Intergrated Public Health Care- Case Study of a PPP

1. A Case Study � Integrated Primary Health Care in East Africa  The EAAG Givers� Lounge 30 March 2012 Dr. Michaela Mantel Aga Khan Foundation/Aga Khan University

2. Aga Khan Development Network 2 A group of international, private, non-denominational development agencies Empowers communities and individuals to improve livelihoods and opportunities Focus on poor people in resource-poor areas The AKDN offers a different, coordinated approach. AKDN a group of international, private, non-denominational development agencies and institutions. It seeks to empower communities and individuals to improve their living conditions and opportunities, and it usually works with poor people in resource-poor areas. In response to the question raised in the slide above, AKDN replies that financing alone is not the answer. The recent World Bank HNP stratgegy notes that � money for medicine and equipment alone, without the right chain of events isn�t enough to save lives.� The AKDN shares this conviction and affirms that: (a) the development perspective must be long-term; and that (b) there must be a focus on human resource development (remember Botwana), proper governance, effective management and community involvement. AKDN�s vision is improving living conditions and opportunities for people in the poorest parts of the developing world.A group of international, private, non-denominational development agencies Empowers communities and individuals to improve livelihoods and opportunities Focus on poor people in resource-poor areas The AKDN offers a different, coordinated approach. AKDN a group of international, private, non-denominational development agencies and institutions. It seeks to empower communities and individuals to improve their living conditions and opportunities, and it usually works with poor people in resource-poor areas. In response to the question raised in the slide above, AKDN replies that financing alone is not the answer. The recent World Bank HNP stratgegy notes that � money for medicine and equipment alone, without the right chain of events isn�t enough to save lives.� The AKDN shares this conviction and affirms that: (a) the development perspective must be long-term; and that (b) there must be a focus on human resource development (remember Botwana), proper governance, effective management and community involvement. AKDN�s vision is improving living conditions and opportunities for people in the poorest parts of the developing world.

3. 3 AKDN worldwide: 30 countries, 7 regions

4. 4 The Madrasa Early Childhood Development Programme

5. 5 The Raha Leo Community Health Programme AKDN � Johnson & Johnson Partnership established in 2001: The Rahaleo Community Health Programme, Zanzibar The Aga Khan University (AKU) Advanced Nursing Studies (ANS) programme in Kenya, Tanzania,  and Uganda The Aga Khan Foundation (AKF) Madrasa Resource Centre (MRC) and preschools in Zanzibar (since 2005)AKDN � Johnson & Johnson Partnership established in 2001: The Rahaleo Community Health Programme, Zanzibar The Aga Khan University (AKU) Advanced Nursing Studies (ANS) programme in Kenya, Tanzania, and Uganda The Aga Khan Foundation (AKF) Madrasa Resource Centre (MRC) and preschools in Zanzibar (since 2005)

6. 6

7. Build human capital Enable and empower people in developing world to solve problems affecting their societies Improve quality of their lives Build bridges across communities 7

8. Making a Difference Focus on quality over quantity Community-based learning Upholding international best practices Research-based policy impact Creating leaders with critical thinking and problem solving abilities for academia, government, business and civil society Respect for pluralism Ethical framework and value system Accountability

9. 9 Advanced Nursing Studies (ANS) Learn and earnLearn and earn

10. 10 The AKDN Integrated Health System in East Africa � proposed settings

11. �Assets� in East Africa�Assets� in East Africa

12. Integrated Primary Health Care Start-Up Project (IPHC S�UP) 

13. Objectives To develop an IPHC model that recommends effective mechanisms for partnership between district health systems and higher education institutions and identifies social innovations to increase access to high-quality primary health care services in resource poor, rural East African communities with focus on maternal. Newborn, and child health (MNCH) Planning grant for proposal development and Resource identification and mobilization for testing of the IPHC model in selected geographical area(s).

14. The Partners Kaloleni District, Coast Province, Kenya Aga Khan University (AKU) University of California, San Francisco (UCSF) Community Health Department, Aga Khan Health Service-Kenya Aga Khan Foundation

15. What we did Signing agreement with the Provincial Govt. Community engagement exercise Health facility assessment/mapping Capacity building (district & AKDN internally) Social innovation workshop and internet research The nursing alumni conference E-health training and health system workshop Testing the role of family medicine doctor in a district health system Workshop with nurses/midwives Building a partnership with the Kaloleni District Health Management and the Hospital teams

16. The three delays in maternal care

17. What we learned We learned about How to engage the communities to identify gaps and barriers in MNCH Community demands and priorities Engagement with community leadership and importance of participatory approaches in planning and monitoring Health workers needs for capacity building and effective methodologies for training /mentoring District management needs including the need for community based HMIS Strategies that have high potential to enhance community health, primary health care and referral system Cost-effective interventions and innovations (e.g.mobile technology), franchising, output-based approach and other good practice models We also learned about structures and processes that are essential to meet the universities� needs in terms of education and research relevant to local health systems .

20. Envisaged IPHC partnership programme Partnership Model (AKU/UCSF/Local Govt. & AKDN/other): Education Research Services Critical Inputs from external resources (resource mobilization) Monitoring and evaluation � documentation and dissemination � informing/influencing policy Initial focus on MNCH Model of an open concept: changing focus according to changing needs and priorities; e.g. NCD, environmental health; even beyond HEALTH

22. Our vision To create an IPHC partnership model that contributes to the health of communities in resource poor areas through community engagement, improved access to quality care, and strengthening health systems offer students unparalleled access to divergent communities provide faculty a unique opportunity to apply for research funding to undertake multidisciplinary, multi-sectoral research enabling AKU-UCSF / AKDN to design innovative, locally applicable, globally relevant solutions Develops education programmes relevant to local needs and utilizing locally applicable modern technologies to build multi-sector capacities addressing the current inequity in health and education Can bridge communities across three continents (AKDN focal regions)

23. Critical inputs: examples Community based solutions and innovations Training and mentoring of community health workers Increasing systainability of CHW system e.g. through small enterprise development Franchising of community midwifery services Voucher system for maternal services Birth planning and preparedness (savings for transport) Resilience and positive deviance approach Support tools Material and learning tools Communication systems Infrastructure improvements e-health system e-learning tele-medicine m-health Information systems Local media Support to training and capacity building Support to alumni networks Technical assistance to develop tools and innovations

24. Asanteni Sana Thank you