NETWORK OF NURSE MANAGED TELE-LINKED CLINICS
In Kenya, WHP is currently administering a pilot project of three clinics that addresses the health and reproductive health needs of rural communities within walkable distance. Called Maisha Clinics, these facilities are located in Homa Bay County, one of the poorest in western Kenya. The clinics, focused on women and children, are selected to ensure that each can serve a cluster of villages that together offer an adequate catchment population necessary to achieve economic viability.
The chief innovation of this project is in deploying nurses drawn from the pool of an estimated 20,000 un- and under-employed nurses in Kenya. The nurses are willing to work in areas where the doctors don’t want to locate and are able to serve communities that are vastly underserved even of basic health services. While most clients are treated by the trained nurses on their own, cases that require higher levels of medical competence are remotely treated by city doctors or clinical officers using a specially developed electronic system called Althea. (Refer to the ‘Technology’ section for more details.) Currently, over 80% of the clients receive treatment from nurses.
Clients at Maisha Clinics pay for services which are significantly lower than the total costs they incur for obtaining them from urban-based clinics, the most common alternative. WHP projects that each Maisha Clinic will reach complete sustainability within three years.
In order to create demand for the services its facilities supply, WHP utilizes the large contingent of government-trained Community Health Volunteers (CHVs) who counsel the clients/patients and refer them to their assigned clinic. Currently, five CHVs are attached to each clinic. They earn an incentive for each successful referral.
The project started implementation under Global Health Innovation Grant of $100,000 from Pfizer Foundation in 2016.
Lessons and results:
One of the key lessons is that the clinics need to offer a broad range of services to generate adequate caseloads. This is the way to strengthen the revenue stream, spread the costs to keep the prices to the clients low and set the facilities on their way to total cost recovery. The focus on commercial viability has a flip side: it leaves out a significant part of the population who cannot afford to pay market prices. To address the needs of the poor, WHP engages with the government and donors to underwrite the expenses either fully or partially.
Maisha Clinics currently provide services to an average of 700 clients per month up from 200 clients at inception in August 2016. Currently the clinics have achieved an average sustainability of 50%.