Deploying digital technologies to make healthcare affordable in the slums of Nairobi
Last year, Kenya’s healthcare system came to a standstill when nurses went on strike for 5 months. Healthcare in Kenya, like many other developing countries, is crippled by underfunding and misuse of resources. The poorest and most marginalised individuals are left with few options, particularly those living in informal settlements. For the majority, this results in debt and low quality care, and encourages the use of unregistered clinics and chemists that provide unsuitable or counterfeit medication.
Access Afya, founded by Melissa Menke in 2012, is one organisation transforming healthcare in Kenya by offering an alternative option for those living in the slums of Nairobi. As a social enterprise, Access Afya is deploying digital technologies within an integrated community health service to provide affordable healthcare for the ‘mass market’ - the majority of whom live on the poverty line of $2-5 a day.
Their model is making a difference by providing essential health services and products to a population that has historically been underserved. They do this by running an ecosystem approach to primary healthcare that is sustainable, high quality and scalable. The backbone of their operation is a chain of low cost microclinics that run 11 hours a day, 7 days a week, including holidays. The clinics are able to handle most of what the community needs through efficient, outpatient care. In Menke’s view:
“We make a real impact by providing another option to those communities - that you can get fast, affordable, quality care. This means people who feel sick can get in and out of clinics within an hour, they pay under $4 per visit on average, they don’t need to go into debt for that type of bill, and they actually get the right treatment.”
When nurses went on strike last year and public healthcare was brought to its knees, Access Afya was still able to provide quality care to communities. One of their largest services - Child Wellness Care - allowed families to continue having access to routine immunisations.
Access Afya also run standalone pharmacies, ensuring access to high quality, affordable medicine. In Kenya, the majority of people in informal settlements go straight to a pharmacy when they feel sick; so by owning that frontline, Access Afya can help get more people into a safe ecosystem. For those that can’t access a clinic, mobile teams are deployed to take the clinic to them. Community members are trained to become field based agents. They are deployed with a fully equipped backpack, and screen for things like hypertension, diabetes, pregnancy, and eye infections, which they can refer back to Access Afya clinics.
“Field-based care allows community members to be part of our value chain, which enhances their ability to earn livelihoods and buy into our model. Plus, ultimately it saves us time as you are not having simple things happen in clinics, and are instead saving cases that actually need to be in clinics.”
Access Afya’s care is heavily focused on user quality, emphasising patient outcomes and needs. Sustainable practices such as working with strategic partners to offer health financing, ensuring operating costs are lean and low, working with the local government and involving the community has allowed Access Afya to run a successful affordable healthcare system. Central to that model is using appropriate technologies such as electronic health records, mobile tech, an online training academy, and clinical decision support as a way to help lower costs and improve efficiency. However, Access Afya is more than just a technology company - over the years they have tested and integrated a combination of different models and approaches for high-touch, high-tech healthcare.
“We are sometimes labelled a digital health company, but really we are a vertically integrated healthcare company," says Menke. "Successful companies must tackle logistical problems, human resources and training, and forge good relationships with government to scale here. So whilst we use some really interesting technologies, we also run medicine supply chains and have a huge HR program where we hire, train, motivate, and maintain good healthcare providers.”
By getting community members involved in patient care - a process known as ‘task shifting’ or ‘collaborative care’ - time spent with doctors is greatly reduced and so too are substantial costs. Melissa comments how collaborating with local communities, as well as being hyperlocal, has been central to Access Afya’s success.
“We are a hyperlocal company, we build from the ground up, our patients are on our team as full-time team members. A third of the company is coming from the slums where we work, and 95% is coming from Kenya. Our backgrounds are diverse, our education is diverse, and we are also making sure we are really realistic, and including people who are users of our services in the design and processes of those services.”
Interview with founder Melissa Menke
Photos credits: Access Afya
Read the organisation's recent annual report here