copc – the aku family medicine journey. of health community aga khan hospitals aga khan outreach/...

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

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

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

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

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

AKU East Africa – Faculty of Health Sciences

• Medical College.

• Schools of Nursing & Midwifery.

• School of Allied Health Sciences.

• Population Health Sciences.

• Biomedical Sciences

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.

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

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

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

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.



Comprehensive- skilled “all rounder” at a district hospitalCoordinated care- leadership and management in district healthcare systemCommunity-oriented- mentoring team-based care in community


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

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

Methods


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

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.



2. Emphasized the importance of understanding local environmental impacts on health outcomes and identified challenges in teaching these concepts.


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


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 – 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..


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.


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….


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.


A Colloboration

Add photos here

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

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

32

Integrating Primary Health Care (IPHC) Programme

Joint identification of priorities

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

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

TO HOSPITAL AND BACK

Integrating Primary Health Care (IPHC)

HOME VISITS

medicine and nursing students at the community level before doing patient journey

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

Are We There Yet


• 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

Asanteni [email protected]

copc – the aku family medicine journey. of health community aga khan hospitals aga khan outreach/...

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