The ‘3 delays’ problem
Ideally, women contact a community or primary care professional when their health calls for it. But in sub-Saharan Africa, women often don’t seek out health care at all, or they try to gain direct access to secondary or tertiary care, bypassing primary care and causing overcrowding and delays.
Although maternal mortality numbers in sub-Saharan Africa have dropped over the past few decades, too many women still die as a result of complications during and following pregnancy and childbirth. Most of these complications are preventable or treatable with current-day health care solutions. Speed of care is of the utmost importance here. For example, severe bleeding after birth — the world’s leading cause of maternal death — calls for the immediate injection of oxytocin to reduce the risk of a woman bleeding to death.
However, in many sub-Saharan African countries, access to primary care in rural areas is hampered by large distances and poor infrastructure. The nearest primary health facility may be a four-hour walk away, discouraging women from leaving their communities. Pregnant women who don’t enter the health care system cannot be screened for possible complications in their pregnancy that may require a caesarian section in a health facility. If these women deliver at home, there is a higher risk of mortality for mother and child.
When women do seek professional help, they may head directly for a hospital and bypass primary care because they know that such facilities may lack trained health staff, medication, and equipment. This causes congestion at secondary or tertiary health care levels, further compounding the problem. Women get treated too late, and complications or even death may ensue.
Striving toward universal health coverage
The importance of primary care in numbers
► 90 percent of health issues can be handled at the primary care level.
► WHO has calculated that in order to reach UHC in low- and middle-income countries by 2030, more than 50 percent of additional health care spending should be allocated to primary care.
As the World Health Organization points out, all women should have access to antenatal care in pregnancy, skilled care during childbirth, and support in the weeks after childbirth. To achieve the goal of universal health coverage by 2030, strengthening primary care should be a top priority.
WHO has calculated that in order to attain UHC in low- and middle-income countries by 2030, more than 50 percent of the additional health care spending in the coming years should be allocated to primary care, particularly to human resources, infrastructure, and equipment. Close to the community, that’s where we can make a difference.
The promise of the Community Life Center platform
Over the past few years, my colleagues at Philips and I have been closely involved in bringing this vision into practice in several African countries, together with local governments, NGOs, and communities. Central to our way of working is establishing a Community Life Center, known as a CLC, which is an open platform that offers a community-driven, holistic approach to improving access to primary care.
Addressing the ‘3 delays’ problem
The philosophy behind the community life center platform is to improve access to care and prevention programs at the community level, while also strengthening connections with higher levels of care, thereby providing timely and appropriate care for all.
For example, just recently we opened a CLC to bring access to quality primary care to 40,000 people in one of Kenya’s most challenging regions: Mandera County, close to the border with Somalia and Ethiopia. Mandera County has one of the world’s highest maternal mortality ratios, with 3,795 maternal deaths per 100,000 live births. The region has a difficult terrain and faces a lack of qualified health care workers, electricity, and basic health care technology. To address these challenges, we collaborated with the United Nations Population Fund and the Mandera County government in designing and implementing the CLC.
The CLC in Mandera serves as a community hub where people have access to primary care. The project started by listening to the needs and requirements of the local community. We then created a healthy and safe environment in which primary care services can be delivered and optimized across the health continuum, from prevention to diagnosis and treatment. The health center is equipped with medical devices, monitoring tools, and support services, all tailored to the community’s needs, and supplemented with consulting and maintenance services. Community health workers and nurses receive training and continuous education to help them provide quality care.
We have also supplied community health workers in Mandera with “outreach kits” — backpacks with basic measuring devices to monitor the health of mothers and children in their daily environment. Community health workers can upload health data to an IT system via an app on their mobile phones. A health care professional on a higher level of care can then review the data and give direct feedback. This allows for timely home care or referral to the appropriate health care facility.
Encouraging first results
Ultimately, the objective of this approach is to bring quality care closer to people’s homes and relieve the burden at higher levels of care, thereby improving the health of the overall population. Maternal and child health is a focus area, but the scope of the CLC approach goes well beyond that, addressing the health care needs of the overall population.
We have seen that for less than $10 per person per year we can improve access to quality care at the primary care level. The first results are encouraging. For example, in Kiambu County in Kenya, where we opened the first CLC in June 2014, the monthly number of women attending at least four antenatal care visits rose from six to 94 within 18 months. Over that same period, the total number of patients visiting the CLC grew from 900 to 4,080 a month.
The CLC approach allows us to simultaneously work on other U.N. Sustainable Development Goals — not just SDG 3 on health and well-being. Solar power provides a reliable clean energy supply for the health care facilities. Durable indoor and outdoor LED lighting enables extended opening hours and provides security to patients and staff. The CLC also fosters local socioeconomic activities, spurring the development of community.
The need for modular and integrated solutions
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If there is one thing we have learned from our CLC approach over the past few years, it is that there are no standard, one-size-fits-all solutions to improving access to primary care. Populations in different regions have different health care needs; for example, to address certain diseases that may be more prevalent in one area than in the other. Every region also has its own infrastructural and environmental challenges, local practices, and cultural beliefs. As we look to extend our CLC approach to wider Africa and other areas of the world, we should be aware of such differences.
This means we need to think in terms of integrated modular solutions — standardized building blocks that can be put together flexibly to create a local solution. For example, if roads in a certain region are inaccessible for large parts of the year due to weather conditions, we need to rely more heavily on a network of community health workers — or we could also create a large number of small health posts that are close to the local communities. These building blocks can then be replicated in other regions, in a configuration that fits the needs and challenges of a particular region. Scalability and flexibility go hand in hand.
Partnering up to make a difference
Creating tailored solutions for specific regions requires deep knowledge of local needs and challenges. That’s why it’s so important for companies including Philips to partner with local governments and organizations. Our global footprint allows for scalability of a community-based approach to primary care, but at the same time we need local expertise and involvement to truly make it work.
Although we have a long way to go toward UHC, I believe we can make huge strides if the private sector, governments, and NGOs join forces. If we focus our efforts on improving access to primary care and prevention, the whole health care system will benefit — and people will receive better care where they feel most at home: in the heart of their communities.
How do we ensure that people worldwide get the care they need without the risk of being pushed further into poverty? Devex explores the path to universal health coverage. Join us as we ask what it will take to achieve UHC for all by visiting our Healthy Horizons site and tagging #HealthyHorizons, #Health4All and @Devex.
The content, information, opinions, and viewpoints in this Healthy Horizons content series are those of the authors or contributors of such materials. Content produced as part of the series does not represent an endorsement of the contributing institutions or their positions, nor does it imply the existence of any relationship or engagement among them in connection with this series.