Akiba ya Roho

Akiba ya Roho reduces premature morbidity caused by NCDs in the developing world through mobile screening and quality clinical management.

Akiba ya Roho (“save your heart” in Swahili) is a comprehensive diabetes and hypertension management program developed and administered by Access Afya (AA) in Nairobi, Kenya. 

We have developed a multi-touchpoint approach that makes it easy for people living in slums, working long days and trying to get healthy on a tight budget, to access new information and services relating to their heart health. The initial “touchpoint” is delivered by community members who provide education and screening in rotating spaces convenient to residents. A mobile application leads a trained community member through a series of questions for each patient, provides prompts for clinical measurements, and suggests specific education. Mapped to global standards of care, this process is broken down into steps that non-clinicians can do. Those patients with identified risk are referred to an Access Afya Clinic for follow-up.

All patients start a mobile savings program. Only 20% of Kenyans are insured, so most people pay out of pocket for health. Dedicated health savings is a potential way for people with low incomes to ease the pain of paying bulky amounts for health.

At the clinics, patients access world class care. Regular patients get digital vouchers deposited into their mobile savings account, to incentivize them to keep it up. Care is affordable because of Access Afya’s lean, data driven model that combines evidence based medicine with clinic workflows designed for scale.

Program goals:

• 10% patients meaningfully lower their blood pressure/ blood sugar. This reduces mortality risk by 50%.
• 50% patients with a risk factor identified start the use of formal health services.
• Increased community awareness regarding cardiovascular health.
• Access to cardiovascular health screening and management provided to one million East Africans over the next five years.
• Drive low cost clinic sustainability through a new service offering.

Akiba ya Roho aligns with our commitment to provide accessible, affordable, quality care for patients in the world’s poorest communities, while meaningfully reducing premature mortality from NCDs (SDG3).

This solution is additive to other work being done on frontline health. We are leveraging tools such as Dimagi to build our field apps, mtiba for our health wallets, and Jana Care's diagnostic tools. The missing link currently in effective last-mile chronic care management is the end-to-end solution that ties awareness, screening, diagnostics, clinical management, lifestyle education and clinical outcomes. We provide this process innovation managing longitudinal data to understand effectiveness of our work over time. Akiba ya Roho will scale across emerging markets with Access Afya's other health services, which are targeting the 7 million people living in informal settlements. 

Our innovation is our comprehensiveness, and our ability to weave together a number of accelerating tactics and technologies to drastically reduce NCD morbidity. Our innovation combines: Evidence-based field screening algorithm for risk, behavioral nudges to follow risks up at the clinic, digital clinic decision support systems to support Clinical Officer led care, and telemedicine to specialists as needed. It is common to see innovations tackle one thing such as a cheaper device, but we are committed to building comprehensive systems to solve health care for the global mass market with our partners. 

Technology helps us lower cost, assure quality and facilitate scale. We are expert integrators and users of data to improve operations. 

CommCare: tool for field case management, which we train health workers on so that they can screen close to patients. 

Odoo: cloud-based inventory management so that we never stock out at our sites. 

CarePay: digital savings wallet for predictable care expenses. 

Sasa: instant health loans at our clinics delivered via mpesa.  

Access Afya Academy: online training portal we built to get our providers and community workers up to speed on latest health knowledge quickly.

Goals relate to scaling reach(screening), improving compliance and improving disease control(outcomes).

Ongoing >55% of patients adhere to treatment regimen.

October 2018: one-year longitudinal outcomes prove 25% clinical control for diabetes and 22% hypertension. (This would mean we beat global NCD benchmarks, which range between 10-20%.)

Sept18- Jan19: screen additional 9000 people and enroll 400 in ongoing chronic care.

March19: Phase II data analysis proves >60% visit adherence and >25% control.

• Scale through Access Afya: when programs leave our “Labs” environment by proving sustainability and impact they are transferred to our health operations arm, which is growing at a rate of one clinic per month, serves ~4500 people per month currently and will be serving >35k people per month by 2020. At this rate we will have served >1.5m people by 2022.
• Partnerships: we are working on the Universal Health Coverage movement in Kenya advocating for community based primary care and tech-enabled care as essential pillars in UHC. As health financing options scale we can more easily scale. 

Internal reach: field based screening model, Access Afya Pharmacies and Clinics immersed in informal settlements. We've proven our internal operations and trust.

Partnership: agents engaged in screening camps e.g. pharma companies and NGOs can be partnering with us for long-term management and progress towards better patient outcomes. 

Retention: planned development of tools proving benefits of clinical control for patients, planned (already funded) work with behaivorists on tactics for retention. Active: peer support systems. 

>11,000 served with digitally enabled education and screening for NCD risk factors through a paid community agent model.

14% of screened patients exhibit risk factors. ~1/3 of people with NCD risk follow-up for further testing at a clinic. We push them on their journey through digital vouchers, messages and sometimes visits.

>500 people in active clinic management for NCDs, served with high-quality evidence based care at Access Afya Clinics. 

25 AA staff trained in NCD best practice and served through digital decision support tools to improve quality. 

70k visits to date at Access Afya.

12 months: >19k engaged in education and screening, >1k engaged in clinical management. One dozen field agents. AA Health has >230k served to date in 20 sites.

3 years: AA Health passing 900k served, all with access to Akiba ya Roho NCD education and screening module, est.126k people with NCD risk and target 63k in active clinical management. 

Our Medical Director Daphne manages Akiba ya Roho, leading a company task force that includes representatives from operations, clinical, customer care, and technology departments. Dr. Daphne is a Kenyan Physician with an Executive MBA in Healthcare Management and has worked in care delivery and at a telemedicine start-up. 

Founder Melissa Menke champions the program and has spoken about it through the Ashoka network, convinced BI to continue to invest, and was recognized by the Prince of Wales for AYR.

Our Informatics Director is starting a paper on the intervention with aim to publish in a peer-reviewed journal.

We earn revenue from screenings and clinical management. Clinics are experiencing a 15% boost in revenue from diabetes and hypertension management. We previously offered NCD services, but AYR’s approach of going into the community to educate people about cardiovascular health yielded increased clinic usage.

We are driving sustainability at our low-cost clinics through new innovative service models, while also learning that this program created loyal customers:

"...I happened to see your people on the road and they convinced me to get tested since it was free, they found that my pressure and my sugar level was high. I was shocked, I got the voucher and went to the clinic for the tests.  I am a truck driver, and that means I am gone for some time from Nairobi but I always come back for follow at the clinic and to buy more meds. Now my blood sugar is under control.” - Sayyli All Hassan Ahmed

The program drove sustainability because of both revenue and costs. A community member earns 10% of a Kenyan doctor’s salary, but can still uphold the same screening standard if they have the training and the tools that we created for this program.

We have a really strong foundation and an operational model that works and that we are growing. We want to scale faster through partnerships. Solve can provide visibility and a global network to facilitate this. We love the spirit of open innovation and build a lot of our tech on open source platforms (including one that I met while visiting MIT's D Lab and looking for health innovators to partner with). We are looking forward to learning more about the solve community. 

Health Financing: people get the best outcomes when they do not have to come up with the money for their full treatments on the spot. We have a lot of data on health needs and patterns and cost and would like to work with partners (micoinsurance, fintech, governments) to co-create models where patients do not always pay on the spot for their own healthcare.