copc – the aku family medicine journey. of health community aga khan hospitals aga khan outreach/...
TRANSCRIPT
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Dr Jacob Shabani
COPC – The AKU Family Medicine Journey.
Inaugural Person and Community Centered Health Consortium April 17 - April 19, 2016 at Little America Hotel in Salt Lake City, Utah, USA
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Outline
• Preamble – Just a little bit about AKDN• Definition• We did not know how to do it – so we studied it• We thought we knew – we tested the pudding• Are we there ?
Inaugural Person and Community Centered Health ConsortiumApril 17 - April 19, 2016 at Little America Hotel in Salt Lake City, Utah, USA
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The Aga Khan University (AKU) – part of AKDN
HIS HIGHNESS THE AGA KHAN
AGA KHAN DEVELOPMENT NETWORK
ECONOMIC DEVELOPMENT SOCIAL DEVELOPMENT CULTURE
Aga Khan Fund for Economic Development
Tourism PromotionServices
Industrial PromotionServices
Financial Services Media Services
Aviation Services
Aga KhanFoundation
Aga KhanUniversity
Aga KhanHealth Services
University ofCentral Asia
Aga Khan Planning& Building Services
Aga KhanEducation Services
Aga Khan Agency for Microfinance
Aga Khan Trust for Culture
Aga Khan Award for Architecture
Historic Cities Support Programme
Education and CultureProgramme
Source: AKDN
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AKU - an international university with local relevance
Activities in Egypt and Syria suspendedExpansion into Rwanda and Burundi planned
United Kingdom
Uganda
Kenya
Afghanistan
Egypt
Tanzania
Syria Pakistan
• Multi-country, multi-campus university
• Global but local
• One university, integrated
• Common standards
• Opportunities for students, faculty & staff
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The Aga Khan UniversityExamination Board
The Aga Khan University Hospitals
Institute for the Study of Muslim Civilisations, UK
Medical College
Institutes for Educational Development
School of Nursing
Faculties ofArts and Sciences
AKU - Infrastructure and ProgrammesFaculty of Health Scances
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AKU East Africa – Faculty of Health Sciences
• Medical College.
• Schools of Nursing & Midwifery.
• School of Allied Health Sciences.
• Population Health Sciences.
• Biomedical Sciences
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AGA KHAN UNIVERSITY HOSPITAL
• 300 bed Premier institution in sub Saharan Africa
• 46 Community Outreach Centres providing clinical and diagnostic services.
• Enhanced facilities in surgery, obstetrics, critical care, and imaging
• State-of-Art Diagnostic services – radiology, pathology.
• International fellowship trained full-time faculty.
• Joint Commission International Accreditation.
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AKDN Integrated Health System in East Africacatalyzing change
Expanding quality healthcare and education
• Expanding access to high-quality healthcare in all 5 EACcountries and covering an economically diversepopulation
• Educating and creating clinically relevant leaders andhealth managers who are catalysts for change in theregion
• Conducting research into local disease burden andhealth system design so relevant knowledge is created
Collaborating with the public sector in health• Will impact more patients through partnerships than what
the AKDN system can care for directly through its ownhealth services
• Will accelerate human resources development in termsof numbers, qualification and motivation of personnel
• Will be replicable and sustainable (human resources andfinancially)
• Will be complimentary and not competing with publicsector
Coverage of AKDN’s East Africa Integrated Health System
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Legend
Hospital
University Campus
Public Private Partnership site
Satellite clinic
Primary Medical Center
Kigali
Kampala
Arusha Mombasa
Dar es Salaam
Kilwa
Kwale/KilifiBujumbura
Meru
Nyeri
Moshi
DianiTanga
Zanzibar Is.
EldoretNak
uruKiambu
Machakos
KitengelaMwanza
Kisii
Dodoma
MorogoroIringa
Mbeya
Thika
Nyali
Kakamega Nairobi
TANZANIA
KENYAUGANDA
BURUNDI
Malindi / Lamu
Arua
Bukoba
Pemba Is.
LindiMtwara
Kigoma
Sumbawanga
Songea
Tabora
Geita
Musoma
Taita / Taveta
Voi
Kisumu
RWANDA
Naivasha
172 Outreach Health Centers by 2027
Future Footprint of AKDN Integrated Health SystemEast Africa
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Ministry of Health
Community
Aga KhanHospitals
Aga Khan Outreach/ Health Centres
AKUAcademic Programmesand Hospital Nairobi External
Partners
Quality
Impact
Relevance
Access
Core Principals
Accountability
Transparency
Sustainability
Resilience
Values
County Government
District Hospital&District Health Team
Primary Health Care
Community Health Workers
AKDN Partnership Model
AKDNHealth
Equity
Aga KhanFoundation
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Definition
• Community Oriented Primary Care (COPC) is a systematic approach to health care based on principles derived from epidemiology, primary care, preventive medicine, and health promotion.
• It has demonstrated positive health benefits for communities worldwide.
Inaugural Person and Community Centered Health Consortium April 17 - April 19, 2016 at Little America Hotel in Salt Lake City, Utah, USA
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Inaugural Person and Community Centered Health Consortium April 17 - April 19, 2016 at Little America Hotel in Salt Lake City, Utah, USA
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Inaugural Person and Community Centered Health ConsortiumApril 17 - April 19, 2016 at Little America Hotel in Salt Lake City, Utah, USA
Comprehensive- skilled “all rounder” at a district hospitalCoordinated care- leadership and management in district healthcare systemCommunity-oriented- mentoring team-based care in community
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Inaugural Person and Community Centered Health ConsortiumApril 17 - April 19, 2016 at Little America Hotel in Salt Lake City, Utah, USA
Comprehensive- chronic and emergency care at district hospitals and clinicCoordinated care- managersCommunity-oriented- not practiced, more “aspirational” than real -improving quality of care through PHC teams
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Inaugural Person and Community Centered Health ConsortiumApril 17 - April 19, 2016 at Little America Hotel in Salt Lake City, Utah, USA
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Nelligan I, Shabani JS, Mohamoud G, Mahoney M, Tache S
THE UNIVERSITY OF CALIFORNIA
SAN FRANCISCO
A qualitative exploratory study of the feasibility and best practices of Community
Oriented Primary Care projects during Family Medicine Residency training in Kenya.
Inaugural Person and Community Centered Health Consortium April 17 through Tuesday, April 19, 2016 at Little America Hotel in Salt Lake City, Utah, USA
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Methods
Inaugural Person and Community Centered Health ConsortiumApril 17 - April 19, 2016 at Little America Hotel in Salt Lake City, Utah, USA
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Results
• 2 broad themes emerged that are associated with a successful residency COPC program in Kenya; – Expected learning outcomes.– CHWs for sustainability of COPC projects.
1st Global Conference on Patient Centered Care. September 30th, 2015 – Kenyatta University, Nairobi, Kenya
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Results – Expected Learning Outcomes
1. How to make a community diagnosis.• Making a community diagnosis is important
to guide project development.
Ultimately the project has to benefit the community, either health, maybe financially.
1st Global Conference on Patient Centered Care. September 30th, 2015 – Kenyatta University, Nairobi, Kenya
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Results – Expected Learning Outcomes
2. Emphasized the importance of understanding local environmental impacts on health outcomes and identified challenges in teaching these concepts.
1st Global Conference on Patient Centered Care. September 30th, 2015 – Kenyatta University, Nairobi, Kenya
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Some Quotes – Thematic Approach
Through COPC projects, students expect to learn social determinants of health.
I think one of the major determinants of health in that community is the socio economic……..
Certain cultural beliefs or certain religious beliefs of certain behavioural practices that are unique to that particular community
1st Global Conference on Patient Centered Care. September 30th, 2015 – Kenyatta University, Nairobi, Kenya
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3. Facilitators include training in research skills, proposal writing and communication skills, and personal and peer experiences with COPC.
I think it is those skills that you acquire, provide you a great opportunity to engage the community in terms of what is happening,………. you will be able to engage the community much better and also be able to incur change in terms of behaviour.
Results – Expected Learning Outcomes
1st Global Conference on Patient Centered Care. September 30th, 2015 – Kenyatta University, Nairobi, Kenya
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Results – CHWs for sustainability of COPC projects. 1. Community health workers (CHWs) should be embraced to facilitate linkage to the community.
The community health workers are a summary of the big communities.
They are people who would do home visits………..
They will be able to give you an indicator of the health status in the community..
1st Global Conference on Patient Centered Care. September 30th, 2015 – Kenyatta University, Nairobi, Kenya
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Results – CHWs for sustainability of COPC projects. 2. Empowerment of community fosters ownership and sustainability of a project.
I think the essence behind a community engagement is to make sure that the community kind of takes responsibility of things. When you let these people
[community members] on this project, you make them get a sense of responsibility…
It [community engagement] is the only way it will be able to sustain itself.
1st Global Conference on Patient Centered Care. September 30th, 2015 – Kenyatta University, Nairobi, Kenya
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Results – Overarching Themes
5. Financial constraints threaten sustainability and include the cost of transport and payments expected by CHWs and community members.
It has proved to be quite an uphill task because of who is financing….
1st Global Conference on Patient Centered Care. September 30th, 2015 – Kenyatta University, Nairobi, Kenya
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Discussions
• Our findings illustrate the expected learning outcomes and important finding that CHWs and Family Physicians are associated with the successful implementation of COPC projects in Kenya and will help to inform future curriculum development.
1st Global Conference on Patient Centered Care. September 30th, 2015 – Kenyatta University, Nairobi, Kenya
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A Colloboration
Add photos here
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Inaugural Person and Community Centered Health ConsortiumApril 17 - April 19, 2016 at Little America Hotel in Salt Lake City, Utah, USA
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Kenyan Theoretical COPC Model
• The Kenyan Vision 2030 project seeks to address pervasive health disparities
• Includes the establishment of the “community unit” by subdividing each district to the level of 100 households
COPC in Kenya = Family Medicine Community
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6%
15%
18%
31%
17%
13%
Overview of Health Care System in Kenya. Mugo, R et al. http://www.measuredhs.com/pubs/pdf/SPA8/02Chapter2.pdf
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Integrating Primary Health Care (IPHC) Programme
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Joint identification of priorities
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Relationship with Community Joint identification of priorities Regular training and mentoring Community activities Nursing program Family Medicine residency Registration of Households with emphasis on
MCH
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Start-Up Phase June 2011- May 2012
Community and Health Facility Assessment
Participatory Process Established
Social Innovation Identification
Family Medicine Experience
Phase 1 October 2012-March 2014
Capacity BuildingEducationResearch Health Services
Health Management Information System Assessment
Transition into PHS
Expansion and Development of Sites for Education and Research in PHSKaloleniGatunduJHI TanzaniaPakistanAKHS
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TO HOSPITAL AND BACK
Integrating Primary Health Care (IPHC)
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HOME VISITS
medicine and nursing students at the community level before doing patient journey
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ROLES
• Review difficult cases• Refer appropriately• Supervising and educating the team on current disease
management
Family Medicine Resident
• Triage• Management of routine illnesses and dispensing of medication• Involved in teaching sessions, mentoring of junior staff.
Nursing Cadre
• Follow up of patients• Assists by running the MCH and well baby clinic when nurses
are overwhelmed.
Community health Worker
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Are We There Yet
Inaugural Person and Community Centered Health ConsortiumApril 17 - April 19, 2016 at Little America Hotel in Salt Lake City, Utah, USA
• 3 Cycles of 1st Year Residents have rotated in Kaloleni
• Principles of COPC learned in 1st year incorporated in 3rd and 4th year rural rotations –Current 4th year cohort did the first continuous provision of cryotherapy and cervical cancer screening at Kinango District Hospital ?
• We can learn
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Asanteni [email protected]