the contribution of N C D noncommunicable diseases is contributing around 41 mortality rate. As we sit now as we stand now. Uh So this uh research that was done three years ago uh by Douglas show and of course, the Ministry of Health Kenya and UNICEF because they found out that the high access to, to healthcare close to 70%. But then there's lower low service covering it. So it's not just enough to have structures, you know, to have a dispensary, it's also uh calls. Um of course, it calls that we have services. Uh I did services, for example, we should be able to have a lab service, OPD services, immigration services, X ray services, imaging services, for example, blood transfusion services and so forth. But of course, what they found out is that if it is that you in every five kilometers, of course, not five kilometers, but the depature requires that in every five kilometers, there should be a head facility. So in Kenya, we have i access to health facilities, but in such Elst care facilities, the service that you find, of course, the the you do not have varied services, maybe you could have an OPD, an outpatient uh and maybe you could also find a pharmacy in there, but then you may not find diff different or varied uh services. But of course, the the that gives us an unfun shinning facility because it's not just enough to have structures. It is also just equally important to have structures and have different services in there. So of course, the other problem that he found out is financing of primary healthier. So it's not enough. And when it's there, of course, sometimes you find that there's, the expenditure is, it's got a strong thick, it is not well organized to be able to, to come up with, I'm honest of healthcare services. So the next one, of course, you have primary health services you find in that um what you can see is that the density of uh facility is to every uh 100,000 population. You also find out that we have 13,707 primary care service, possibly according primary care services is level 23 and the community and the level of one, of course, it is a community level where we have people called community health volunteers, people. Uh uh Of course, you know the local people coming from the from the villages. So we normally identify, we do mapping of the villages. And of course, uh we come up with something called chew community Health unit. A community unit is formed by 5000 heads, you know your population 5000 and then you do a mapping of of at the household level, you're able to, to to this uh to aggregate such population. So in every 5000 people, you come up with something called community health units. And in those units, you have around 10 uh community health volunteers, people appointed from the community level, people living in that community day today, people who know each and every person in the community. So they form up something called community health unit. So that is a level that is missing at the uh as we speak. So you also see that you have 50% of uh of the facilities being public health facilities, 37% being private and 13% being an nonprofit that is according to Kenya M F L uh 2020 you can also see that there's only 24% of facilities that are all basic equipment. Also, as you can see down there. Uh the the main availability of essential medicines is stands at 44% dispensaries in the average had about 37% of the sense of drugs. Yeah. When it comes to human resource, you see that core health workforce density is a stance at around 17 uh for every 100,000 people. I mean population. So what the court health workforce density that of course, you are interested to find out who forms uh category. So it's of course, the doctors, nurses, nutritionist, pharm pharmacist, you know, uh and so forth. Uh Next, when you look the landscape, that is the primary healthcare policy landscape. So those of course is that, that's uh the the 2005 is called the National health sector Strategic Plan of 2005. Uh There was the first time that community level was introduced into as a part of the health of the service delivery unit in Kenya. And of course, you run all the 2013 2014 2020 2020 is when we had the first Kenya primary healthcare strategic framework. And then of course, uh 2020 20. Also we had a Kenya Community Health Policy, the trans between 2020 2030 and then 2200 Kenya Community Health Strategy. So basically, this is the landscape of uh policy uh as far as primary healthcare is concerned, but it's in ventilated that now the Kenya primary healthcare strategic plan which strongly uh strongly um put spray healthcare in the forefront, you know, health healthcare delivery. So we'll look at what's primary healthcare. It's for example, this is a model of uh the Kenyan probably healthcare network. So the model basically is what do you have at the top? Yeah, that you have a hub, a hub basically which serves the spokes. So international, the hub is supposed to be a level four orders of going to hospital and the spoke is supposed to be the dispensaries, supposed to be the health centers and supposed to be the the community level where now you have set up the community health volunteers. So of course, we we have a uh level one being the community health unit uh run by community health volunteers and those are the people who are selected among the community members. And of course, there's a mapping done at community level, such that in a village you say for every 100 households, it is served by one volunteer for another 100 in South by a second volunteer. You go on and on to the first level of this network, community health unit served, ran by community health volunteers. Then of course, the level one is the dispensary. And then of course, currently our dispensary uh run by nurses then level too. I mean, number three is the health center and health centers. Of course, that is where you begin to have uh clean colossus nurses and nutrition's. Then level four is where you is collected PHC referral facility. Level four, that is where you have the hub. So you have a hub, we're supposed to serve the dispensaries, supposed to serve the centers, supposed to serve the community health unit. So that is what you can see in that, that uh that dry a gram. So what is the PCN primary care network? Primary care network? So primary care network basically is an administrative region at least to increase access to primary healthcare services for formation that's recording with local hospital. In order to improve the overall operational. A visions of the network, the PCN or primary care networks are deciding to have a modified huh and spokes model. This emphasis is the need of the population with the community being the entry to the health system. The habits expected to be a level four facility that is a sub county hospital or faith based or private hospital and will support levels 12 and three, which I'm now quoted as books. So what is the criteria for establishment of a PCN? That's the Primerica Networks? Of course, you must have a one level four uh hospital. It could also be a private or faith based facility and of course, this one facility, level four facility should be able to serve at least three, three of level two or level three facilities within the region. And then of course, you must have at least five level one community health unit. So you must have uh five the one, but there must be an evidence of public private partnership established between county governments and the private sector partners. So of course, this uh the idea is to be able to, to be able to have coming to government establishing partners with private parts, of course, coming up international with private partners partnership to be able to run such a uh such a uh health uh service because it's new, of course. So we need, we need to, to have over, that's why the W H O the units is really pushing the national government of Kenya to to make sure that this program goes down to the community because this is the only problem that will be able to push services to the household, to the community level because that can really like I talked to you about the young people coming for kilometers to come all the way to the U K, 100 kilometers, 200 kilometers to come to the new key to pick drugs, uh tend to pick and diabetics, you know, to have, you know, full mammogram van to have you student elected that. You hope all of course transport in this country is very expensive. It is also just not ok to tell someone to board a matter too, a public transport to come all the way for 100 kilometers to pick a drug. So the idea is to take such services closer to the people, closer to the communities, to an extent where people can only just walk to a facility and have their drugs, you know, have their, their laboratory, you know, services done uh you know, pick their drugs uh at a convenient location. So that is the idea. So everybody should come on board to make sure that this idea come to fridge. So the guiding principle, of course, uh for, for primary healthcare is a result orient, of course, looking at performance reviews, increased access. So availability of audited through the MDT very soon uh in a few minutes, I'll tell you what M D T is. Of course, the referral system is also one of the main agendas resource shared were necessary. Also, we should be able to have a lab at the level of uh those primary healthcare. Uh And of course, we're creating relationship and of course, we were looking into being accountable to the community where we start because this program is person uh sentence care. So the process of establishing PZN, remember that PCN stand for primary care networks. So what is the process of establishing uh primary and network? So establishment of the governance and coordination structures including MDT 70 TV, scaly mean multidisciplinary teams. So of course, conducting a baseline assessment of community health needs health facilities, resources and partners, mapping of the hubs spokes and choo choose basically mean community health units and linkages. Uh mapping and registration of household health status, provide educational financing requirement to establish an and management of a PCN gas segment of the PCN at the county level. And of course setting up a monitoring evaluation system for monitoring the primary care network. So the objective for setting up the PCN, of course, the objective is to distribute to first the injection care across levels of the health system, improve efficiency of the health system by providing care at the optimal level. Ensure no one is left out to have an efficiency, emergency referral system which is basically up and I don't know what the referral of. And also the other objective is share ing of resources across levels of care improvement in data floor. But of course, uh this better is making. That's right. Okay M D is that health professionals working together to provide comprehensive and continuous first consented primary case for individuals, families and communities. So a petition with the committee who will be the first content for a person with an undiagnosed health concern. Refer to a specific specialist Wednesday. I'd also provide expensive and continued continued care of various medical conditions, not limited by the cost organ system or diagnosis between the leaders and families by integrating biomedical, behavioral and social sciences. So the position of the multidisciplinary team basically is led by a family decision. You have medical officer, you have a, you have a uh you have a lack of personnel, public health, yeah, public health officer, uh pharmacy, pharmacy personnel, community health system, health records and formation, managed health promotion officer, mental health officer, medical social worker. So basically that is the team that will be sitting at the the level four facility. So that is the that is the team that will be sitting at the level four facility and taking care of the spokes, the spokes being the health centers, the dispensaries and the community health unit. So all the referrals will be done from those the three pills and then two a referral facility called level four. And uh of course, now you have the composition of this stuff at any given moment. Uh Now, in line with the national program called, of course, primary Healthcare. Now they like keep your county cannot with its own uh program which is equivalent or which is of course minted from the from the widely known primary healthcare. Of course, it's important to tailor make a program of national state in order to suit the local needs and demands. So that's why we call our, we are basically just joining our primary healthcare and call it a lamp like keep eah of your machine any program. And the reason being, of course, we county second and every county has its own priorities in terms of uh what indicators, what needs we have in terms of health. And so that's why we have come out our own primary health and keep you having machine any program. Of course, one of the reason is we have a positive scarcity of resources and the novelty of this program, we saw it fit to start implementing the program from one sub county, then move to the rest once we have the initial success registered. So, so one of some of the milestones that we've registered from the exception of cause the first four months, we have identified a level four facility and it's called Mando. And this uh to be established and use as the first hub and it drives a rounding dispensaries from pokes a facility uh currently is in the laboratory even if it's not fully equipped. But of course, it's a laboratory. He's able to do a full limb a gram, uh your creatinine uh LFTs, it's also able to do um your analysis HIV rest is able to do my cross copies for, for, you know, for things like for diagnosis of, of TB. Uh huh. We also able to, to do a few other things. Of course, there's also an OPD block, the outpatient block and where now the medical officer together with the clinical trials to eat, to see pages. And then of course, we also have a block and in making a block. Uh, the current government was also managed to employ the important role. Of course, the, like I said, the most currently they're cleaned five clean colossus. There are 15 nurses there too. In addition, ists, there is one health record Rosa, there is one of the technician and there's one physical therapist. Then of course, there's construction of a mortuary is ongoing. 50% uh done. This is an emerging department that is coming up of course, where we because we have choices and cultural analysis. Uh That end of course, at that community level, first time in the place. Yeah, of course, we plan to have a standby ambulance at that level electricity connection. Of course, the facilities is ongoing. The wiring has been done. So we wearing has already been done. Uh the connection, the wiring connection to the facility. What remains now is the Kenya Power electricity going to to allow the electricity to flow to that end? Of course, it is already existing uh functional community unit. So we have around three community units which serves the possibility in terms of government. We have what MG the the multidisciplinary, which is made up of familiarly physician, the medical officers, the nurse, the clean colossus, nutritionist and records the community health assistance from the uh the the other part of governance. Uh the monthly meetings for performance, refused monitoring and evaluation. Also, there's a the patient feedback system that we are putting in place, of course, which is service suggestion boxes and also interviews to the patient just to make sure that we're doing the right thing. So the program is uh of course uh are that we are going to run out patient services and we are going to the outpatient services. Of course, we'll include specialized clinics whereby we tend to to have consultants going, you know, provided with transport and you know, Fareed too to the neural areas to be able to provide services, you know, the surgical or patient clinics, the medication clinics, the the pedicle paste clinics in a monthly basis. We should also, you know, we should also be able to have the imaging service is being done at those at that level, at the community level. We should also be able to do outreach services, laboratory services, emergency services. And uh of course, the continuous quality improvement services through Sierra mist witness sickness and uh on job training. So that is uh in a nutshell, that is a problem we intend to do. So basically we are doing it at demand. So then we move on to other sub counties and identified level four uh facilitated which will suffers the hubs. Then of course, we go on and identify dispensaries around those level four hospitals to be able to now refer to that level four hospital. So for example, when it comes to Nanyuki, because in like keep a basically we have three sub counties were not keep West. So we'll basically come and identify uh level four hospital, identify dispensary that will serve, will refer to that before and make sure that that level four is enabled enhanced to be able to have services to be able to offer, you know, uh different types of services. So that patient's do not have to come to Nanyuki. If LaMagna for example, is the one that will be identified as a level of four lumbar area is basically around that 2025 kilometers from Nanyuki. So patient's coming all the way from lumbar area and the and and the areas of the Maria and other and got such areas do not have to come to the new key to pick drugs. You know, they pertain a preventive drug, the diabetic drugs, you know, they do not have to come to for for example, if they have to be admitted for decay, do not have to be admitted. Nanyuki teaching and follow will be admitted Atla Maria through Maruti to like keep your West. Those are the the that is the end of uh that is the areas of Nauru room rooty, you know, D Indica. So we basically just identify one facility, for example, if we identify and Indica to become the hub for like the West. So the facilities that the smaller facilities, the dispensaries, the health centers which are closer to and Indica will now from that network, that primary care network uh LaMagna now being the hub, you know, the referral, the primary healthcare referral facility and having the rest of the dispensaries forming that web. So that is what that is the program that that is a program retail uh which are still uh ongoing. Next, of course, we have the areas of consultation. Of course, we we were still in talks to make sure that our medical cover. Of course, you realize that most of our, most of our clients do not have the purchasing power because they do not have a medical uh of the uh shortcomings as far as our, our success is concerned or the success of our program. So what we are doing, we are in talks with the government, both the national and county government to be able to assist some of the poor clients and pay for them 500 shillings per month. So that when they come as a subscription fee, so that when they do come for for forest is that those uh hours facilities, at least they're able to, to, to, to receive the care otherwise, yes, clients are not able to uh from the pocket you know, so that is one of the areas where we really uh need to, to really very much, you know, of course, it's a collaboration with the administration and also with the consultant forum, uh those in Yuki teaching and referral and those in your urine. So that now we were able to, once we come up with, with the full details, those consultants in the nooky should be able to go to the to the to the machinery, you know, to the grass root level and be able to over such follow up clinics at that level. So of course, that should be able to be done once in a month. So you have consultant, for example, if you have a surgeon going to commando once in a month and see patient's, you know, do the follow up clinics at that level. Of course, that is something that is uh we're still trying to see how that uh we've come to come to success. So, so as far as that is concerned, of course, I know this is a new program and uh uh is a work in progress. So most of you may not may have questions uh because this is a new problem. So I at this point in time, I I actually invite you guys too to, you know, to ask question. So I need that is our program and of course, it's, it's when it comes to. Uh of course, I've, I've been talking to some of you, those of you are who are good to visit in a new key. And of course, you will be interested to, to understand how you guys can also become part of this program. How are you able to chip in to give you a time to give your skills and attend patient's at the uh the grassroot level? Uh I'm sure you get that. Uh I'm happy to do so. So. Welcome. Great. Well, thanks, Doctor Alfred. That was uh informative. So thanks very much for doing that uh presentation for us. Um If you wanna just saying, thank you so much for the, for the presentation. Um What I'll do is I'll open up the floor now to any questions that people might have. Um We've got a question in the, in the chat from Charlotte Hardy, which I'll read out to Dr Alfred. Um Charlotte says I work in a, in a Ugandan setting where there is very little insurance based care. How are you finding uptake of insurance contributions with low income populations? Ready? Come on, come again, Nick. So the question is um from someone who works in a Ugandan setting where there is very little insurance based care. And the question is, how are you finding uptake of the insurance contribution, low income populations? Uh Yeah, I think we have an issue. We have a big issue when it comes to our, you know, our, our oral community is being able to understand. I think the issue is even a level of understanding. You have people who are illiterate, people have no formal jobs. People are basically just li uh you know, you have people, basically we're not employed by any and we are going to tell such such a base of people to pay 500 monthly as a subscription. They are telling us why should the questions? Some of the questions that why should I be 500 every month yet? I'm not sick, do not understand they not small. Some of them do not understand the basis of having that security, you know, that health security. So of course we, that's why we are we, that's why the government has come in strongly. Now for the last two or three months, the government has been able to, to pay uh to pay the 500 shillings monthly for around 500 people in that uh in the in that region of commando and has been able to pay for around 5000 people in the entire like Atypia count and those are the vulnerable, the vulnerable uh cleanse, you know, the vulnerable uh like he pins government has been able to pay for them. That's that amount of money. But of course, that leaves a huge uh constituents or people uh that that subscription. And that's why you find that people come to the new key receive services either inpatient services, ICU services. And at the end of the day at the time when they're being discharged home, they will, I mean, how people are telling you that this is the amount that I've been charged and I do not have money and I have not, I have no idea what any HIV is. So that's how you find sometimes are people who have been disturbed and they still remain in the hospital beds because they do not have that medical cover and also they do not have the money in their pocket to pay for that amount that is being charged. So, of course, that is a big challenge when it comes to to implementing this program. Thank you. Um I had a quick question um just about the care networks and, and setting up the care net works in particular and in regard to particularly the share ing of information between the different healthcare facility. So whether that's a um you know, the big hospital or one of the dispensaries, um what kind of, what kind of things are are in place for that, for the distribution of uh information regarding patient details, etcetera. Uh kind of repeat your