OKOA MAISHA-4NCD -AN INTEGRATED DIGITAL PRIMARY CARE NETWORK

The JOIN Digital Platform seeks to solve challenges around three key thematic areas in health systems strengthening: Human Resources for Health (HRH), Health Management Information Systems (HMIS) and Health Service delivery.

• Human Resources for Health; Under the devolved structure of governance in Kenya, the counties face challenges of acute shortage of health providers across both primary and secondary level of facilities. This is worsened by insufficient number of healthcare specialists. This is largely due to the high wage bill of about 70% of the county’s revenues goes to payment salaries, thereby hindering their ability to employ the correct skill mix of healthcare providers.
• There are few opportunities for capacity building of the existing healthcare workers thereby hampering their ability to offer comprehensive and integrated quality healthcare services that responds to the high double-burden of communicable and non-communicable diseases that requires continuous life-long follow-up. The burden of NCDs is on the rise in Kenya, yet little attention is given. Approximately 50% of hospital admissions are due to NCDs which contribute to 40% of all hospital reported deaths.
• The top NCDs in Kenya are Hypertension, Diabetes and Cancer among others. The prevalence of Hypertension in Kenya is at 24.5% and Diabetes at 2.5%. the prevalence is higher in both urban and rural areas though largely undocumented.
• Among the general population, approximately 47% are reportedly have never had their blood pressure measured and 60% their blood sugar checked. Ideally, these screenings should be carried out routinely at primary healthcare level. However, this is not done due to lack of equipment, inadequate staffing and limited capacity/skills mix. Primary healthcare providers are not equitably empowered therefore communities they serve lack access to high quality services due to inadequate specialists. This is worsened by devolution where counties are not financially able to employ more given the  huge wage bill.   
• Health Management Information Systems; Health information is largely collected and reported using paper-based tools. This results into lack of data sharing, duplication of services, increased wastages available resources and high overall cost of providing services. This negatively impacts data-driven decision making at all levels for health systems.
• Health Service Delivery; A lack of access to quality health services at primary healthcare levels attributable to inadequate skill mix of healthcare workers and lack of proper referral systems for case management. This is especially the case in primary health care settings in Kenya. 

JOIN is a medical application for healthcare providers. It simplifies clinical communication and collaboration between healthcare providers at primary healthcare levels who are linked to specialists for mentorship and timely clinical decisions in patient management.

Under the three key health system pillars, the JOIN digital platform provides the following solutions:

• Human Resources for Health;
  •  JOIN digital platform is implemented in a ‘Hub and Spoke’ model working with both public and private health facilities, where specialists are mapped out within the hub site and linked up to primary healthcare providers in the spoke sites. The healthcare providers are provided with point of care devices to screen patients for diabetes, hypertension using existing ministry of health tools that are integrated to JOIN platform. The data is captured at real time and those at risk of diabetes and hypertension complications are discussed with specialists for early diagnosis, treatment, and effective referral to avert complications such as kidney failure and stroke. Health providers summarize cases in the JOIN platform while the specialists provide guidance, mentorship, and management support.
  • The platform digitalizes current local guidelines for NCDs. Healthcare providers get real time support and offline communication with specialists. JOIN platform breaks down silos and improves care by facilitating collaboration between primary healthcare provider at levels II and III) are connected with specialist at secondary and tertiary referral facilities (levels IV, V, and VI). The dispensaries and health centers therefore have access to the specialist providers therefore cutting cost of consultation and patient transportation.  The interaction between primary healthcare providers and specialist builds their capacity to better manage patients with NCDs. Additionally, this rebuilds trust between the communities and the primary healthcare providers.
• Health Management Information Systems;
  • JOIN is a medical application platform is interoperable with other electronic medical records in Kenya providing seamless communication within and outside hospital care thereby improving referral and continuity of care while ensuring data quality, effective reporting, and research that supports evidence-based decision making. Within hospitals, integrating clinical summaries, laboratory results, and prescriptions allows seamless monitoring and follow-up thereby providing ‘service anywhere anytime.’ This reduces the duplication, wastage, and overall cost of providing care.
  • JOIN has several unique features such as real-time information sharing within a secure platform. Information is encrypted, anonymized, and is stored in the cloud and not the device that collected the information. JOIN is compatible with iOS, Android, and the latest versions of web browsers such as Chrome and Firefox.  JOIN provides a unique feature of DICOM viewer which provides access to diagnostic images when connected to radiological and point of care diagnostic equipment. JOIN is compliant with HIPAA, EU GDPR, and ISO27001 and internationally certified as a medical device by FDA (US), CE (EU), PMDA (Japan), and ANVISA (Brazil).
• Health Service Delivery;
  • JOIN platform provides a robust data sharing system that helps reduce workload and keeping quality record of patient encounters for future use for decision making. JOIN connects primary healthcare providers to specialist therefore improving the quality of services offered across the health system. The continuous interaction between these two parties leads to Equitable skill transfer and improved capacity of primary healthcare providers to offer standard and quality health services at the primary healthcare level therefore assuring patient safety.
  • Using JOIN Digital platform helps in reducing costs and inequalities caused by geographical barriers that limit access to quality healthcare services. The platform allows patients to access specialists early after diagnosis thereby reducing cost of hospital care that arise from NCD complications.

• The solution primarily aims to serve health providers in the primary care network in Kenya who are supported by selected NCD specialists/physicians. These Frontline health workers drawn from both public and private sector working in Kajiado, Nakuru, and Baringo counties who are linked to County selected physicians/specialists. This has led to improved skills and capacity to offer affordable, quality and equitable NCD screening, diagnosis, treatment, follow-up and prevention health services.
• The primary healthcare providers are upskilled through JOIN digital platform who are then able to provide timely, quality health services.
•  Indirectly, the population seeking services in these counties will gain access to quality and equitable health services at affordable cost. The communities in these counties will gain access to integrated quality healthcare services especially for Non-Communicable Diseases (NCD’s) such as Diabetes and Hypertension therefore reducing hospital admissions and NCD related morbidity and mortality.

We are a locally registered organization based in Nairobi working with  public health sector stakeholders like Ministry of health (national) and counties  as well as private sector players like Integral Health Ltd leveraging on each other’s capabilities in strengthening health systems in in Kenya. In addition, our team is sourced locally with extensive experience in business and program management and have a strong, trusted networks at national and county governments level including private sector. 

We are compliant with the policy requirements to operate in Kenya. We have held several counties (county health management teams – CHMTs) and national government engagement meetings to co-create the target intervention areas while borrowing from their current Annual Work Plans (AWPs), County Integrated Development Plans (CIDPs), and County Strategic Plans. 

We have also carried out baseline needs assessment in the target counties to identify gaps across the pillars of health systems which informed our interventions. 

In the selected counties, we have existing Memorandum of Understanding (MoUs) and have developed good working relationships. Through this collaboration, we have developed digital solutions that are responsive to the needs of the target population. 

To assist us in developing a strong and sustainable model of care that can be scaled up to other regions. We are seeking the support of the Solve network. While we believe that our solution offers a revolutionary and transformative unique approach to shape healthcare in Kenya and sub Saharan Africa, we feel that our model can be further strengthened through the advisory support of global experts  We require resources to overcome market barriers through collaborative approaches.

JOIN is a digital application platform for healthcare providers that simplifies communication and collaboration between d healthcare providers and specialists through a secure and compliant patient information sharing technology platform. JOIN connects different infrastructures across the facilities we work with in collecting data, share and use the same to optimize the existing resources. Therefore, leading to improved access to affordable equitable healthcare services across the various levels of health facilities. The skills transfer can be adopted across other disease areas. The telemedicine, digital approach will transform how health is offered through policy, legislation and quality standards in healthcare in Kenya.  

Next year:

Increased knowledge and skills among Primary Healthcare providers on NCD management

Increase the capacity of PHP to identify patients with NCDs

Improved management and referral of patients with NCDs to specialists for care

Improved equitable health services across the facilities supported

Improved quality of data collected at primary health facilities supported

Increased accuracy of reporting after data Quality Audit at primary health facilities supported

Increased use of data for decision making at primary healthcare facilities supported

Next five years:

Reduced number of patients with complications of NCDs

Improved accuracy of decision making for NCD management 

• Number of primary Healthcare providers enrolled in to the JOIN platform per county
• Number of primary Healthcare providers trained on NCD management guidelines per county
• Number of primary Healthcare providers actively using the JOIN platform for case management per county
• Number of cases actively engaged by specialist per county
• Number of patients identified with NCDs per county 
• Number of concurrences in data quality audits per county
• Number of data review meetings held per county 

Vision: Bridge the gap in inequitable access to care in primary healthcare through digital mentorship for early identification and management of NCDs

Goal: To reduce NCDs related mortality

Objectives 

1. To train Primary healthcare providers (PHP) on NCD management using digital tools
2. To mentor PHP in identifying and managing patients at risk of NCDs complications 
3.  To improve data sharing among PHP for decision making 

Outputs 

• Increased knowledge and skills among PHP on NCD management
• Increase the capacity of PHP to identify patients at risk of NCDs complications
• Improve management and referral of patients with NCDs to specialists for care
• Improve equitable NCDs healthcare services across the facilities supported
• Improve quality of data collected at primary health facilities supported
• Increase accuracy of reporting after data Quality Audit at primary health facilities supported
• Increase use of data for decision making at primary healthcare facilities supported

Outcomes

• Increased number of skilled primary healthcare providers 
• Reduce number of patients with complications of NCDs 
•  Improve accuracy of decision making for NCD management

Summary of logical framework

If we train healthcare workers to identify patients at risk of NCDs complications using digital tools, we will reach more PHP within the target counties while they remain offering services without disruption of service provision.

If we connect PHP to specialist using digital tools then we will increase their capacity to identify and managing patients with NCDs will reduce the number of patients at risk of NCDs complications

If we correctly use JOIN application to collect and share data obtained from patient encounters, we will Improve quality of data collected at primary health facilities, this will improve the accuracy of decision making for patient management. 

Our strategy of working with existing systems and processes through the leadership structures within the target counties to create a shared value for patients and staff who are equipped with the necessary skills from specialist while utilizing a motivated workforce will lead to strong data driven decision making and quality of care at primary care facilities in target counties. 

This aims at form primary care network and strengthening of Primary health care (PHC) systems starting from the dispensaries and health centers, all linked to the hospital who have specialist thus forming a network of empowered practitioners who center around shared values that brings all together. These actors need to work in a balanced way to ensure effectiveness of this collaboration. The more the primary health providers in our network, the less the cost to support the systems and thus this value translates to lower cost of providing services due to reduces cost of transport and consultation per patient who seek care with the physicians and specialists directly. This will be achieved by comparing counties with intervention and those without the intervention by carrying out project evaluation and economic evaluation during baseline and thereafter regular and end term assessments.   

Join, a multifunctional platform that enables communication among medical professionals in a secure and mobile environment, using three critical and diagnostically important means of communication: text, video and medical information such as Digital Imaging and Communications in Medicine (DICOM) images and lab test data. Communication and information sharing are critical for treatment and knowledge sharing, Allm leverages technology to help healthcare providers fill gaps in care. The solution facilitates the exchange of information, encourages collaboration across different teams and facilities and enables task-shifting/sharing, Communication among frontline healthcare workers is critical for diagnosis, rather than solely image sharing, which makes this a key feature of the tool. Many DICOM solutions exist for image sharing but Join is the only platform that can be used with little or no hospital IT infrastructure because most of the systems can be kept in secure and consolidated servers outside the hospitals at low costs.

• One-on-one messaging and/or group communication
• Video live streaming: Join provides connection with cameras in the ICU and/or operating room, and with monitoring devices (e.g., electrocardiogram) for live streaming
• DICOM viewing: Images and pictures in messages can be shared, and DICOM images can be transmitted.
• The system can tie-up with hospitals’ picture archiving and communication systems.
• Join is standardized: DICOM viewer is a standard function, so the hospital PACS images can be viewed through Join, which doesn’t depend on the hardware type or manufacturer
• Video uploading for asynchronous access and video conferencing as a Telemedicine tool
• Tagging and timestamping: tagging the chat (e.g.: Disease name, nicknames or Special notes) when sending a message, the discussion can be focused on a specific patient or specific topic such as treatment, disease, symptom, or etc. Join can be used without using privacy information data such as patients' name and so on. This system therefore prevents misidentification of patients, and is also useful when reviewing a patient’s previous medical treatment.

We have ensured that our staff represent the countries where we work (Ghana, Kenya, South Africa and Rwanda) with a strong emphasis on equity and inclusivity; 40 % of staff are women in leadership, 90% of our staff are from Africa. The executive director is from Africa, The country, manager teams are from Africa. We envision to onboard the best talent of diverse, equitable and inclusivity. we are a equal opportunity employer non discriminatory in any way.

Our business model focuses on Primary healthcare providers and the patients they serve to deliver a comprehensive managed care services.  We provide a digital health solution for remote consultation and training (Primary Healthcare Providers) and the patients receive an integrated, quality and affordable health services through a hub and spoke model that combines diagnostic services, training, and follow up services. The primary healthcare providers gain skills that empowers them to be confident in providing health services therefore become trusted by the communities they serve.

We have various plans that support our interventions towards sustainability

Investors in our company

Grants, funding from our partners

Service contracts from partners

Fees charged for managed care services including teleconsultation for diagnostic treatment and follow up appointment. 

We have obtained grants from various partners such as the government of Japan(JICA), Investment capital from outside investors(Philips, Mitsui, Sompo holdings, AAIC) and contracts from Pharmaceutical companies.