Personalized Antibiotic Stewardship Initiative (PASI)

Penda Health's Personalized Antibiotic Stewardship Initiative builds upon our large real-time AMR surveillance dataset sourced from physical and digital networks to bring individually-tailored antimicrobial guidance to clinicians using our AI-powered clinical decision support system.

Robert Korom - Chief Medical Officer

Penda tackles antimicrobial resistance (AMR) daily in our clinical practice, with clinicians across 16 Nairobi outpatient centers and a national telemedicine service witnessing AMR's severe impact. Patients fail to respond to standard antimicrobials for routine conditions or receive inappropriate broad-spectrum antibiotics from local pharmacies, leading to major safety concerns and side effects.

The causes of AMR are complex and multifaceted, and we've pinpointed key factors our solution targets. Firstly, healthcare providers in Kenya and much of sub-Saharan Africa are financially motivated to prescribe broad-spectrum antibiotics for common illnesses. This practice, involving both community pharmacies and healthcare facilities, has led to patient demand for broad, brand-name antibiotics. These problems, are further exacerbated by a distrust in outpatient care, causing patients to switch providers frequently, resulting in disjointed care plans and records. Misdiagnosis at the primary level and skepticism towards treatment plans contribute to antibiotic overuse and inadequate treatment of bacterial infections that actually need antibiotics. Our solution targets these root causes of AMR, including the lack of effective surveillance, misdiagnosis, overprescription, and the use of substandard medications, aiming to impact the millions at risk in Kenya and beyond.

Our solution is designed for low-income families across sub-Saharan Africa most at risk from the adverse health effects associated with AMR. This demographic encounters barriers to accessing quality healthcare services, significantly exacerbated by the widespread misuse and overprescription of antibiotics. Recognizing the complexity of these challenges, our approach is multifaceted, engaging community health workers deeply rooted in these communities and leveraging advanced digital platforms to ensure our interventions are both accessible and relevant.

We involve the target communities in the development of our solution, facilitating a two-way dialogue to understand their needs and preferences and empowering them to make informed healthcare decisions. This participatory approach ensures that our initiatives — from educational programs about responsible antibiotic use to improving access to quality medications — are tailored to address the specific challenges faced by our communities.

Our engagement strategy goes beyond consultation, incorporating feedback mechanisms through platforms like our call centre, telemedicine and digital apps, allowing for continuous adaptation and refinement of services based on real-time community input. This dynamic interaction fosters a sense of ownership and partnership among the communities we serve, ensuring that our solution not only addresses their current needs but is also adaptable to future healthcare challenges.

Penda Health is dedicated to advancing public health through our commitment to open research and data sharing, particularly in the realm of antimicrobial resistance (AMR). We plan to publish our methodologies and findings from both our data analysis initiatives and our Clinical Decision Support System (CDSS) enhancements. The intent is to make our AI-driven prompts and insights universally accessible, allowing health systems worldwide to benefit from our work.

Our track record in disseminating knowledge is established through peer-reviewed publications and various public platforms where we discuss our advancements openly, encouraging replication and adaptation. This ethos of sharing knowledge aligns with our vision of creating universally beneficial health solutions, not just for Penda Health's patients but for a global audience. By publishing our results and the data we use to arrive at them, we contribute significantly to the global public good, democratizing access to life-saving healthcare innovations. Through this approach, we strive to empower healthcare providers worldwide with the tools and insights necessary to combat AMR effectively

 Penda Health's AMR solution, leveraging our national leadership in patient-level data and expanding digital tools like WhatsApp and Grace Health, will have a significant impact on antimicrobial resistance management. Our proven track record in deploying digital clinician-facing tools, backed bypublications on CDSS, demonstrates a strong ability to implement the latest AI tools swiftly, ensuring wide adoption and significant healthcare improvements. Our capabilities in guiding clinician care withdigital tools and our track record in implementing AI for rapid, impactful change support this. The solution is designed to improve healthcare outcomes, reduce antibiotic misuse, and add to global AMR efforts. We plan to substantiate the impact with data from our broad patient interactions and healthcare worker feedback, demonstrating the potential to enhance patient care and mitigate AMR spread effectively. 

To scale our impact, Penda Health aims to broaden its AI-driven AMR surveillance across Kenya and into new regions over the next year, focusing on underserved communities. Over the next three years, the strategy includes extending this model internationally to at least two additional African markets, particularly in regions facing similar healthcare challenges.

Within any market that Penda operates in, we collaborate closely with national and local governments, healthcare organizations, and other stakeholders to ensure the integration of our solution into national health systems, leveraging shared resources and knowledge to maximize reach and efficacy.  One example of this in Kenya is our collaboration with NHIF – the government payor – where Penda is one of the largest outpatient capitation providers for the public sector, covering over 30,000 low-income beneficiaries through this program.  In any market we enter, Penda’s path to scalability depends critically on our relationships and engagement with the many stakeholders that comprise the healthcare system, especially the public sector.

Penda aims to scale our impact over the next three years by expanding our reach and enhancing the quality of care. The approach emphasizes both the number of patient encounters across its diverse service channels—including physical clinics, telemedicine, WhatsApp chat service, and the Grace Health app—and the quality of care provided. With over 1 million patient encounters in 2023 and an expectation to double in 2024, Penda focuses on a) process measures linked to quality care, like adherence to clinical guidelines, which notably surpasses the national average. In 2023, we exceeded 90% clinical guideline adherence compared to anational average of about 40%. We also assess quality through b) direct patient outcome measures and c) patient satisfaction surveys, contributing to building one of the largest databases of patient-reported outcomes in East Africa. With more than 80% of visits from repeat patients, our strategy includes continuous improvement based on patient feedback, indicating trust and satisfaction. This multi-faceted approach aims to increase patient engagement and ensure high-quality, accessible healthcare services, contributing to a substantial and scalable impact against antimicrobial resistance and beyond.

Drawing from our resilience during the COVID period and beyond, we aim to apply our strong community-led and innovative adoptions to navigate through financial, technical, regulatory, cultural and market access as we scale. To address financial barriers, Penda will seek new funding and efficiently allocate budgets for facility upgrades and tech stack enhancements, including exploring innovative payment models like capitation. For technical challenges, we will continually upgrade and integrate our mission-critical tech stack, ensuring it remains robust and effective in delivering healthcare services while incorporating global best practices. Collaborations with entities like the Trinity team and leveraging insights from MIT could provide invaluable support in these endeavors. Regulatory, cultural, and market barriers will be navigated through close collaboration with governments, healthcare organizations, and local communities. This approach not only facilitates our compliance and the smoother implementation in new regions but also enhances community trust and adoption of our healthcare solutions.

These adaptive strategies position Penda for significant scale which is crucial for expanding our impact across regions. Our commitment to improve healthcare access and outcomes, particularly in combating AMR, remains at the forefront of our mission as we navigate these challenges and pursue growth opportunities.

Penda Health is applying to The Trinity Challenge to leverage the network's resources, expertise, and funding to overcome barriers in combating antimicrobial resistance (AMR). The challenge aligns with Penda's mission to provide scalable, data-driven healthcare solutions. Specifically, the challenge can assist in overcoming financial constraints for technological advancements, accessing a broader expertise network for scaling our solution, and navigating regulatory landscapes for new market entries. This support would significantly accelerate our efforts to deliver impactful healthcare interventions, particularly in AMR surveillance and management.

Penda Health can greatly benefit from collaborating with The Trinity Challenge members like Google, Facebook, the Bill & Melinda Gates Foundation among others. Partnering with Google can enhance Penda's data analytics and AI capabilities, leveraging Google's advanced technologies and platforms for more effective AMR tracking and response. Collaborating with Facebook and WhatsApp by extension can amplify Penda's outreach and patient engagement through social media platforms, enhancing awareness and education on AMR. The Bill & Melinda Gates Foundation can provide both financial support and invaluable expertise in health innovation, aiding in scaling Penda's solutions and integrating them into broader health initiatives. These collaborations can accelerate Penda's impact in combating AMR, leveraging each organization's strengths to create a more robust and effective response to this global health challenge