A Joint initiAtive Between SAnofi And ReAch out to humAnity foR heAlth (Roth)

Providing diagnostic services for the residents of Piave, Kenya.

introduction

In 2007, ROTH OveRsaw THe cOnsTRucTIOn Of THe PIave MaTeRnITy waRd and HIv/aIds cOunselIng cenTRe In THe RuRal vIllage Of PIave, lOcaTed OuTsIdeOf nakuRu, kenya.

ROTH partnered with sanofi and the nakuru Ministry of Health (MoH) to increase access to essential primary and maternal health care services to Piave and surrounding areas.

THOugH THIs PROjecT was veRy successful, close monitoring revealed the emergence of a dangerous referral system resulting from the health facility’s lack of diagnostic laboratory and the lack of support that would facilitate adherence to treatment.

each year, thousands of individuals were regularly being referred to hospitals located many kilometers away for testing, a journey that many could simply not afford to make.

This situation has been particularly problematic for patients living with HIv/aIds and/or tuberculosis (TB). Many IndIvIduals delayed OR RefRaIned fROM seekIng MedIcal TReaTMenT, OPTIng InsTead TO use THe seRvIces Of TRadITIOnal HealeRs.

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of those who did seek appropriate medical care, many were not properly adhering to their medication [e.g. cutting antiretroviral (ARv) medication in half to sell to other hiv+ persons; tB patients foregoing their weekly directly observed treatment (dotS)].

furthermore, the lack of diagnostic services meant that the diagnosis of malaria was necessarily clinical; only severe cases were referred. this led to quarterly shortages of essential medicines due to misdiagnosis and over-dispensation.

Roth is a non-profit, secular organization founded on the principle that every human being has the right to proper health care, clean water, education, nutrition, and shelter regardless of race, gender or religion. the AfoRementioned deficiencieS ReveAled thAt thiS mAndAte could not Be Achieved foR the ReSidentS of PiAve without the PRoviSion of diAgnoStic SeRviceS.

theRefoRe, fRom June until SePtemBeR 2011, Roth PARtneRed with SAnofi to eStABliSh the PiAve lABoRAtoRy. together, Sanofi and Roth were able to build a space annexed to the existing dispensary, equip the new laboratory with the necessary equipment, and provide the techni-cal support and expertise necessary to successfully improve existing services.

introduction

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PROvIdIngdIagnOsTIc seRvIces fOR THe ResIdenTsOf PIave, kenyaTHe OBjecTIves Of THIs PROjecT

1.TO PROvIde a laBORaTORy wITH THe necessaRy equIPMenT and TecHnIcal exPeRTIse to allow for malaria diagnosis in order to realize a decrease in referrals that were made to provincial hospitals for testing last year, thus allowing a more efficient use of anti-malarials.

2. TO PROvIde TRaInIng fOR 100 cOMMunITy HealTH wORkeRs (cHws) to ensure adherence to antiretroviral, anti-TB and anti-malarial treatments.

3.TO Run a HealTH educaTIOn caMPaIgn THROugHOuT THe caTcHMenT aRea to increase awareness about the voluntary health services offered at the Piave dispensary and to increase the number of individuals coming to the dispensary rather than traditional healers for health services.

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PROvIde a laBORaTORy wITH THe necessaRy equIPMenT and TecHnIcal exPeRTIse TO allOw fOR MalaRIa dIagnOsIs In ORdeR TO acHIeve a decRease In THe PeRcenTage Of RefeRRals PeR PaTIenT vIsITs fROM 2010 levels.

The planning, construction, and equipping of the laboratory took place over the full project duration.

The plans adhere to kenyan Ministry of Public Health and sanitation requirements; the kenyan national Policy guidelines for laboratories 2010 ed.; and world Health Organization guidelines for laboratory services.

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objective 1

additionally, the layout of the laboratory facilitates efficient patient flow; the safety of both the lab technologist(s), patients, and the surrounding community by providing sufficient room and proper safety equipment to conduct potentially dangerous tests, and the observation of proper disposal standards for material that poses a biohazard risk.

construction was carefully overseen to ensure that the laboratory is structurally sound and that financial resources were allocated as efficiently as possible. Materials and equipment were carefully selected based upon the best compromise between durability and cost-efficiency.

To ensure an appropriate level of technical expertise, representatives of the Ministry of Public Health and sanitation as well as senior staff from Piave’s health facilities conducted interviews for a lab technologist.

To be eligible for the position, it was necessary that interested parties be certified by the kenya Medical laboratory Technologists’ and Technicians’ Board (kMlTTB), a professional accreditation body. The gentleman selected came from within the community of Piave and holds a masters degree in lab technology.

THe laB Has Been fully OPeRaTIOnal sInce sePTeMBeR 15TH, 2011.

adherence to the various aforementioned guidelines and requirements ensures that the laboratory is equipped to accurately diagnose malaria as well as HIv/aIds, TB, brucellosis, typhoid, sTIs, diabetes, rheumatoid arthritis, and many other diseases and afflictions besides.

additionally, the laboratory is equipped to improve the function of the maternity ward by providing antenatal profiling. sanofi staff contributed towards establishing clear standard operating procedures for the accurate and consistent performance of malaria testing.

ROTH’s PROjecT ManageR was lucky enOugH TO TesT THe successful acHIeveMenT Of THIs OBjecTIve HIMself By InadveRTenTly cOnTRacTIng MalaRIa. THe case was accuRaTely dIagnOsed sHORTly afTeR THe laB BecaMe OPeRaTIOnal, and THe PROjecT ManageR was effecTIvely TReaTed aT THe adjacenT PIave dIsPensaRy.

RefeRRal TO anOTHeR facIlITy was unnecessaRy, and wITHIn days THe PROjecT ManageR RegaIned HIs HealTH and vITalITy

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• IT can Be cHallengIng TO fInd cOMPReHensIve guIdelInes fOR PROjecTs sucH as THIs One. IT Is RecOMMended TO sOuRce Plans OR guIdelInes BefORe eMBaRkIng On sucH a venTuRe and MOdIfy THeM as necessaRy Once On THe gROund.

• ThepriceofconsTrucTionmaTerialscan IncRease RaPIdly and unexPecTedly due TO uncOnTROllaBle cIRcuMsTances. IT Is RecOMMended TO RequesT a Tax waIveR fROM THe gOveRnMenT fOR sucH InITIaTIves.

• forprojecTsinvolvingongoingcOnsTRucTIOn cOMBIned wITH cOMPlIcaTed lOgIsTIcal IMPleMenTaTIOn, IT Is RecOMMended TO send seveRal PROjecT ManageRs TO ensuRe effecTIve OveRsIgHT Of eveRy asPecT Of THe PROjecT.

objective 1

lessOns leaRnedand RecOMMendaTIOns fOR fuTuRe PROjecTs

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during the duration of this initiative, ROTH and sanofi concurrently ran a project to train 50 cHws in addition to the 50 already trained, and subsequently to improve upon the knowledge of the existing cHws. The resulting 100 cHws are each responsible for monitoring approximately ten families in their respective locations within the community.

PROvIde TRaInIng fOR 100 cHws TO ensuRe adHeRence TO TReaTMenTs agaInsT HIv/aIds, TuBeRculOsIs, and MalaRIa.

objective 2

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This project included training all 100 cHws to recognize the symptoms of HIv/aIds, TB, and malaria; to monitor suspected cases; and to counsel potential patients on their options for treatment

By PROvIdIng dedIcaTed MeMBeRs Of THe cOMMunITy wITH THIs BasIc knOwledge, sanOfI and ROTH Have PROvIded THe cOMMunITy wITH THe aBIlITy TO decenTRalIze PaTIenT MOnITORIng and TO PROvIde ResIdenTs Of THe cOMMunITy wITH TRusTed cOunsel fOR HealTH-RelaTed Issues.

This model serves to ensure higher rates of adherence to treatments for the diseases listed above and contributes to overall health system strengthening in Piave.

when the laboratory project neared successful completion in mid-september, the cHws were sensitized to the services that would be available. The laboratory facilitates the administration of aRvs, dOTs, and antimalarials by providing accessible diagnostic services adjacent to a dispensary stocked with those medications.

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TO Run a HealTH educaTIOn caMPaIgn THROugHOuT THe caTcHMenT aRea TO IncRease awaReness aBOuT THe vOlunTaRy HealTH seRvIces OffeRed aT THe PIave dIsPensaRy and TO IncRease THe nuMBeR Of IndIvIduals cOMIng TO THe dIsPensaRy RaTHeR THan TRadITIOnal HealeRs fORHealTH seRvIces.

objective 3

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One Of THe BIggesT HuRdles TO THe adMInIsTRaTIOn Of PROPeR and effecTIve HealTHcaRe In PIave Is THe aTTITude Of cOMMunITy MeMBeRs TOwaRd THe seRvIces OffeRed.

There are a lot of myths and misconceptions regarding disease and healthcare in the community, many of which breed outright distrust. Many people still rely on traditional healers for healthcare simply because it is familiar territory. It is very common for people to self-diagnose and medicate.

In ORdeR TO Run an effecTIve HealTH educaTIOn caMPaIgn, IT Is fIRsT necessaRy TO assess THe knOwledge Of THe caTcHMenT aRea.

To this end, ROTH’s project manager worked with Health centre staff to compile a list of the most common and damaging myths and misconceptions and then used this information to compile a survey.

The survey was subsequently administered to approximately 600 people via the network of cHws. Results are pending.

Once the results will have been analyzed, the Health centre staff will be able to conduct

a series of targeted outreach programs to ensure that accurate information regarding preventive medicine is disseminated throughout the catchment area.

Individual cHws can be given specific instructions to remedy deficiencies in knowledge within the family grouping they are responsible for. all in all, this approach will test the efficacy of each cHw and efficiently utilize the limited resources available to increase the knowledge of the catchment area.

during the first week of september, the cHws were informed about the new services that would be available at the laboratory as well as the prices of each test. They were instructed to inform their respective family groupings.

THIs aPPROacH aPPeaRs TO Have Been successful; as sOOn as THe laBORaTORy OPened, aveRage daIly PaTIenT vIsITs TO THe HealTH cenTRe MORe THan dOuBled.

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test frequencyTuBeRculOsIs (TB)...................... 10MalaRIa......................................... 189dTc (HIv)........................................... 56TyPHOId feveR (wIdal)............45anTenaTal PROfIle.................... 24OvaRIan cysT................................ 30H. PylORI............................................. 8uRInalysIs....................................... 12

Less than 8 weeKs into the Laboratory’s oPening, over 404 PeoPLe had aLready been screened with 2 cases of tb being detected.

this level of throughput continues to be maintained.

the following is an abridged summary of the tests performed as of november 1, 2011:

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lessOns leaRnedand RecOMMendaTIOns fOR fuTuRe PROjecTs• ThoughmanyofThechWsarevery

dedIcaTed, a sMall PeRcenTage Of THeM aRe cuRRenTly InacTIve. THIs ResulTs In InequITaBle dIsTRIBuTIOn Of HealTHcaRe InfORMaTIOn wITHIn THe cOMMunITy. IT Is RecOMMended THaT THe cHws Be PROvIded wITH sOMe sORT Of IncenTIve scHeMe THaT RewaRds cOnTInued PaRTIcIPaTIOn. THIs sHOuld Be alIgned wITH MOH POlIcy On cHw and Be InITIaTed By THe gOveRnMenT Of kenya. nOn-fInancIal IncenTIves knOwn TO IncRease MOTIvaTIOn aMOngsT cHws sucH as BIcycles, Badges, and PuBlIc RecOgnITIOn duRIng naTIOnal IMMunIsaTIOn days cOuld POTenTIally Be facIlITaTed By fuTuRe cOllaBORaTIOns.

• surveysshouldbeadminisTeredbyHealTH cenTRe sTaff duRIng OuTReacH PROgRaMs. HavIng 100 PeOPle adMInIsTeR a suRvey ResulTs In a lack Of caReful OveRsIgHT, THus InTROducIng a gReaT Many vaRIaBles.

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fOR ITs secOnd cOnsecuTIve yeaR, THe PROPITIOus PaRTneRsHIP BeTween ROTH and sanOfI Has sIgnIfIcanTly IMPROved access TO HealTH caRe fOR sOMe Of THe wORld’s MOsT vulneRaBle POPulaTIOns.

This year, our collaborative effort resulted in the construction of a laboratory in Piave, thereby officially elevating the status of its health infrastructure from a dispensary to a health centre.

This initiative has already led to a twofold increase in the number of patient visits to the health centre and a significant decrease in the proportion of cases necessitating referral to larger health centres.

To further facilitate effective health care, ROTH and sanofi encouraged the active participation of willing community health workers to improve surveillance within the surrounding villages and to bridge the gap between existing formal and informal health systems.

ROTH wOuld lIke TO exTend ITs sInceRe gRaTITude TO sanOfI fOR THeIR OngOIng cOMMITMenT TO glOBal HealTH.

concLusion

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