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Handheld health - making the LEAP to sustainability

*This article originally appeared in Allen & Overy's 2016 Annual Review. 


Amref Health Africa and Accenture have worked together to create LEAP, an effective way to transform healthcare provision using relatively simple mobile phone technolog y to train community health workers. But the benefits of this collaboration are potentially much more profound.

During our conversation, Dr Githinji Gitahi, CEO of Amref Health Africa, asks a question that puts it all into very sharp context.

“Africa has only 3% of the global health workforce, but we carry 25% of the world’s disease burden,” he says.

“How can we up-skill and tool people so that they can move on to the next level and make Africa a place of lasting health change?”

It is a clear description of the mission of Amref, an organisation that has been working to improve healthcare provision, training and education in Africa since 1957.

“Amref has been involved for a very long time in developing capacity not only of healthcare workers in Africa, but also communities themselves so that we can empower people with the information and knowledge they need to make their own decisions,” says Githinji.

In the early days this work was all face to face. But, bit by bit, Amref has been finding ways to harness technology to train more healthcare workers and to reach further and deeper into communities.

For the last 11 years, it has worked in increasingly close partnership with leading global professional services company Accenture to develop and build more effective programmes.

In 2005 the partners began building an e-learning platform to train some 22,000 nurses to diploma level in a programme run initially with Kenya’s Ministry of Health, but subsequently launched in Tanzania, Uganda and Zambia.

Learning by computer rather than in a classroom was still a relatively new thing at the outset, so advocacy was an important part of the partners’ mission as they sought to persuade governments of the power and potential of e-learning.

The rapid penetration of mobile phones across Africa in recent years has now opened the way for a new and more ambitious mobile health project – LEAP.

“Working closely with Accenture we asked ourselves: how can we use mobile phones as a learning platform?” he says. “And obviously there are challenges here. You can’t deliver the same amount of content on a mobile phone as you can on a laptop or a PC, especially as the majority of people we are training do not have smartphones but the original, small screen analogue phones.”

Amref had the capacity to develop content and to engage governments in the project, he says. Accenture bought their expertise in technology, forming partnerships, financing and project management.

Matthew Edwards, managing director – Accenture, takes up the story: “The discussion turned into a concept, and Accenture worked side by side with Amref to create a truly unique cross-sector partnership comprising Amref Health Africa, Accenture, the Kenyan Ministry of Health, M-PESA Foundation, telecoms provider Safaricom, and Mezzanine, the technology group, to deliver it.”

Grants totalling USD4.4m were provided by Accenture, with an additional USD2.1m coming from the M-PESA Foundation.

“LEAP is designed to make health training accessible to all communities,” says Matthew. “By leveraging the power of technology, Accenture is helping Amref Health Africa deliver medical and job skills training at speed and scale – a critical component in improving the health and long-term economic sustainability of communities in Africa.”

LEAP has been piloted in Kenya, with content being delivered to 3,000 health workers serving 300,000 people living in urban, rural and nomadic communities. The health workers have been taken through a series of government-accredited training modules.

The system means their work can be supervised, supported and monitored remotely, allowing them to work with greater confidence. In addition, individual health workers can stay in contact with their peers and learn from each other, all thanks to the power of group chat.

That makes LEAP a powerful tool not only in the provision of day to day community healthcare, but as an early warning system in controlling the outbreak of diseases, such as ebola and malaria.

“Through their training, the healthcare workers know how to recognise syndromes and symptoms and can therefore identify a pattern of disease like malaria,” says Githinji.

“If, in a group of 50 workers chatting together, ten or 15 spot the same symptoms in their communities, that information can be shared with each other and with supervisors and act as a red flag warning of a possible malaria outbreak.”


Going to scale

With the successful pilot completed in Kenya, the next task is to take the project to scale, with plans to introduce the technology in Ethiopia, Uganda, Tanzania, Mozambique and Zambia.

Throughout, Amref has worked closely with Accenture Development Partnerships, bringing the breadth and depth of Accenture’s global capabilities and experience to support development organisations across the world. A team has been working both on the ground in Nairobi and in the field alongside Amref colleagues.

“Over the last four years we’ve been able to develop the vision and strategy for LEAP, manage the development of the technology and learning pedagogy, and monitor the pilot implementation,” says Matthew.

But the focus has now shifted, he adds. “Most recently the project team has been working closely with Amref to transform LEAP into a commercially viable social enterprise. That means advising on organisational structure, guiding on branding, developing a go-to-market strategy and building capacity in key commercial areas such as sales, marketing and financial management skills.”

The support and guidance has been invaluable, says Githinji.

“When you team with a company like Accenture you start to learn how business is done. And you start to learn that talking about moving away from aid to trade and starting to think about long-term sustainability is not just a boardroom discussion – it is actually possible.”

The partners now plan to explore other potential areas for collaboration, specifically looking at which of the UN’s Sustainable Development Goals they can address together. They are also looking again at the e-learning programme – their first collaboration – to see if it can be further and sustainably developed.

Matthew says the support of LEAP is part of Accenture’s Skills to Succeed corporate citizenship initiative, which is equipping more than three million people around the world with the skills to get a job or build a business.

That initiative is all about using Accenture’s corporate strengths to forge smart partnerships that have real and lasting impact.

“Personally, I have found it immensely rewarding to see both the power of true partnership – how businesses and NGOs can collaborate to achieve outcomes which none of us could have achieved on our own – and the transformative potential of digital technology for the most disadvantaged people.”


Shared goals

It’s just such outcomes that A&O has been seeking to achieve in its two-year partnership with Amref, which concludes in October this year.

Since Amref was selected by A&O staff as the firm’s global charity partner, A&O has been providing a mixture of funding and pro bono support for two key sexual and reproductive health projects aimed at 130,000 young people in Tanzania.

The initial target to contribute GBP1m has already been achieved, with GBP1m provided in direct funding and GBP692,000 in volunteering and in-kind support.

Elaine Johnston, a New York partner helping to lead the Amref partnership, pays tribute to the fantastic support people across A&O have given both through fundraising and pro bono volunteering. She’s delighted, too, that the firm has helped Amref build its advocacy capabilities around sexual and reproductive health.

“We are delighted to be working with Amref and it’s great that we’re not only providing funding but also using our legal skills to make Amref’s work more sustainable,” she says.

“We’re particularly proud to have helped build Amref’s advocacy skills in Tanzania so that it can work, from community level up to regional and national government, to achieve lasting change in sexual and reproductive health across the country. This is about reducing adolescent pregnancies and making sure thousands of young people get the chance to stay in education, as well as eliminating harmful traditional practices such as FGM and early marriage that adversely affect the lives of women and girls.”

That work has involved over 760 hours of volunteering, involving 23 lawyers and seven professional support staff who have developed a toolkit and delivered training on the ground to help Amref staff engage in advocacy to promote the rights of children and young people and to eliminate discrimination and violence against women.

“This has been A&O’s largest pro bono project with a global charity partner ever and we’ve learned many important lessons through our partnership.”

For Githinji the partnership has also been truly two-way. “A&O is helping Amref transition itself to a sustainable position, and, through us, it is getting access to the communities in Africa we work with and really engaging with them – that’s what makes the partnership so important.”


Perspectives on partnership

Amref Health Africa looks for particular qualities in the partnerships it forms. So what, for Dr Gitahi, makes for a great relationship?

  • A shared mission – not necessarily overall, but around the project you are working on together
  • Shared values – so that both organisations feel comfortable working together and are assured of each other’s integrity
  • Co-creation – the ability to sit down together and address a problem, bringing your joint strengths together
  • Clarity – each having a clear idea of the other’s role, preferably captured in an MoU at the outset
  • Fun – people who have fun working together create better solutions
  • A common idea of success – knowing that success looks the same from both sides