Afya Bora: An Approach to Global Health LeadershipAliza Monroe-Wise, MD, MScCarey Farquhar, MD, MPH

OverviewAfya Bora: The Concept, Participants, Timeline, and ActivitiesStructure 3 week modulesAttachment sitesMentorshipMy experiencesAttachment siteActivitiesGO Health Project

Afya Bora: The Concept4 US Academic Institutions partnered with 4 African InstitutionsUW - University of Nairobi (Kenya)UCSF - Makerere University (Uganda)UPenn - University of BotswanaJohns Hopkins - Muhimbili University (Tanzania)Participants chosen from 85 applicants in medicine, nursing, and public health

Afya Bora: The Participants23 Fellows selected7 Kenya, 4 Tanzania, 4 Uganda, 4 Botswana, 4 USMultidisciplinary group10 Medical post-graduates and post-residency physicians13 Graduate nurses9 with public health degrees (2 PhD; 6 MPH)7 men and 16 women

Afya Bora: Timeline and ActivitiesJanuary 7-28 January 31-April 28

2-day Orientation and Responsible Conduct of Research Training

Core Curriculum 3 one-week modules

Independent Projects at Attachment Sites

1-day workshop for Mentoring Teams within first 2 weeks

Weekly meetings with primary mentor

Semi-monthly meetings with Country Lead and Fellows in-country

Monthly meetings with Mentoring Team

Project report due last day of rotation

OverviewAfya Bora: The Concept, Participants, Timeline, and ActivitiesStructure 3 week modulesAttachment sitesMentorshipMy experiencesAttachment siteActivitiesGO Health Project

Module 1: Leadership Skills Leadership attributesDefinitions of leadershipLeaders vs. ManagersStrategic thinkingThinking vs. PlanningSWOT analysisConsensus buildingModalities, stepsMentorshipMentoring vs. training vs. coachingThe learning contract modelRoles, benefits

Module 2: Implementation Science & Health Systems Stakeholder and policy analysisPolio eradication caseMeasuring impact and effectiveness (surveillance, metrics)Operations researchQualitative Health Systems ResearchSex worker caseCost effectiveness and economic analysisMotor vehicle injury prevention caseSocial marketingGroup Case Discussion

Module 3: Project Management & Research CoordinationFederal and international ethics regulationsExamples and cases from US, Kenya, etcBudget and financial managementCase: how to develop a budgetPersonnel managementCase: the SHARE projectSubject recruitment and retentionData ManagementCreating questionnaires and databases

Afya Bora: Timeline and ActivitiesJanuary 7-28 January 31-April 28

2-day Orientation and Responsible Conduct of Research Training

Core Curriculum 3 one-week modules

Independent Projects at Attachment Sites

1-day workshop for Mentoring Teams within first 2 weeks

Weekly meetings with primary mentor

Semi-monthly meetings with Country Lead and Fellows in-country

Monthly meetings with Mentoring Team

Project report due last day of rotation

Attachment SitesKenya: MoH, AMREF, Kenyatta Hospital, Kenya Medical Research InstituteUganda: Joint Clinical Research Center, MoHBotswana: University of Botswana, i-TECH, Botswana-USA CDC Tanzania: Ben Williams HIV/AIDS Found, AMREF,

Mentoring1-day workshop for Mentoring Teams within first 2 weeks, includes fellows As needed meetings with Attachment Site MentorWeekly meetings with Primary MentorSemi-monthly meetings with Country Lead and Fellows in-countryMonthly meetings with Mentoring TeamProject report and evaluation due last day of rotation

OverviewAfya Bora: The Concept, Participants, Timeline, and ActivitiesStructure 3 week modulesAttachment sitesMentorshipMy experiencesAttachment siteActivitiesGO Health Project

Attachment Site: AMREFFounded in 1950s by British DoctorsEmphasis on flights to remote areasInternational organization with operations in 29 African countries, as well as offices in UK and USAVision: Better health for AfricaStrategic foci: Community partnering for better healthHealth systems and policy researchCapacity Building

AMREF: KenyaHIV/AIDS integrative approach Sanitation and basic servicesMaternal and child healthNursing clinical skills coursesCommunity health worker trainingWork in remote rural areas, and urban slums

KiberaUrban slum with ~2.5 million residents; 60% of Nairobi population (govt estimate 170,000)?Largest slum in Africa2 water pipes, 20% electricity, no sewage

AMREF: KiberaFull care clinic in KiberaMaternal health carePediatric clinicAdult clinicHIV testing/careTB clinicLaboratorySocial workPharmacy

AMREF: KiberaHIV counseling and testing programOver 3,800 HIV-positive patients have enrolled to dateAlmost 2000 on ARVs823 defaulters identified (no return to clinic in >90 days)Tracking in progress

ActivitiesEvaluation of clinical practice by Clinical Officers in the adult medicine clinicHIV testing, counseling, group information session, enrollment, follow-upEvaluation of procedures in laboratoryHIV rapid tests, CD4 count, malaria blood smears, stool O&P, UA Evaluation of tracking activities performed by the clinic Social WorkerHIV social assessment, tracking defaulters

ActivitiesReview of HIV/ART databaseLarge longitudinal database from all HIV positive patients in the clinicPreliminary literature reviewSeveral studies published regarding HIV positive cohort in Kibera slumAttendance at meetings of ART program staff and clinical providers

Project: Goals & HopesAfya Bora FellowshipLearn GH leadership skillsGain valuable GH experience with international organizationAMREF ManagementData analysis of existing dataJournal publicationAMREF Kibera EmployeesImprove working conditions in clinicServe as advocate & liaison with managementPersonal Goals

Project OverviewQuantitative Data analysisEvaluation of overall project retentionTiming between visitsFactors affecting time between visitsValue Stream MappingSteps taken in clinic visitsValue in individual steps analyzedTime in Motion AnalysisTiming of steps taken in clinic

Preliminary Data Analysis

Major Bottlenecks3848HIV+310881%303198%236178%202586%194096%111758%Eligible for ProgramCD4TestingRetention >90 days#ExtraIfEliminated270320823

Time and Motion AnalysisOne observer watches all patients coming to the clinicRecords of wait times at each step taken in clinicOverall bottleneck steps can be evaluatedCan be used in conjunction with value stream mapping

*This is only the first half; this repeats at the end of april, but i will not be participating*This is only the first half; this repeats at the end of april, but i will not be participating