In an engaging discussion to update Amref Health Africa supporters on our work, Ky’okusinga Kirunga, CEO of Amref Canada, Caroline Mbindyo, CEO of Amref Health Innovations, and Catherine Kanari, UHC Lead at Amref Heath Innovations, discussed how innovative technology is helping to take primary health care to where it is needed most.
Innovation to the last mile
Ky’okusinga: How are the Mobile Vaccine Clinics impacting our work in under-resourced communities?
Caroline: COVID-19 taught us that we're all vulnerable, that health drives the world, and that where you live still determines your access to health services. We're now two years on from the approvals of the first vaccines and 64% of the global population is fully vaccinated. In Africa, that figure is just 24%. Africa was at the back of the vaccine queue, when the incentives to get vaccinated were highest. Now, we're fighting lack of incentive and lack of access.
To understand how best to tackle these barriers to vaccination and push for uptake, Amref did a study on access. It found that, alongside supply chain issues and training of health workers, physical access to vaccination sites were the critical factor. Now we are fighting the perception of COVID-19 infection being low-risk, we have to ensure vaccination is as convenient as possible. Through the Mobile Vaccine Clinics programme, we have focussed on the most vulnerable sections of society - the elderly or those living in informal settlements. We go to where people need services the most and we ensure that we're providing the service in the ways they need - for example, staying open until 9pm so those working can access vaccinations after work.
Now we are using this model to deliver services to last mile communities: HPV vaccination, routine childhood immunisations, and also screening and referral for non-communicable diseases (NCDs).
Ky'okusinga: Can you share with us one of your favourite success stories about an Amref innovative solution?
Catherine: Blueprints for Success is an initiative to close gaps in the patient journey for high blood pressure, breast and cervical cancer. It uses mobile learning and training to increase the awareness and education of community healthcare workers, nurses and clinicians, in order for them to better detect, diagnose and treat these NCDs in a local setting. This was a co-created solution with like-minded partners in order to tackle the NCD burden. And we are seeing the impact; through better screening and diagnosis, we are seeing more cases being detected earlier and fewer cases of stage 3 and 4 cancers.
When health is absent, wisdom cannot reveal itself, art cannot manifest, strength cannot fight, wealth becomes useless, and intelligence cannot be applied.
Ky'okusinga: Caroline, what excites you about Amref’s work around innovation? And how are you working with local communities to create innovative solutions?
Caroline: Like the saying goes, health is really the driver of everything: wisdom, strength, wealth and intelligence. What is truly exciting is how Amref is committed to developing African solutions for African problems to ensure health is accessible to all.
At the heart of that is how we are listening to community lived experience, to advise on how to build these solutions. The Leap mobile learning platform is a great example of this. It was community feedback that helped us understand that mobile learning was the way to go. It also informed which mobile devices to design the platform for, the languages of use, how long the topics should be, and what features should be included to ensure health workers' access to content, and incentives for them. It's now used in eight countries where we've partnered with Ministries of Health to reach more than 100,000 of health workers, in turn reaching millions of households.
We need to shift from "not now" to "why not?"
Ky'okusinga: Catherine, can you speak to what the barriers to innovation are when working in the African context?
Catherine: There are many ways to innovate in the health context: technology, delivery or social determinants to address. It all centres around learning and re-learning. A lack of inclusivity has traditionally been a barrier to access the workforce and the market in the African context. But with our mHealth platform Leap we are innovating to include visually impaired community health workers (CHWs) in our training programmes for breast cancer screening. We knew that visually impaired people have a heightened sensitivity to touch, and so they are naturally good at screening and detection. Innovation starts at the individual level before scaling to the systemic. We're making the case so that governments then recognise that we need to do things differently.
Caroline: Thinking back to COVID, and for Africa as in much of the rest of the world, overnight we changed things to run online. That was a mindshift, from the "not now" or "maybe in 5-10 years" to the "why not?". The big barrier we're facing is the regulatory environment. We have a marketplace of 1.3bn people but that is spread over 50+ countries. That means we are dealing with diverse standards; innovation in one country will not work in another. If we don't address this we will limit what innovation can achieve.
Ky'okusinga: What do you see as the biggest innovative category we will be focusing on in the future? How do the innovations that we discussed today fit into the wider picture of Amref’s work?
Catherine: Data and information to help us make decisions must be the focus. Planning in Africa traditionally circles around problems, and if we can harness large data sets around health and the social determinants for health, then we can use this data to understand our issues better and to predict what could happen at the community and country level. This leads to predictive tech and the ability to plan and to adapt quickly.
Caroline: We need to operationalise a trade agreement to create the largest single market in the world. We know that our response to challenges must be a 'whole of society' response to include the public and private sectors, to focus on solving problems sustainably. And, if I were to make a bet, I would bet on the youth of Africa to drive this. They are dynamic, hungry, and full of ideas. As digital natives they're already creating tech solutions, doubling with these types of technologies. We need to continue this drive forward, to collect data to inform practice and policy and drive change. I would say: Youth x enterprise x technology = sustainable change and the future of Africa.
Youth x enterprise x technology = sustainable change and the future of Africa
Ky'okusinga: How can data make our work better?
Catherine: Amref works to create impact. By harnessing data we can make that impact bigger, and more sustainable. In the Blueprint project, our work with data enabled policy change at the national level and county level. At the county level we used data on NCD incidence and population impact through community experience in our advocacy to the county health board during the budget process. This succeeded in securing funds for NCDs screening. At the national level, we used data analysis on cancer to advocate for more diverse treatment options to be added to the Kenyan Essential Medicines List. This only had three molecules (each used in specific cancer therapies) and we added 19 more. Now those are in the public system and are ensuring more people have the option for treatment. Data is also used to advocate for those treatments to be included in social health insurance. In Kenya, there were no chronic care packages in social health insurance. With that data evidence we were able to advocate for packages to include cancer care; for $5 per month, the patient can receive six cycles of chemotherapy which would have otherwise been paid for out-of-pocket.
Caroline: We know that health, education, agriculture, housing and other what we call social determinants of health are all interlinked. When we work with health data, we overlay other social data to gain insights to drive change. In one county in Kenya, we used this approach to identify the most vulnerable households, and advocated for them to receive a subsidy for social insurance. The county then used the same data to provide an agriculture subsidy. Two to three years on we can go back to these households to see how those subsidies have improved their livelihoods, and their health. Knowledge is power!
Caroline and Catherine also took questions from the audience of supporters of Amref Canada, UK and USA. Here's what they said:
To what extent is there opportunity to commercialise the innovations Amref is developing. Or export them beyond Africa?
Caroline and Catherine: Yes there is certainly opportunity for this. We are working with entrepreneurs from Africa, and from elsewhere to test and scale their innovations. This ranges from medtech (medical technology) wearables which monitor vital signs to embedded sensors in white canes for the visually impaired to help with location. Our work with them is on testing and scalability, then sustainability - how can this be added to the national supply chain, for example.
What is the best approach to standardising regulatory and legal frameworks across the continent - and what impact will that have?
Caroline: Many policy standards were not put in place with innovation in mind. Each country is just focussed on the national and that makes it a difficult market for entrepreneurs. For example in Kenya you would need to set up a bricks-and-mortar shop in order to run a telehealth clinic. That's not needed if you do the same in Senegal. Entrepreneurs building health space innovations are not usually health experts. Amref works with them across 33 countries, understanding policies and regulations and how to do the business of health. We leverage each others' strengths to build products and lobby for concessions. And we have seen successes in changing and harmonising policies to allow innovations to thrive.
Catherine: To add to that, we see the cost of data (mobile internet) as an inhibitor of innovation. Regularising that will ease the road for innovation and increase potential impact.