Geneva Health Forum Archive

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GHF2014 – PS28 – Patient-Centric Technology: Innovation for Health

PS28 THURSDAY, 17 APRIL 2014 ROOM: 15 ICON_Fishbowl
Patient-Centric Technology: Innovation for Health
Mr. Hani Eskandar
ICT Applications Coordinator, ICT Applications and Cybersecurity Division,  Telecommunication Development Bureau of ITU, Switzerland
SPEAKERS (tentative):
Dr. Oliver Harrison
Senior Vice President, Healthways International; Consultant to WHO on mHealth for tackling Non-Communicable Diseases, Switzerland
Mr. Andrés Martin
Head of Digital Strategic Planning, BUPA
Mr. Sameer Pujari
mHEALTH secretariat for WHO and ITU joint program on mHealth for Non-Communicable Diseases, WHO, Switzerland
Mr. Simão Ferraz de Campos Neto
Counsellor for ITU-T Study Group 16, Secretariat of the ITU Standardization Sector, Switzerland
With the fast pace of technology development and the demand of improved service accessibility and quality, disruptive innovation has been having the perfect environment and opportunity to show its potential. Within healthcare, this mainly took form as the now very well-known field of personalized medicine, which allowed information and services to be more accessible to patients, healthcare professionals as well as the overall public and private sectors. Due to higher interaction between stakeholders, health services accessibility and quality will improve and to meet everyone’s expectations and needs. These technology advances allowed patient’s empowerment as well as the emergence of new services and trends. Special focus has been put on wearable technologies, which with time have been widening its use and purpose besides decreasing in size. Such technologies enabled the self-management of patients with chronic diseases, the improvement of quality of life of elderly and the promotion of healthier behaviors concerning physical activity and nutrition. Smart watches or bracelets track now users’ activities, wireless sensors correct a person’s posture, ingestible sensors are used for drugs’ compliance, biosensing clothing monitor heart rate and activity among many others. Innovation within healthcare has therefore been focused more and more on each person’s unique conditions and needs.The objective of the session is to facilitate a dialog between all stakeholders involved, namely government regarding policy-making and standardization requirements, private sector regarding future technology advances and trends, healthcare providers regarding new opportunities and international organizations regarding required global actions to unlock possible bottlenecks and to address challenges that will accelerate large scale uptake of these new technologies for improved health outcomes.

Hani_EskandarMr. Hani Eskandar

Mr. Hani Eskandar is the ICT Applications Coordinator at the ICT Applications and Cybersecurity Division of the Telecommunication Development Bureau of ITU. Mr. Eskandar is currently involved in providing assistance to several developing countries by advising on eApplications strategies and policies, assisting in implementing technical co-operation projects and developing guidelines and best-practices on eApplications.

Previously, Mr. Eskandar had extensive experience in the field of ICT for Development where he, through his work with the International Federation of Red Cross and Red Crescent in Switzerland and, UNDP and other NGOs in Egypt, was involved in several development projects in the fields of Health, Education, Illiteracy Eradication, Community Development, SME development and Micro Credits. This included, among others, introducing Telemedicine services in rural areas, introducing ICT in Schools, creating Community Development Portals, Community Learning Centres, developing e-Learning and training programs for Youth.

Mr. Eskandar has an educational background in Electrical Engineering (Telecommunications) and has completed an MBA from McGill University, Canada and a Master Degree in Social and Economic Development Studies from University of Paris I, France.

Oliver_Harrison_squareDr. Oliver Harrison

Dr. Oliver Harrison is a Senior Vice President with Healthways International, a global health and wellbeing company specializing in population health management based on more than 30 years of experience.  He is also a Consultant to the WHO for their joint initiative on mHealth for tackling Non-Communicable Diseases, and Co-Founder of Platform Health (, a non-profit Standards Development Organisation and ITU Sector Member.  Platform was created to help close the remaining gaps to enable secure “plug and play” health data system interoperability, including mobile.

Until 2013, as Director of Strategy at the Health Authority – Abu Dhabi, Dr. Harrison helped drive a comprehensive health system reform.  Progress was driven and tracked using data from pioneering IT systems designed/implemented by the Health Authority team (; these systems have become the blueprint for several additional countries (  Dr. Harrison established the Abu Dhabi Public Health Department, which used these data systems as the foundation to design and implement “Weqaya” – an award-winning population health management programme targeting diabetes, hypertension, and other risk factors for cardiovascular disease (

Before Abu Dhabi, Dr. Harrison spent five years with McKinsey working worldwide with the healthcare practice.  He is a UK physician with US National Board Certification in Public Health, and Masters’ degrees in Public Health from Johns Hopkins and Neuroscience from Cambridge University, a Non-Executive Director of Guy’s and St. Thomas’s NHS Trust, and a member of the World Economic Forum Global Agenda Council on Behaviour and Cognitive Science.

Andres_Martin_squareMr. Andrés Martin

Andrés Martin Diana was born in Seville, Spain, has academic background in Media and holds a MBA by the IE Business School (Madrid). He has been working in the digital arena since 1997, when he co-founded and managed a pioneering online content start-up. Passionate about healthcare disruption by innovative online services and technologies, he led the digital marketing, sales and services for Sanitas, a leading healthcare company in Spain, until 2008. After that, he was responsible for Bupa’s global digital strategy until 2013. He now leads the partnership between Bupa and the WHO and ITU for mHealth, supporting the initiative Be Healthy Be Mobile to tackle non communicable diseases globally. He has been invited as speaker in several international conferences on strategy, digital transformation and eHealth/mHealth

Sameer_PujariMr. Sameer Pujari

Currently with WHO, Sameer Pujari is part of the mHEALTH secretariat for the flagship WHO and ITU joint program on mHealth for Non-Communicable Diseases; Be He@lthy Be Mobile. With WHO, he has also provided technical advise and support to over 30 countries in the development of surveillance and management information systems. He is also a core member of the Health Data Forum at WHO and the co-chair of the WHO mHEALTH working group. Before coming to WHO, Sameer worked with the US Governments health agency helping various countries build informatics systems for immunization and vaccination programs in Asia Europe and Africa. He started his career working with WHO's National Polio Surveillance Project in India for 7 years, where he led the development and implementation of various information management systems for surveillance across the country.

Campos NetoMr. Simão Ferraz de Campos Neto

Simão Ferraz de Campos Neto joined the secretariat of the ITU Standardization Sector in 2002, and is the Counsellor for ITU-T Study Group 16 (for standardization work on multimedia services, protocols, systems, terminals and media coding, including accessibility, IoT, IPTV and Digital Signage). He organized several workshops (e.g. Multimedia in NGN, Telecoms for Disaster Relief, RFID, E-health standards; SIIT2005) and was the editor of the first version of the ITU-T Security Manual.

Prior to joining ITU in 2002, Mr Campos worked for 8 years as a scientist in COMSAT Laboratories performing standards representation and quality assessment for digital voice coding systems, and before that he was a researcher at Telebras’s R&D Center (CPqD).

A Senior Member of the IEEE, Mr Campos authored several academic papers and position papers, served in the review committee of several IEEE-sponsored conferences, and organized the first ITU Kaleidoscope Conference.

Prof. Dilrabo Kadirova

Kadirova PhotoProf. Dilrabo Kadirova

Prof. Dilrabo Kadirova is the Head of the Family Medicine Department No.1 of the Tajik State Medical University (TSMU) named after Abu Ali ibn Sino, MD, Professor. She has over 25 years of teaching experience.

Prof. Kadirova received her candidate of science and doctorate degrees studying at the Medical University in Moscow. Her research focuses on cardiology, in particular hypertension and its prevalence, diagnosis and treatment of different age groups: women, youth, elderly and senile, as well as the development of family medicine in the Republic of Tajikistan (RT).

She is the founder of the Family Medicine Department at TSMU. Before the establishment of the department, she studied the development of family medicine and was trained in UK, the USA, Austria and Estonia. She developed training programmes for students, master students, clinical residents and trained 78 family doctors in RT. Prof. Kadirova currently supervises the work of the department, where there are 14 teachers of family medicine. About 1000 students in the family medicine department have been trained, students are being trained in this subject at clinical internship and master’s level as well. She delivers lectures to all students and conducts seminars. In addition, she conducts seminars and conferences for family physicians at the City Health Centre in Dushanbe. Prof. Kadirova consults patients daily.

GHF2014 – PS06 – Integrated Management of NCDs at the Primary Health Care Level : a World View

Integrated Management of NCDs at the Primary Health Care Level:
a World View

Dr. Nicholas Banatvala
Senior Adviser to the Assistant Director General, Noncommunicable Diseases and Mental Health, World Health Organization, Switzerland
An Integrated Approach to Management of Diabetes and Hypertension in Western Kenya
Dr. Simon Manyara, Pharmacist, Academic Model Providing Access To Healthcare (AMPATH), Kenya
Introducing a Model of Cardiovascular Prevention in Slums of Nairobi
Dr. Steven van de Vijver, Senior Research Officer, African Population and Health Research Center, Kenya
Clinical Audit on Diabetes Care in UNRWA Health Centres
Dr. Yousef Shahin, Chief Disease Prevention and Control, Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Jordan
Identifying the Barriers to Care and Medicines for Diabetes and Hypertension: A pilot study in Lima-Peru
Mrs. Maria Kathia Cardenas, Investigator, CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Peru

Nick Banatvala_squareDr. Nick Banatvala

Dr. Nick Banatvala is currently Senior Adviser to the Assistant Director General (Noncommunicable Diseases and Mental Health) at WHO in Geneva. Current responsibilities include leading development of a global coordination mechanism for the prevention and control of NCDs, spearheading a newly set up UN NCD Taskforce and leading WHO’s global training programme to build capacity on NCDs for senior policy makers in middle and low-income countries.

Prior to this, Nick was Head of Global Affairs at the Department of Health in England where he led the development and implementation of the UK Government's first-ever global health strategy, its strategy for working with WHO and DH’s bilateral engagement with emerging economies. (Read more)

PS06_ManyaraDr. Simon Manyara

Dr. Simon Manyara is a pharmacist working in Eldoret, western Kenya. He also studies Global Health (masters) at the University of Edinburgh, Scotland. His two key areas of interest are non communicable diseases and access to medicines. He works in rural western Kenya to provide care for patients with diabetes and hypertension using a model that combines both peer groups and microfinance. Additionally, he implements community revolving fund pharmacies which ensure accessible and affordable supplies of essential commodities in government facilities within the same catchment area.

PS06_VijverDr. Steven van de Vijver

During his studies he worked in Ethiopia, India, Australia and the United States and published articles on this in various magazines. After specializing as a tropical doctor he worked for Doctors without Borders in the Democratic Republic of Congo. There he discovered the need for care of chronic diseases, and specifically cardiovascular diseases, in low resource countries. In order to obtain this expertise he went back to The Netherlands to finish his specialization in Family Medicine and Masters in International Health in order to focus on primary health care in slums. He obtained the position of Director of Urban Health, at the Amsterdam Institute of Global Health and Development (AIGHD) and moved with his family to Kenya to work on prevention of cardiovascular diseases in slums. Currently he works as a Senior Research Officer at the African Population Health Research Center (APHRC) on the SCALE UP project. The aim of the SCALE UP study is to design an effective and efficient intervention to prevent cardiovascular diseases in the slums of Nairobi that is sustainable and scalable to other settings in Sub Saharan Africa.

PS06_Yousef_Shahin_squareDr. Yousef Shahin

After graduating in Medicine and General Surgery at Zaprozyha Medical University in the Former USSR in 1985, he joined Jordan University of Science and Technology where he completed Master degree in Public Health in 1995.

Joined UNRWA in 1992 as Medical Officer in charge of health centers till 2005, when he was promoted to a senior position at UNRWA headquarters. He has more than 8 years’ experience in disease prevention and control programme, and responsible for the development, monitoring and evaluation of the UNRWA’s progrmme for disease prevention and control by preparing technical instructions, clinical guidelines, periodic assessment and supervision of related activities.

Dr. Shahin was designated to World Health Organization/ Eastern Mediterranean Region from July-December 2011 as Technical Officer on non- communicable diseases.

He has publications in medical journals including the Lancet on different health topics mainly diabetes care among Palestine Refugees. Participated in many international conferences and workshops addressing public health related topics.

PS06_Maria Kathia CardenasMrs. Maria Kathia Cardenas

Mrs. Cardenas is a Peruvian investigator at CRONICAS Center of Excellence in Chronic Diseases at Universidad Peruana Cayetano Heredia (UPCH) based in Lima. She graduated from Economics and studied a Master in Epidemiological Research at UPCH through a Fellowship supported by The National Heart, Lung and Blood Institute.

Prior to her move to CRONICAS, she worked in areas devoted to Economic Evaluation of Projects and Public Policy in Social Development at two larger economic and development Think Tanks in Peru: Centro de Investigación de la Universidad del Pacífico and Instituto de Estudios Peruanos. Her area of main interest is Health economics applied to chronic diseases. Her desire and main motivation is to help improving the quality of people's lives of Peruvian population through better health status, especially of the most deprived.

GHF2014 – PS03 – Primary Health Care Reforms and Family Medicine

PS03 TUESDAY, 15 APRIL 2014 ROOM: 15 ICON_Fishbowl
Primary Health Care Reforms and Family Medicine
Prof. Jan De Maeseneer
Head of the Department of Family Medicine and Primary Health Care of Ghent University, Belgium
Identifying and Addressing Structural Quality Gaps in Primary Health Care in Tanzania
Dr. Dominick Mboya
Research Scientist, Research Department, Ifakara Health Institute, Tanzania
Medical Student and Clinical Teaching Staff Attitudes and Perception of Family Medicine: Tajikistan
Prof. Dilrabo Kadirova
Professor of Family Medicine, Chair of Family Medicine Nb. 1, Tajik State Medical University, Tajikistan
The Impact of the Family Health Team (FHT) model on UNRWA PHC clinic: a success story in a resource-limited and refugee setting
Dr. Ali Khader
Family Health Team Coordinator, Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Jordan
Making the Profession of Family Doctors Attractive for Future Doctors: Kyrgyzstan
Dr. Salima Sydykova
Teacher, Kyrgyz State Medical Academy I.K. Akhunbaev, Kyrgyzstan
Dr. Flora Lucas Kessy
Senior Lecturer in Development Studies, Mzumbe University, Dar es Salaam Campus College, Tanzania

JanDeMaeseneerProf. Jan De Maeseneer

Professor Jan De Maeseneer is a family physician and Head of the Department of Family Medicine and Primary Health Care of Ghent University. His research at the university focuses on Education, Health Promotion, Health inequity, Health Services Research and Global Health. He published more than 100 articles in scientific journals.

In 2013 Jan De Maeseneer was appointed to the Expert Panel on effective ways of investing in health of the European Commission. In 2012 Jan De Maeseneer became a member of the Global Forum on Innovation in Health Professional Education at the Institute of Medicine in Washington. (Read more…)


PS03_Mboya_squareDr. Dominick Mboya

Dominick Mboya has over 25 years experience as medical practice and teaching, currently employed as a research scientist at Ifakara Health Institute in Tanzania, responsible for coordinating Health System Quality Improvement initiatives implemented by Ifakara Health Institute through Initiative to Strengthen Affordability and Quality of Health Care (ISAQH). The initiative is funded by Novartis Foundation for Sustainable Development. Apart from that he is the Intervention coordinator for the Connect project designed to test the model of trained and paid Community Health Workers to accelerate achievement of MDG 4 & 5, the project is funded by Doris Duke Foundation and Comic Relief. (Read more)

Kadirova PhotoProf. Dilrabo Kadirova

Prof. Dilrabo Kadirova is the Head of the Family Medicine Department No.1 of the Tajik State Medical University (TSMU) named after Abu Ali ibn Sino, MD, Professor. She has over 25 years of teaching experience.

Prof. Kadirova received her candidate of science and doctorate degrees studying at the Medical University in Moscow. Her research focuses on cardiology, in particular hypertension and its prevalence, diagnosis and treatment of different age groups: women, youth, elderly and senile, as well as the development of family medicine in the Republic of Tajikistan (RT). (Read more)

Dr. Khadrer_squareDr. Ali Khader

Worked as medical doctor in different clinics and hospitals in Jordan and Saudi Arabia, worked at different managerial and technical levels with the United Nations Relief and Works Agency (UNRWA). Developed guidelines, training materials, assessment tools, project and research proposals, developed PHC interventions, conducted scientific and operational research, published papers in the fields of maternal and child health, NCDs, Tobacco, school health, micronutrient deficiencies, family medicine…..  provided guidance and mentoring to staff and junior researcher. Represented UNRWA health department in regional and international meetings.

Kessey Profile PhotoDr. Flora Lucas Kessy

Flora Lucas Kessy, a Senior Lecturer in Development Studies at Mzumbe University, Morogoro Tanzania holds a PhD in Agricultural and Consumer Economics with a major in Family and Consumer Economics and a minor in Women and Gender in Global Perspective from University of Illinois at Urbana Champaign, USA. Dr. Kessy has researched and published on issues related to income and non-income poverty, social sectors development and good governance. In particular, she has researched on poverty reduction strategies in Eastern and Southern Africa, poverty escape routes, covariate and idiosyncratic shocks affecting households in Tanzania and social protection. In the area of governance, she is involved in public expenditure studies for the health sector and water sector and the use of evidence for actions to improve maternal and newborn health. (Read more)


Causes, determinants, andtrends in maternal mortality among Palestine refugees during 2000-2010

Author(s) Ali Khader1, Majed Hababeh2, Wafaa Zeidan3, Irshad Shaikh 4, Yousef Shahin 5, Akihiro Seita6, 7, 8
Affiliation(s) 1Health, UNRWA, Amman, Jordan, 2Health, UNRWA, Amman, Jordan, 3Health, UNRWA, Amman, Jordan, 4Health, UNRWA, Amman, Jordan, 5Health, UNRWA, Amman, Jordan, 6health, UNRWA, Amman, Jordan, 7, , , , 8, , ,
Country - ies of focus Palestine
Relevant to the conference tracks Women and Children
Summary Despite the hardship socioeconomic status, the patern of Maternal mortality among palestine refugee population is similar to that among stable midle income countries, A shift was observed during the last decade from causes related to poor obstetric care such as hemorrage and infection to thromboemblic diseases.
Background The United Nations Relief and Works Agency for Palestine Refugees in the Near East has for over 60 yearsprovided comprehensive primary health care to 5.2 million Palestine refugees in five fields of operation: Gaza, Jordan, Lebanon, Syria and the West Bank. Despite the contextual challenges of chronic instability and poverty, the agency maintains high standards of antenatal care supported with subsidy of delivery in local hospitals, with comprehensive follow up of all registered pregnant women.
During the period 2000-2010 a total of 978,446 pregnant women were registered and followed up through UNRWA antenatal care services. A system to trace the outcome of each pregnancy was established. During the first year (2000) of implementation, 2145 (2.8%) pregnancies were with unknown outcome that was reduced to only 199 (0.2%) cases in 2010 and during this period a total of 230 maternal deaths were reported.
Objectives The aim of this analysis is identify the main causes and determinents of maternal mortality among Palestine refugees women served by UNRWA PHC system
Methodology UNRWA uses the Confidential Maternal Mortality Enquiry method for in-depth investigation of the direct and indirect causes of each maternal death. This retrospective study examines 230 confidential enquiry reports on maternal deaths of Palestine refugee women in five fields of operation during one decade. The confidential enquiry is completed immediately after a maternal mortality. A thorough investigation is conducted by a special committee established to investigate and reoprt on each maternal mortality
Results Analysis of the confidential enquiry reports revealed a maternal mortality ratio of 24/100000 with significant variations among fields (Lebanon and Syria the highest at 34, followed by Gaza and West Bank at 25 and Jordan at 19). 1.8% delivered at home while 14.8% of deaths occurred at home. 53% of them died in hospitals during the intra-post-partum period. 88% received 4 or more antenatal visits. Maternal deaths increased with higher parity. There was a shift in the leading documented causes of maternal deaths from pre-eclampsia and hemorrhage to pulmonary embolism. Thromboembolism was the first cause of death with 41% followed by toxemia and hypertensive disorders at 12, heart diseases at 11.8%, hemorrhage at 10.5% and infection and sepsis at 7.4%
Conclusion Maternal Mortality has plateaued over the last 10 years among Palestine Refugees. We have managed to reduce the deaths from infections, hemorrhage and pregnancy induced hypertension but the deaths from obstetric embolism and medical disorders in pregnancy have either stayed the same or have increased over the years. This can be partially attributed the lack of embolism prophylaxis in high risk cases as well as poor care of high risk women with medical disorders prior to pregnancy

Analysis of Medicine Entitlement Programs for NCDs in the Philippines.

Author(s) Raoul Bermejo1, Beverly Lorraine Ho2, Wim Van Damme3
Affiliation(s) 1Department of Public Health, Institute of Tropical Medicine -Antwerp, Manila, Philippines, 2Health Unit, Philippine Institute of Development Studies, Manila, Philippines, 3Department of Public Health, Institute of Tropical Medicine -Antwerp, Antwerp, Belgium.
Country - ies of focus Philippines
Relevant to the conference tracks Governance and Policies
Summary In response to rising non-communicable disease prevalence and access to medicines challenges for the worst-off, the national government has launched three medicines access programs. Data were collected from informant interviews, site visits and document reviews. These were analyzed by first creating a chronology of events. Then, using a health policy framework, strategies and actions used along with the results were examined. Findings revealed that the rapid roll out of the NCD access programs exhibited strong political commitment towards UHC. However, weak policy processes have failed to ensure equitable access to quality and cost-effective medicines and implementation success.
Background As more Filipinos continue to be exposed to non-communicable disease risk factors such as tobacco and alcohol use, unhealthy diets and physical inactivity, prevalence for hypertension and diabetes mellitus have risen to 21% and 7.7 % respectively in 2008, and are expected to increase further. Cardiovascular disease and diabetes, along with cancer and chronic respiratory disease account for 57% of total deaths during the same year. According to the National Health Accounts, 52.7% of health expenditures are out-of-pocket. Of these, pharmaceuticals – accounting for 65.75% of household spending – are the single largest item of health care expenditures for households. Republic Act 9502, a law providing for cheaper and quality medicines was enacted in 2009.The Department of Health’s National Center for Pharmaceutical Access and Management launched three medicine access programs, namely DOH Complete Treatment Pack (ComPack), Valsartan (VAP) and Insulin Access Programs (IAP). ComPack provides complete (monthly) treatment regimens at no cost to the poorest families identified under the NHTS who are diagnosed to have diabetes and hypertension. VAP and IAP make available patent-protected Valsartan and Insulin at 60% lower cost than market prices.
Objectives The paper aims to document the policy process of three NCD medicine acces programs in the Philippines using a health policy analytical framework. Specifically, the paper seeks to understand the interaction of strategies that were employed and the factors that contributed greatly to policy advancement.
Methodology A qualitative, case study methodology using an in-depth longitudinal, prospective examination of events was employed for each of the three programs. Primary and secondary data were collected from (1) interviews with key policy and programme stakeholders; (2) visits to programme implementation sites; and (3) review of government documents, development partner reports, meeting records, conference proceedings and media clips. Representatives from government, academic institutions, nongovernment organizations, multilateral and bilateral agencies were interviewed. The interview guide reflected the three themes of emergence, formulation and implementation as described in the analytical framework by Lemieux (2002). A chronology of events was developed and process tracing was conducted. Triangulation of multiple data sources and discussion/verification with key actors supported interpretation and minimized bias.
Results Emergence: Our analysis shows that the following were critical in moving the access programs forward: (1) political commitment to achieve Universal Health Coverage by 2016, (2) availability of national health budget, (3) strong NCD policy community and access to medicines alliances, (4) increasing focus for the worst-off population and (5) strong industry lobbying.Formulation: The policy unit responsible for the programs was operational for less than 3 years when the policies were conceptualized and launched, and did not receive full technical support as was required. A relatively participative process was undertaken to define the contents but there was minimal integration into the health system.Implementation: Full subsidy of $15 million/annum and $400,000 are allocated for the ComPack and VAP. IAP has no subsidy since it is procured on a supply now-pay later (or consignment scheme). Information activities, implementation and evaluation support were constrained for all three programs largely due to funding limitations. The non-uniformity of information across health workers and patients resulted in a varied application of the policy in different implementation sites. Implementation was compromised by immediate national roll-out and devolved set-up for ComPack and the limited access sites for IAP and VAP. Availability of an efficient means for monitoring and responding to stock-outs remained a major challenge. To date, no plans for program evaluation have been articulated. IAP and VAP were also unable to address access challenges especially for the worst-off.
Conclusion The rapid roll out of the NCD access programs exhibit strong political commitment towards UHC. However, weak policy processes have failed to ensure equitable access to quality and cost-effective medicines and implementation success. Findings indicate that that rapid rollout of access to medicines programs is possible only if strategies employed are purposeful and contextually sensitive. Favorable conditions for the emergence of a policy may not always exist but can be created.

Making heathcare affordable to poorest communities through acupuncture: India

Author(s) Walter Fischer1
Affiliation(s) 1Barefoot Acupuncturists, Barefoot Acupuncturists, Mumbai, India.
Country - ies of focus India
Relevant to the conference tracks Health Systems
Summary Barefoot Acupuncturists is a non-profit organisation registered in Belgium and founded by acupuncturist Walter Fischer in 2009. We run acupuncture clinics in slums of Mumbai and villages in Tamil Nadu (south of India), and also train local acupuncturists in order to encourage autonomy.Our services have been developed to give the poorest communities access to affordable and efficient healthcare, limited mainly to pathologies for which acupuncture has been recognised and proven (among others by the WHO) to be an effective treatment.
Our range of action covers chronic or acute pain, paralysis and stroke recovery, digestive disorders, fatigue, gynaecological issues and hypertension.
What challenges does your project address and why is it of importance? In India the healthcare sector, which is highly privatised, urged around 39 million people to fall into poverty in 2004-2005 because of out-of-pocket expenditures for their treatments.
India is the country with the largest number of poor people in the world and also has one of the most privatized healthcare systems.
It was estimated in 2010 that in India there was a shortfall of 100.000 doctors and 1000.000 nurses.High absenteeism and corruption amongst health workers discourage the poor to access public facilities. Surveys have pointed out that even when the poor try to seek medical assistance in the public sector, richer people have a greater share of public services.The challenge we are trying to address with Barefoot Acupuncturists is the great disparity between rich and poor, between public and private health systems, in which the poorest:
- choose to be treated in private sector at a high cost that puts them at even higher risk in terms of financial insecurity and social instability.
- often choose low quality publics services with the risk of not being taken care of properly and with the threat of developing more chronic diseases, which in the long term might negatively impact their future.

In both cases, the poor become poorer.

How have you addressed these challenges? Do you see a solution? We have been trying to address that great disparity between rich and poor in healthcare by providing efficient and affordable health services to the poorest through low-cost acupuncture clinics and offering acupuncture training to local communities.
Acupuncture is a unique tool not only for social health practitioners as it is cheap, effective and easy to teach. It treats pain and illness without harmful side effects. A healthcare system provided by local «barefoot doctors» who offer first-line services is a simple solution to ensure much-needed healthcare in slums or rural areas where there is little or sometimes no access to medical facilities.Why is acupuncture a unique tool against poverty:
Acupuncture from an economic perspective:
• Allows treatment at a low cost (acupuncture equipment is cheap).
• Is highly adaptable to different environments due to its simplicity and portability.
• Provides an alternative to expensive and sophisticated treatments.
Acupuncture from a healthcare perspective:
• Offers a proven and effective solution to health related issues.
• Can offer help in cases that have not been successful with conventional medicine.
• Can reduce the excessive use of chemical drugs and their potential side effects.85% of our patients consult for pain related to musculoskeletal disorders.
Coolies, farmers, workers, housewives, drivers, and maids are the majority of people at the lowest economic level who earn their living through physical works. Those are our patients.
Because their body is overused, often misused, and because of poor living conditions, this group will suffer more than others from physical pain. At the same time, they cannot afford to remain inactive without wages. Acupuncture (well known for and particularly effective against pain) allows them to recover faster and better.
The well-known efficiency of acupuncture against pain has not only been an observation through our practice in India, but globally in our acupuncture clinics around the world. In 2002 The World Health Organisation (WHO) issued a detailed report about acupuncture and a list of diseases for which through controlled clinical trails acupuncture has been proven to be an effective treatment.

- In 5 years, we have treated more than 3.500 patients, both in slums and villages.
- Today we offer 10.000 treatments every year.
- We are employing a team of 20 local people, including 7 acupuncturists.
- We are preparing to organise acupuncture trainings at a larger scale.

How do you know whether you have made a difference? We are presently making a difference at a very local level, in the slums and the villages where our clinics operate. Our clinics are busy due to our reputation spreading in the community by patients who have been encouraged to consult us by relatives or neighbours who were treated by our barefoot acupuncturists and found relief and solutions to their health problems.
A medical survey and various testimonies have shown and explained the impact and the level of satisfaction among slums dwellers and villagers.
Although our impact is clear upon surrounding poor communities, it is true that we lack scientific data to support our field experience and to quantify that impact.
We plan to hire specialised external skills to enable us to build our practises and communication.In order to expend our impact to other areas, others states in India and later in different countries, Barefoot Acupuncturists is developing an acupuncture training program. This program is aimed at the staff of local NGO’s that will fully manage their own acupuncture clinics, based on their own network and financial resources. This will allow an exponential growth of low-cost clinics, independently of Barefoot Acupuncturists’ human and financial resources. By bringing all the knowledge and tools into the hands of local communities, we hope to create more sustainable growth and functioning.
Have you or the project mobilized others and if so, who, why and how? - Founders: private founders in Europe and India have supported us financially and made it possible for our project to develop during these 6 years.
- Around 30 experienced acupuncturists and medical doctors from all over the world have joined us to work and teach in our Indian clinics.
- In 2012 we signed a collaboration with the "World Federation of Chinese Medicine Societies", an important group of Chinese doctors and professors in Beijing (China) to work on the elaboration of an acupuncture training manual.
- The Foundation Frédéric et Jean Maurice in Switzerland has offered us financial and technical support.
- The association "Humanitarian Acupuncture Project" was created in 2012 in the United-States by American acupuncturists to support our work in India with funding and volunteer acupuncturists.
- Two Indian organisations, UnLtd India and Toolbox, have been advising and coaching us for the year to help us strategise our goals and grow more efficiently.
- Professionals from various fields share their skills continuously with us: graphic designers, photographers, web designers, professional development coaches, accountants, lawyers, film makers…
When your donor funding runs out how will your idea continue to live? Today Barefoot Acupuncturists fully manages and finances all its activities. If funds run out, clinics close and all our patients lose the benefit of our services. This is the main reason (added to the need of a better cost-efficiency ratio) why in the following two years we are preparing to become an organisation offering acupuncture training to local NGO’s and communities, making possible not only an exponential growth but also sustainable structures that will function independently from Barefoot Acupuncturists resources.

Barriers for Care and Medicines in Diabetes and Hypertension: A pilot study in Lima-Peru.

Author(s) MARIA KATHIA CARDENAS1, Dulce Morán2, Jaime Miranda3, David Beran4
Affiliation(s) 1CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru, 2CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru, 3CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru, 4Division of International and Humanitarian Medicine at the Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Country - ies of focus Peru
Relevant to the conference tracks Health Systems
Summary The aim of this study is to pilot test the implementation, for the first time in Peru, of World Health Organization manual to identify barriers to access to medicines and care in patients with non-communicable diseases (NCD). As part of an active stakeholder engagement in the process, this study aims to promote a policy response. Tools were prepared to collect quantitative and qualitative data. In total, 141 interviews and meetings were conducted in four levels . This study identifies existing bottlenecks in the access to care and management of patients with diabetes and hypertension. This system-level analysis elicits current challenges and opportunities to improve care for NCDs in Peru.
What challenges does your project address and why is it of importance? Non-communicable diseases (NCDs) have been recognized by the global community as a major public health challenge. World Health Organization's (WHO) response includes the development of a Global Action Plan for the Prevention and Control of NCDs for years 2013-2020 and a Research Agenda with focus on the prevention and control of NCDs in low- and middle-income countries (LMICs) such as Peru. The importance of the challenge posed by NCDs in the context of Peruvian health system was also highlighted by the Peruvian Ambassador during the 43rd Session of the Commission on Population and Development. For Peru, WHO estimates a NCD burden that represents 60% of mortality in Peru, which highlights the relevance of chronic diseases for our health system. According to Nolte and McKee the management of chronic NCDs is one of the largest challenges that health systems throughout the world currently face and each system needs to find locally-adapted solutions. These solutions require a clear understanding of the barriers within the health system to access to NCDs care and medicines, from higher policy-level to the individual patient-care experience. Our projects precisely address this challenge.
How have you addressed these challenges? Do you see a solution? We have addressed this challenge by contributing to the limited available body of evidence concerning NCDs and health systems in Peru. Specifically, our study determined barriers for the access to medicines and health care for diabetes and hypertension using a novel tool for health system assessment that was adapted for the Peruvian health sector context. The tool applied was based on the Rapid Assessment Protocol for Insulin Access (RAPIA), a tool that has previously been implemented in six countries (representing four WHO Regions) with the support of the International Insulin Federation: Kyrgyzstan, Mali, Mozambique, Zambia, Nicaragua and Vietnam. Previous implementations of the RAPIA have resulted in improvements in access to medicines like insulin (Mali, Mozambique and Zambia), development of NCD policies (Mozambique and Zambia), inclusion of recommendations in government policies and programmes (Kyrgyzstan, Mali, Mozambique, Nicaragua and Viet Nam), improvement and increase in the visibility of Diabetes Associations (Mali, Mozambique, Nicaragua and Zambia), inclusion of recommendations in projects and programmes of national NGOs (Mali and Nicaragua), external funding and support for diabetes programmes (Mozambique, Zambia and Vietnam) and the use of RAPIA for monitoring and evaluation (Mozambique).At the health system level, the introduction of this tool for the assessment of NCDs will also be helpful for developing future research agendas in the field. This tool can also serve as a field guide to assist researchers in collection, analysis and presentation of data to evaluate and inform the development of health-care services and policies for specific NCDs or groups of diseases.Policy makers can also benefit from these assessments as it can inform them about ongoing challenges or bottlenecks in NCDs-related health care provision. It is expected that the engagement in the planning phases of the study will provide windows of opportunity and knowledge translation that will likely directly translate in policy changes aimed to improve NCD care.
How do you know whether you have made a difference? The results from this study will contribute to a better understanding of the current situation of the management of diabetes and hypertension in the context of the Peruvian health system, in order to formulate appropriate recommendations for the policy decision makers. However, we know that it is premature to attribute any change to this study. In the context of almost non-existing systematic assessments of health systems in the Peruvian health sector, in particular around NCDs, we expect this research to set the grounds for future policy recommendations. Our results show that NCDs are not yet a priority for policy-makers in Peru, at least not in the practice. There are some initiatives that have not yet reached the expected results such as the basic regulation to protect patients with diabetes and a policy to promote reduction of anti-diabetic drug prices. Presently there is only a national guideline for hypertension attention at the primary health level but no guideline approved for diabetes as well as a National Strategy for NCDs without a current Strategic Plan. The universal health coverage in Peru includes a list of essential treatments for each disease covered by any insurance, but it is partially implemented due to the lack of clinical guidelines and the lack of awareness on this topic by the health professionals. At an intermediate and local level we found problems facilitating the demand for medication and laboratory consumables.General practitioners in the lower-level of management provide care mostly to those patients with no complications. Patients with complicated disease are referred to Hospitals, where patients must wait long periods to obtain an appointment. Even those patients with public health insurance often buy their medication at private pharmacies, due to the lack of stock in pharmacy facilities of public sectors. The high price of medicine in private pharmacies is one of the main reasons for treatment cessation by the patient.In order to strive towards achieving a difference we will perform a follow-up on the following activities. As part of the implementation study, a list of recommendations will be shared with the stakeholders before the end of year 2013 and a follow-up of activities will be performed starting the year 2014. During year 2014, every 4-6 months, a member of the research team will contact the stakeholders by e-mail, telephone or by person in order to monitor the implementation of the recommendations.
Have you or the project mobilized others and if so, who, why and how? Since the beginning of the project we participated in different meeting with stakeholders from different sectors in order to establish initial contacts. The purpose of the meetings was to provide information about the project, to listen to different perspectives, and finally, a last activity will be developed before the end of the year to jointly discuss potential recommendations and to define an action plan towards policy changes that are pragmatic and feasible in the current local context. We have developed a presentation of the study to stakeholders, in which we invited them to a workshop session in order to receive feedback of the study. At this workshop we explained the past experience with RAPIA as well as the background and methodology of the present study. The stakeholders gave suggestions and confirmed their support and interest. Among the participants was a high officer of Ministry of Health (MoH), as well as members of different areas of Peruvian MoH, social Security, public health insurance, health organizations, acadaemia, among others.Members of our CRONICAS research team also participated in meetings with the Experts Committee in NCDs, a coordination unit of the MoH. We participated in one of the activities of this Committee which was the discussion of the National Strategic Plan for Prevention and Control of NCD 2014-2021, as well as the meeting for discussing the National Guidelines for Diabetes Management, which has not yet been approved. Additionally, regarding to the Social Security, we also contributed to the Health Services Portfolio, which is a technical guideline for the effective interventions for specific chronic diseases during the patient's lifespan. CRONICAS contribution was cited in the technical document.
When your donor funding runs out how will your idea continue to live? CRONICAS Center of Excellence in Chronic Diseases has as part of its goals "to contribute to research development on NCD in Peru (Goal 1)" and "to participate actively with public health policy-makers and study population (Goal 2)". Therefore, when funding runs out we will still remain in communication with stakeholders. Most of policy makers and stakeholders find our evidence-generation group an ally for policy-related interactions and a source of technical expertise in the generation of future health policies. Whilst being a research-based institution, our group strives towards contributing to the transition from research to action for the improvement of health care in patients with diabetes and hypertension. We also plan to obtain funding in order to develop the study in other regions in Peru which are less-urban and poorer, and have different epidemiological profiles and, obviously, different health-system needs.

Social media in health information and communication: a content analysis of Facebook groups related to hypertension.

Author(s) Mohammad Al Mamun1, Tanvir Chowdhury Turin2.
Affiliation(s) 1Department of Public Health , General Directorate of Health Affairs in Tabuk Region, Ministry of Health, Kingdom of Saudi Arabia, Tabuk, Saudi Arabia, 2Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada, Calgary, Canada.
Country - ies of focus Global
Relevant to the conference tracks Advocacy and Communication
Summary Studies on the utilisation of social media sites for health related information and communication are still limited. We conducted a content analysis of the Facebook groups related to hypertension by searching Facebook ( We identified 187 hypertension-related Facebook groups containing a total of 8,966 members. The majority of the groups were formed to create awareness regarding hypertension-related diseases, and to provide support to the affected patients and caregivers. Facebook has a great potentiality to be utilised as a popular and useful platform for health information and communication purposes in order to build up a better global health.
Background Social media is a convenient means of communication where people create, share, and exchange information and ideas across the internet-based communities and networks throughout the world. Studies on the utilisation of social media sites for health related information and communication are still limited. Facebook ( has become one of the most popular social media sites possessing more than one billion active users. Although several disease-specific information sites are available now on various social media, little is known about how Facebook groups are used for people suffering from hypertension related diseases, or how these groups contribute to creating awareness regarding hypertension among the netizen in the current context of global health.
Objectives This particular research program studied the Facebook groups related to hypertension in order to characterise their objectives, subject matters, member sizes, geographical boundaries, activeness, and user-generated contents.
Methodology We performed an intensive search in Facebook using the keywords ‘hypertension’, ‘high blood pressure’, ‘raised blood pressure’, and ‘blood pressure’. We limited our search activity within the open groups (accessible to anyone having a Facebook account) utilising the customised search options available in Facebook’s built-in search engine. Reviewing all search results we excluded the groups that contained subject matters either unrelated to hypertension or in non-English languages. Facebook pages for individual users, organisations, events, and applications were not included in the present study.
We extracted the following data from the content of each eligible group: title of the group, web address (URL), introductory description, total number of members, top-displayed most recent wall post with posting date, number of likes and comments on it, and presence or absence of photos, videos, events and attached files on the group wall. We developed a coding and categorising scheme for the whole data set by reviewing the content of the first 100 groups based on the theme present in each data.
We identified the main objective of each group derived from a content analysis of the group title, introductory description, or any message posted by the group creator or administrator. We assigned a specific code for each of the main objectives, which ultimately led to the identification of seven major categories of the hypertension groups: (a) awareness creating groups (b) support groups for patients and caregivers (c) experience sharing groups (d) fundraising groups (e) product promotion groups (f) research conducting groups (g) health professionals groups.
According to the date of the most recent wall post or comment, we categorised the Facebook groups into two categories: active (most recent wall post or comment was posted on or after 1st January 2013); and less active (most recent wall post or comment was posted before 1st January 2013). Multivariable logistic regression (backward elimination method) was used to explore the factors independently associated with the activeness of the Facebook groups related to hypertension. All variables having a univariable level of significance p.
Results Our search results yielded a total of 263 groups on Facebook. Finally 187 groups were found eligible for data extraction and analysis after applying the exclusion criteria. A total of 8,966 Facebook users were members of these eligible groups related to hypertension. Total number of members in each group ranged from 1 to 2161. Group activities were restricted to a particular geographical location for 15% of the groups, while most (85%) of the groups were global in nature. Hypertension was the general focus for majority (40.6%) of the groups, while 29.9% groups concentrated on pulmonary hypertension, 14.4% on intracranial hypertension, and the remaining 15% groups dealt with hypertension and other diseases together. Analysing the main objective of each group we found that the Facebook groups (n=187) were created for the purposes of hypertension-related awareness creation (59.9%), providing supports to patients and caregivers (11.2%), sharing disease experiences and life stories (10.7%), raising funds for relevant organisations (7.5%), promoting pertinent products or services (3.7%), conducting studies or surveys (3.7%), and networking among health professionals (3.2%).
Regarding the user-generated contents, at least one wall post was available for 87.7% groups. Among these groups (n=164), 24.4% groups had at least one ‘like’ on the most recent wall post, and 17.7% had at least one comment on that wall post. Moreover, at least one photo, video, event, or attached file was present for 51.2%, 5.5%, 1.2%, 8.5% of those groups (n=164), respectively. Top-displayed most recent wall posts (n=164) were those focused on promoting a relevant product or service (21.3%), sharing hypertension-related information (20.1%), sharing an external web address related to health (13.4%), query to members for a particular information (9.8%), greeting, wishing or thanking message (9.1%), promoting an event (8.5%), describing the group interest (7.9%), sharing disease experience or life story (6.7%), and fundraising message (3%).
Of the 187 groups analysed, 27.8% were found active, while the remaining 72.2% groups were less active. Logistic regression analyses showed that the activeness of the hypertension-related Facebook groups was independently associated with the group-size (adjusted OR=1.02, 95% CI=1.01–1.03), presence of likes on the most recent wall post (adjusted OR=3.55, 95% CI=1.41–8.92), and presence of attached files on the group wall (adjusted OR=5.01, 95% CI=1.25–20.1).
Conclusion Facebook has great potential to be used as a popular and useful platform for creating awareness among the global population about hypertension-related diseases, and also for providing supports to the affected patients and caregivers across the world. Social media sites can be utilised more widely for health information and communication purposes in order to build up a better global health.

An Integrated Approach to Management of Diabetes and Hypertension in Western Kenya

Author(s) Simon Manyara1, Jemima Kamano2, Diama Menya3, Jeremiah Laktabai4, Benjamin Andama5, Evans Tenge6, FlorenceSituma7, SonakPastakia8
Affiliation(s) 1Pharmacy, Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya, 2Department of Medicine, Moi Teaching and Referral Hospital, Eldoret, Kenya, 3Epidemiology and Nutrition, School of Public Health, Moi University, Eldoret, Kenya, 4Family Medicine, Moi University, Webuye,Kenya, 5Family Preservation Initiative, Academic Model Providing Access to Medicines, Eldoret, Kenya, 6Family Preservation Initiative, Academic Model Providing Access To Healthcare, Eldoret, Kenya, 7Home Glucose Monitoring, Webuye District Hospital, Webuye, Kenya, 8Purdue University College of Pharmacy, Purdue University, Eldoret, Kenya
Country - ies of focus Kenya
Relevant to the conference tracks Chronic Diseases
Summary This pilot project seeks to establish whether the provision of intensive, self and peer management trainings to patients combined with the integration of income generating incentives leads to enhanced diabetes and hypertension control for resource-constrained patients in rural western Kenya. Patients are placed into peer support groups where they receive group care and are trained on various aspects of diabetes and hypertension self-care. These groups also double as microfinance groups that offer capital to patients to start up income generating activities. The groups are further incentivised to compete against each other based on both clinical and non clinical parameters.
What challenges does your project address and why is it of importance? Developing countries are facing an increasing burden of non communicable diseases (NCDs). While there has been increased emphasis in addressing communicable diseases by the international community, the vast majority of NCDs have been neglected, leaving patients with very poor outcomes and limited prospects for a healthy life. Due to their chronic nature, NCDs strain the already scarce resources of healthcare systems and families in resource constrained settings. Furthermore, NCDs are no longer associated with the wealthy or elderly, for they also affect poorer rural dwellers and younger members of the society who are expected to be economically productive. This adversely affects economic development in these populations, further propagating the vicious cycle of poverty. The prevalence of diabetes in Kenya is 4.7%, while that of hypertension has been reported to be as high as 23.7% in some urban settings. Patients with chronic diseases in Kenya face several barriers to care, including lack of access to essential services and inadequate information. This project uses a holistic approach which directly addresses barriers related to the socioeconomic status of patients with diabetes and hypertension, while encouraging positive health seeking behaviors.
How have you addressed these challenges? Do you see a solution? Bridging Income Generation with Provision of Incentives for Care (BIGPIC) uses an integrated approach that capitalizes and builds on the AMPATH’s (Academic Model Providing Access To Healthcare) existing infrastructure and years of experience in managing patients with HIV/AIDS throughout western Kenya. We focus on the following points of intervention:
1) Peer Groups.
Following community-based screening, positively diagnosed patients are placed into peer groups where they receive intensive training on self-management strategies for diabetes and/ or hypertension. They are given targets for their management which will be evaluated upon completion of the pilot. Targets will comprise of both process metrics such as clinic attendance, medication refills, fulfillment of ordered tests and clinical outcome metrics including blood pressure and sugar control. Patients receive group care and are provided with essential services like clinical consultations, selected portable laboratory tests and medication at affordable prices. They are expected to pay for each service and all the money collected is used to restock supplies.
2) Incentivization.
Patients are instructed on the incentives that can be earned through participation in this program. Their care is evaluated after 6 months to document the progression of their glucose and/or blood pressure control using standardized laboratory assessments. They receive points based on the set targets and these points can be used to earn various predetermined rewards. Incentives are awarded at two levels of participation – the group level where the top three groups with the most improved outcomes will receive rewards, and at the individual level where each participant attaining pre-set goals receives a reward.
3) Economic empowerment
The economic component of the project is facilitated by the Family Preservation Initiative (FPI), which is AMPATH’S income generation program. This will be achieved by the incorporation of a micro finance component which provides interest-bearing loans to members while offering a limited form of financial insurance. Participants mobilize and manage their own savings. They can therefore access affordable loans and get advice from FPI agribusiness officers on sustainable income generating activities. BIGPIC combines the socioeconomic benefits of FPI activities with the care strategy utilized by our diabetes program to synergistically enhance the outcomes and retention in both programs.
How do you know whether you have made a difference? While AMPATH has enjoyed immense success in the management of patients with both communicable and non communicable diseases, a lot of effort still needs to be put into retention of new patients to care. Data from the chronic disease management team shows that only 30% of patients who screened positive for diabetes and hypertension ever returned to a health facility for care. Preliminary data from this project shows that out of the 902 patients that were screened, 157 patients screened positive for either diabetes or hypertension. Of those that screened positive, 67.5% (n=106) came back to the health centre for confirmatory screening. Currently, 70.3% (n=71) of all those who confirmed positive for diabetes or hypertension are enrolled into the peer groups and are receiving care. The pilot will be completed in December and the final results will be presented at the conference
Have you or the project mobilized others and if so, who, why and how? This project draws expertise from a multidisciplinary team and intricately incorporates several aspects of patient care. The chronic disease management team provides the necessary platform for the management of diabetes and hypertension, from facilitation of screening activities to capacity building through staff training at health facilities. The Primary Healthcare team at AMPATH provides valuable insights into community strategies and engagement both at the macro and micro levels. One of the key approaches has been the use of community health workers (CHWs) for the purposes of finding patients, linking them to health facilities and raising awareness on chronic diseases within the community. The peer groups are also led by the CHWs who we train intensively on diabetes and hypertension self-care and on the operations of the GISE groups. The project taps into AMPATH’s Family Preservation Initiative’s GISE project. Through the microfinance groups, we strive to empower our patients economically through access to capital and giving them advice on viable business ventures. These microfinance groups have been shown to have high retention rates of its members, an outcome that we hope to achieve by incorporating the microfinance element into healthcare. This project is further strengthened by AMPATH’s pharmacy team which has a revolving fund pharmacy project that provides quality medicines to its patients at affordable prices. The revolving fund pharmacy works by procuring quality controlled medication in bulk and availing it to patients at a price that is almost at cost. Through this project, we have been able to provide quality, low cost essential antidiabetic and antihypertensive medicines to our patients. The biggest piece of the puzzle is the government health management team which is responsible for the implementation of all health initiatives within a district. This team facilitates all our activities on the ground. Part of the activities that we engage in include capacity building of the existing infrastructure by carrying out refresher courses on good practices in the management of diabetes and hypertension and mentoring the staff in the lower level facilities like dispensaries and health centres.
When your donor funding runs out how will your idea continue to live? BIGPIC offers a sustainable means of ensuring access to healthcare while at the same time promoting economic empowerment, leading to a healthier, more productive labor force. The project is modeled around the existing healthcare system and infrastructure in Kenya. Care for diabetes and hypertension at the facility level is enhanced through capacity building by training of the existing government healthcare workers. This is followed by close mentorship by the chronic disease management team at AMPATH, ensuring that patients can access quality care even in our absence. The microfinance groups have been shown to have a high retention rate of its members, and we believe that this model will maintain the members of the peer groups long after completion of the initial six months of our involvement. This will promote self-care within the members hence leading to improved patient outcomes. Patients are also empowered economically through these groups where they can access capital from their own savings. The groups create their own constitutions that guide their operations, and we only facilitate income generation through our agribusiness advisors. This ensures that they own the project and that the groups can continue independent of our support. Provision of drugs through the revolving fund pharmacy ensures continuity of drug supply since patients pay for the drugs and the money collected is solely used to purchase more drugs. Furthermore, antihypertensive and antidiabetic medicines are not supplied to dispensaries and health centres and the provision of these drugs at this level ensures accessibility while promoting the use of lower level facilities, with only complicated cases being referred to higher level facilities. Patients are expected to pay for every service that is provided through group care. The money collected from this model of care makes its continuity sustainable. The information provided to the community through the CHWs and the patients participating in the project will also go a long way in preventing NCDs by averting common risk factors such as poor diets, physical inactivity, unhealthy use of alcohol and cigarette smoking. This project therefore draws its strengths from a multidisciplinary team and integrates proven, sustainable interventions to achieve a holistic care model for diabetes and hypertension within a resource-constrained setting.