Addressing access to quality care through the
Community

County Government of Kiambu, Kenya

Access to quality primary healthcare is an ongoing problem across Africa. In the Eastern and Southern Africa region, every year some 80,0001  women die during pregnancy or childbirth, and 440,000 infants do not survive their first month. 

In 2014 Philips introduced the first Community Life Center platform - or CLC for short - in Kiambu, Kenya. The CLC is not a traditional product-driven approach but a community-driven, open, and holistic solution. It is designed to provide a wide range of services and solutions aimed at providing better access to care and addressing community issues, such as providing a safe and heathy environment. 

 

Background
Lack of access to quality health care is a persistent condition in most of sub-Saharan Africa, where neonatal mortality has seen no significant change in over a decade. Nearly 4 in 102 under-five deaths are among newborns up to 28 days of age. Ethiopia, Tanzania, Uganda, Kenya, Angola, Mozambique, Somalia and South Africa, account for 75%3 of all neonatal deaths in the region. Non-communicable diseases already pose an enormous risk to global health and social and economic development, and while governments search for strong and effective responses, evidence4 points to the positive impact that community-based interventions can have as a means to delivering primary healthcare and improving health outcomes. The UN has now set Sustainable Development Goals (SDGs), one of which, SDG3, targets improving healthcare. It is clear that primary healthcare is the foundation of any health system and is essential to achieving the goal of Universal Health Coverage.
 

Philips has developed the idea of the CLC platform – which is an open, holistic and flexible approach to strengthening primary and community healthcare and the links to the existing health networks.

While significant gains have been made in eradicating common killers associated with child and maternal mortality, children still face an array of health issues. 

 

There are a total of 120 million episodes of pneumonia annually2, of which 14 million progressed to severe episodes. Pneumonia is one of the most solvable problems in global health, yet / still a child dies from the infection every 30 seconds. 

 

A high proportion of pneumonia deaths (81%) occur in the first two years of a child’s life, with the vast majority of deaths occurs in low-resource settings in developing countries, where diagnosis is poor - in many cases pneumonia is misdiagnosed as malaria – and treatment is not readily available.

 

Advanced diagnostic tools, such as chest x-rays and laboratory tests, are not available in low-resource health settings. Instead, health workers are trained to diagnose pneumonia by observing and counting how quickly a child’s chest rises and fall. But achieving an accurate count can be difficult, as shallow breaths are hard to detect, children often move around and there may be distractions and other checks to perform.

 

Anecdotally, experts believe that this method is subjective and inaccurate. Many studies have demonstrated clinically obtained measures to be inaccurate, lacking both reliability and reproducibility in a variety of health care settings.

 

“If we can remove the subjectivity associated with health workers counting breaths, we can improve the quality of treatment and help reduce the inappropriate use of antibiotics,” says Salim Sadruddin, Senior Child Health Advisor at Save the Children.

Empowering remote communities
Developed in Africa, the CLC is a flexible, modular, and open platform approach bringing Philips and third party products, solutions and services together. It works to address the issue of access and quality of care in under-resourced areas by strengthening primary and community health care, and empowering people through the setting up and running of the centers.
 

The CLC was introduced in collaboration with the County Government of Kiambu in Kenya. Located at the Githurai Lang’ata Health Center in Kiambu County, the CLC is not a traditional product-driven approach but a community-driven, open, and holistic solution, which means as well as simultaneously acting as mother and child centers to address urgent infant mortality rates, they offer additional value through the provision of 24/7 sustainable light, power and clean water.
 

The primary focus is addressing infant mortality and maternal health as well as the broader goal of universal health coverage by 2030, in line with the SDGs targets.
 

Looking beyond primary care
An important element to the CLC’s success is its broad view of the healthcare continuum, where healthy living and prevention play core roles. This can involve, for example, such features as social areas and a solar-powered soccer pitch LED lighting adjacent, enabling social and economic activity in the evenings.
 

Another key element is the early involvement of health workers and local community in the assessment and design of the CLC in order to create ownership and a tailor-made solution addressing the needs of that specific community. Community members develop ownership in the centers, playing active roles in the assessment and design of the CLC. As well as providing vital primary care the center goes beyond that function, by turning health facilities into community hubs where technology is bundled with services.
 

“The engagement of the community was the most important part of the project. From the beginning, the endorsement from them led to more people visiting the facility from outside the community,” says Bahaa Eddine Sarroukh, Philips head of
Research Africa.


A number of commercial developments in the area since the facility was built show the positive effect it is having on the community. Property prices around the CLC have gone up, and there are now pop-up shops and small businesses emerging on the road towards the facility, making their livelihoods off increasing traffic and people flows. A motorbike station now acts as a place where people can be transported to and from the facility. Anecdotally, police say that outdoor lighting may have helped ease crime in the area.
 

“We do believe that when you provide access to care, you ease the flow of people and enable a host of other activities, which support the community’s growth and development. We have seen a very clear knock-on effect from the CLC through the availability of quality care and simple services,” says Sarroukh.
 

“People are empowered both socially and commercially, and what has grown around the CLC very clearly reflects that – empowerment takes many forms, but the community now has access to affordable and quality care and they are empowered to make decisions about their own health.”
 

Outcomes at Kiambu
Within 18 months of its opening (from June 2014 – December 2015), the total number of outpatients visiting per month increased from 900 to 4080, the number of children being treated quadrupled from 533 to 2370; first antenatal care patients grew fifteen fold from 13 to 188 patients each month; and, the number of fourth visit antenatal care patients each month grew sixteen fold, from 6 to 94.
 

The maternity wing of the center enables women to deliver their babies in a safe and secure environment. Since its inception, 634 babies have been born with an average of 36 babies currently born at the facility each month.
 

1 UNICEF, 'Gender and Health' https://www.unicef.org/esaro/7310_Gender_and_health.html

2World Health Organization, 'Children: reducing mortality'  http://www.who.int/mediacentre/factsheets/fs178/en/

3UNICEF Eastern and Southern Africa, 'Children and newborn health' https://www.unicef.org/esaro/factsonchildren_5774.html

4 WHO - http://www.who.int/bulletin/volumes/91/4/12-109660/en/