Week’s Highlight – Institute of Health Policy, Management and Research http://www.ihpmr.org IHPMR Sat, 11 Apr 2015 13:19:05 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.3 Lean Café at Kisumu County Hospital http://www.ihpmr.org/lean-cafe-at-kisumu-county-hospital/ Sat, 11 Apr 2015 13:17:46 +0000 http://www.ihpmr.org/?p=674 IHPMR hosted a Lean Café for the Quality Improvement Team (QIT) on 31 March 2015. Adapted from Lean Coffee by Modus Cooperandi, Lean Café is an informal, but structured way to hold discussions that draws from the expertise and diversity around the table to build the best possible agenda and deepest possible conversation in every single meeting.  Typically, a Lean Café is held over a 1-1 ½ hour session.


How Lean Café Works

  • Participants gather around a table over a cup of coffee (currently we are doing this at Java because the coffee there is great).
  • A Lean Café Board is created with the following columns:


  •  Each participant get two post it notes on which they write a quality related topic they would like discussed.
  • Each participant is given an opportunity to introduce each of their topics in 1 or 2 sentences.  This way people know what to vote for.
  • Each participant gets two votes.  They can vote twice for the same thing or for two different topics by putting a colored round label on the topic they are interested in.
  • The votes are tallied.
  • All topics are first placed in the to be discussed column, in order of votes received, with the topic with the highest number of votes on top.
  • Topics discussed in order, starting with the one that received highest number votes. The first topic to be discussed is moved to the “Discussing” column.   Each topic is first allocated 8 minutes. After  the 8 minutes a roman vote is taken:
good  Topic not exhausted. Allow another 4 minutes of discussion
 not sure Not sure- Allow another 2 minutes of discussion
 done Done.  Can move to next topic
  • After a topic has been cleared, it is moved to the “Discussed” column. The topic that got the second highest number of votes is moved from the to be Discussed “column to the Discussing column for discussion as described above.
  • Topics are discussed until 15 minutes to the end of the agreed time.
  • A quick wrap around is done during which participants provide feedback about the meeting. Action points are also captured. The next Lean Café begins with a review of actions agreed at the last meeting

Images from the  KCH Lean Café – 31 March 2015

 voting discussion
Voting Discussion in progress 


What Participants said about the Lean Café


Team Building for the Quality Improvement Team at Kisumu County Hospital http://www.ihpmr.org/weeks-highlight/ Wed, 11 Mar 2015 07:36:17 +0000 http://www.ihpmr.org/?p=635 Team Building for the Quality Improvement Team at  Kisumu County Hospital

Living Goods http://www.ihpmr.org/living-goods/ Wed, 09 Jan 2013 05:46:01 +0000 http://www.ihpmr.org/?p=544 Award: Most Innovative Health Market Innovation

Category: Changing Behavior

Sub Category: Supply Chain Enhancements

This program began in 2007 and is operational in Uganda. The objective of living goods is to improve access to basic health products and to dramatically reduce child mortality. Its approach of using Community health promoters goes a long way towards meeting its objective.

Community health promoters are trained to provide basic health counseling on a variety of topics to their communities and make a modest living by selling health products such as mosquito nets, water purification tablets, oral rehydration salts, vitamin A, anti-malarial drugs, de-wormers, condoms, and the like at below-market prices. To boost sales and ensure long-term sustainability, community health promoters also sell personal care products such as soap, feminine pads, and toothpaste as well as products that support household income or savings, such as solar lanterns, efficient stoves, and high-yield seeds. This way, strong connections with clients are developed to influence adoption of healthy behaviors through training, client listening and provision of a reliable source of low cost essential health products.

The program model also combines the latest and best practices from the worlds of micro-finance, franchising, and public health to create a sustainable system for defeating diseases of poverty thereby reducing illness and death by significantly improving access to and adoption of simple, proven health interventions in the many places these are scarce or non-existent. Key components of the program include: local partnerships, public health training, branding and communication.

The program has currently enrolled over 674 community health promoters, who have reached up to 450,000 community members since the program’s inception. This has resulted in increased uptake of FP services, TB screening, malaria and malnutrition prevention strategies. Which in turn have had an influence on achievement of Millennium Development Goals (MDGs) 1, 5 and 6.

One of the long term plan of Living Goods is to build in sustainability into the program by leveraging existing resources, assets and partnerships wherever possible; creating buying power at the retail level and building significant scale economies; bypassing middlemen in the existing distribution chain and maintaining rigorous cost discipline.



APOPO http://www.ihpmr.org/apopo/ Tue, 01 Jan 2013 05:40:31 +0000 http://www.ihpmr.org/?p=541 Awards: Most Innovative Health Market Innovation

Sub Category: Innovative Operational Processes

The APOPO program, which uses rats to detect tuberculosis was launched in 2004 in Tanzania and has expanded its operations to Mozambique.

Tuberculosis (TB) is a widespread disease. 1.7 million people die from TB each year. Only 50% of patients with TB are diagnosed. Left untreated, a person with active TB can infect 10-15 new people each year. A faster, more accurate diagnostic technology is needed to help curb the spread of this deadly disease.

This is where APOPO’s HeroRATs come in. Trained HeroRATs can quickly and accurately sniff out TB in human sputum samples. In Tanzania, APOPO offers second-line screening to their partner hospitals, which in turn has increased new case detection rates by 30 percent. The HeroRATs can evaluate 40 sputum samples in just seven minutes, equal to what a skilled lab technician will do in a full day’s work.

The concept is very simple: rats sniff a series of holes, under which human sputum samples are lined up for evaluation. They identify samples that contain TB bacteria by scratching at the hole. Their correct indications on known positive samples are rewarded with a food treat. Indications on unknown samples, if pin pointed by two rats or more, are confirmed using microscopy. Samples that are in fact positive with TB are then reported to the hospitals who then follow-up with the associated patient(s) for confirmation of diagnosis and treatment. On a weekly basis, the rats find an additional 5 to 15 new TB-positive patients.

APOPO aims at (i) Offering 1st line screening services in the near future (ii) extending its operations in Tanzania and possibly expand to work with prison units in the country to detect TB among inmates (iii) work with national TB programs and Research Institutes to conduct multi-country trials of using rats to detect TB across different continents.


Changamka Microhealth Ltd http://www.ihpmr.org/changamka-microhealth-ltd/ Wed, 26 Dec 2012 04:54:11 +0000 http://www.ihpmr.org/?p=527 Awards: Most Innovative Health Market Innovation

Category: Information Technology

Changamka Microhealth helps the poor in Kenya to access healthcare by issuing them with Smart Cards which allows them to save money through mobile money that can then be utilized towards visits to the doctor, buy medications and much more.

Changamka has been able to come up with a unique business model that heavily uses the power of information technology (the convergence of mHealth, mTechnology and mMoney) to finance care and improve the efficiency of health care provision in Kenya. This goes hand in hand with its mission “to innovatively use technology, to create mechanisms for delivery of easily accessible, affordable, quality healthcare” Changamka uses a practical savings mechanism to ensure access to quality healthcare at discounted pricing. While access to care is expensive to the poor, they can still save up to meet these expenses when they arise. All one needs to do is purchase a smart card at a nominal cost and top up (save) in a sequestered account through payments via MPESA.  This resolves the mismatch between having funds and falling ill.

As of June, 2011, 9,500 Smart Cards and 3,200 maternity cards had been distributed and2300 women had been  given monthly health education;  600 hospital transactions using the cards every month; and over 500 top-ups per month with 35 providers accepting the cards.

Changamka is looking at upgrading its technology to mobile phone based e-cards, increasing the number of partner hospitals and to rolling out its services across the region.

Community Health Africa Trust (CHAT) http://www.ihpmr.org/community-health-africa-trust-chat/ Mon, 17 Dec 2012 06:34:47 +0000 http://www.ihpmr.org/?p=503 Awards: Most Innovative Health Market Innovation

Category: Enhancing Processes

Sub-Category: Mobile Clinic

About 630,000 inhabitants of Laikipia, Samburu, Isiolo and parts of Meru and Nakuru Counties live in abject poverty and have little or no access to professional health care and other essential services. The Community Health Africa Trust (CHAT) provides a wide range of reliable health services including   reproductive health/family planning, child immunizations, basic curatives, TB  and female genital mutilation awareness and education; all interventions include relevant components of HIV/AIDS services – HIV/AIDS counseling and testing, PMTCT, non antiretroviral treatment, other preventions

CHAT, also a registered community based organization, was established in 1999 and is funded by Global Fund via AMREF & CARE Kenya, Private donations from the USA, Canada, UK & Kenya Government, Community Health Africa- Poverty Solution USA, George Small Foundation Canada, Margaret Pyke Trust UK, Athena Trust UK, CHASE/Rift Valley Tree Trust UK, Mpala Wildlife Foundation, Global Giving USA.

This service enhances processes by use of a mobile clinic which uses an integrated system of vehicles, camels, bicycles and walking methods to visit approximately 32 different sites each month.

Results include an increase in availability of products and services, and the number of clients taking family planning services increased from 984 in 2000 to 14313 in 2011. CHAT involves the community by working alongside 11 Community-Based Health Workers who are familiar with, and sensitive to, the customs, traditions and languages of the many communities. Due to this, the staff helps in mobilizing individuals and raise awareness of the clinics monthly schedule visits within their local community.

CHAT has the potential to scale up as it has been in operation for 10 years and networks with other partners, and many nomadic regions of Northern Kenya are still maligned by the national health system.

Accredited Drug Dispensing Outlets (ADDO) http://www.ihpmr.org/accredited-drug-dispensing-outlets-addo/ Mon, 10 Dec 2012 11:21:06 +0000 http://www.ihpmr.org/?p=495 Awards: 2nd Runner-Up; Most Innovative Health Market Innovation

Sub Category: Provider Training

For many common medical problems, several factors encourage people to self-diagnose and medicate. These factors include distance to the facility, seriousness of the illness, availability and quality of medicines.

The ADDO Program began in 2003 as pilot project with the goal of improving access to essential medicines and pharmaceutical services in the rural and underserved areas of Tanzania where there are few or no registered Pharmacies.

One of the ADDO Program’s objectives is to better equip small rural drug shops to provide quality medicines and pharmaceutical services. The program trains and provides oversight of the shop attendants who dispense the drugs, raises consumer awareness about accredited drug sellers, and strengthens the regulatory monitoring and inspection of outlets. Due to its success, the Government of Tanzania has adopted the ADDO model for the entire country, and is expanding the model from the pilot area into other regions of Tanzania mainland.

 The ADDO program has so far been rolled out to cover more than half the population in the country. ADDO Program currently covers about 4,000 outlets with over 9,000 trained providers country wide serving an average of 7,000 people at each outlet. Scale up will be completed in 2012. Pilot results show that there was a reduction of unregistered medicines in the shops from 26% to 2%, an increase in availability of registered drugs, and improved clients’ perception about the availability of medicines.

The Tanzanian government hopes to complete the roll out of the program all over the country by the end of 2012. It is also expected that a maintenance component being developed currently will be implemented to improve the program services to clients and help ensure sustainability of the program.




Tunza Family Health Network http://www.ihpmr.org/tunza-family-health-network/ Tue, 04 Dec 2012 14:08:50 +0000 http://www.ihpmr.org/?p=487

Awards: 1st Runner-Up

Most Innovative Health Market Innovation

Category: Organizing Delivery

The Tunza Family Health Network was launched in Kenya in 2008 to serve low income populations. The Tunza franchise promises friendly, quick and affordable services offered by qualified health providers.  The franchise currently has a membership of 265 privately owned clinics in all of Kenyan’s eight provinces.  The franchise activities are coordinated by PSI/Kenya as the franchisor.

When Tunza was established, the flagship service was family planning with a focus on the more cost-effective, long-term and reversible methods (IUDs and implants).  In the last two years, the Franchisor has integrated other services into Tunza that include Cervical Cancer Screening, STI screening, HIV Counseling and Testing, Voluntary Male Medical Circumcision (VMMC), and Integrated Management of Childhood Illnesses (IMCI).

To support the private sector and complement the government’s effort in strengthening existing Private-Public Partnerships (PPP), Tunza Family Health Network expands access to quality health services.

The new integrated services started in 2011 and by March 2012, 136,884 clients were counseled for HTC with 122,243 of them agreeing to be tested for HIV. They included individual clients, pregnant mothers, couples and even infants. Out of the total number of clients that were tested, 5,919 turned positive for HIV and were referred to facilities where they could access care and treatment, most of these being public sector facilities. During the same year, 29, 211 women were screened for cancer of the cervix at Tunza facilities. Out of these 679 had positive or suspicious results and were also referred to public sector facilities for further screening and management.  Family planning services also increased dramatically, with 391,249 clients accessing a family planning method of their choice through Tunza between the period January 2011 to March 2012. A family planning voucher was launched in July 2011 to enable poor women to access FP services at a highly subsidized cost. By March 2012, 51,867 women had benefited from the scheme.

 A VMMC pilot in Nyanza and the launch of the first phase of IMCI training for all Tunza franchisees, focusing on diarrhea and pneumonia case management was added in November 2011.

 The Tunza franchise has a demand creation component which utilizes community based mobilizers known as Tunza Mobilizers. Tunza mobilizers work in the community raising awareness on the various health areas and make referrals for potential clients to visit the Tunza facilities or public health facilities.


mothers2mothers http://www.ihpmr.org/mothers2mothers/ Tue, 27 Nov 2012 17:04:37 +0000 http://ihpmr.eugenenyawara.com/?p=265

Awards: Overall Winner-Health Market Innovations Awards 2012

Most Innovative Health Market Innovation
Category: Changing Behaviour

Most Innovative Health Market Innovation
Sub Category: Consumer Education

Launched in 2001, m2m operates in seven countries including: South Africa, Lesotho, Swaziland, Uganda, Tanzania, Kenya and Malawi. The program is funded by the Elton John AIDS Foundation, Johnson & Johnson, UNICEF, and USAID, among others.

mothers2mothers is an NGO that works to prevent mother-to- child transmission of HIV, and sustain the long term health of women and children, by training and employing mothers living with HIV to provide education and support to pregnant women and new mothers. The support is given at various points of services such as prenatal clinics, labor rooms, and postnatal programs through targeted community outreach.

1,000 babies in Africa are born with HIV – compared to one a day in the US and Europe. The program therefore has three goals of: preventing babies from contracting HIV through mother-to-child transmission, ensuring mothers living with HIV and their babies stay healthy by increasing access to life-sustaining medical care and empowering mothers living with HIV to fight stigma in their communities, enabling them to live positive productive lives.

Mentor mothers work side-by-side with doctors and nurses, as paid members of the health care teams, supporting and educating women about how to take care of themselves and their babies. The mothers employed come from the communities in which they work and are selected on basis of (i) being mothers (ii) being HIV positive (iii) having attended PMTCT training and (iv) having disclosed their HIV status, as only those who have disclosed their status have the stamina to speak and mentor others.

Results from the program show that mothers who visited an m2m site were more likely to receive anti-retroviral drugs (ARVs) than those who did not. Also, mothers who attended m2m sites were more likely to deliver their babies in health care facilities than their counterparts who did not attend m2m sites.
mother2mothers aims to replicate the model in new countries and to scale up in countries where it currently operates. m2m’s strategic plan is to support the UN led global initiative to reduce the number of new HIV infections among children by 90% and reduce the number of AIDS-related maternal deaths by 50%, by 2015. In the long run, m2m will also diversify its program components.