The Triad forHealth equity

Inequity in health is caused by lack of access to healthcare. This lack results from health workforce shortages and inequity in their distribution globally. Health workers restore and maintain health. They also prevent and control illness.Therefor access to a health worker is essential for good health. According to the World Health Organization, about 1/2 of the world's population has limited access to care when they need it. This limitation endangers their lives and exposes them to complications that are very difficult and expensive to manage. Eventually, they may die in numbers. In Kenya Public Primary Health facilities where the majority seek care are in deplorable condition. Many of the primary facilities are more than five kilometers away with roads in deplorable state. Further, the facilities have persistent shortages of health workers and therefore low staffing levels. The existing workforce in these facilities is demoralized and not motivated because they are overworked and least appreciated. In addition, many of these facilities do not have adequate basic infrastructure for service delivery. Also more often the facilities have inadequate essential Medicine including emergency drugs. Workforce shortage affects access, quality, and availability of health services. However, Tools and workforce measuring and planning models are either lacking or inadequate. Conventional models like the fixed ratio staffing norms and standards though useful are inadequate to address the ever-changing health needs and demands. Over the last 10 years, the World Health Organization developed and published for use the workload indicator of staffing needs model to measure and support workforce planning.  Health Workforce planning suffers the most due to lack or inadequate data driven tools models and evidence required to support human resources for health investment. It is worse for decentralized (devolved) health systems because they lack capacity and financial resources to measure and support  workforce planning that is essential for the overall performance of the health system. The consequences of this is that it exacerbates the bad situation . Makes the working environment unconducive for the existing workforce and increases turnover. Increases workload which has a direct relationship with work pressure  increases the risk to occupation injuries, infection and mental anguish among other negative impacts to the workforce. Also medical errors increase thus endangering lives of clients and patients . Improper hazardous health care Waste disposal may also affect the environment endangering both people and animals . The costs and impacts of the negative outcomes is enormous .

we used the WHOs-workload indicator of staffing needs (WISN) concept to develop a mobile  app that is used to determine a standard workload(number of patients attended to) at a given health standard (Standard operating procedure - SOP) using the available working time in a day (derived from Government policy on labour and employment). Thus the triad. Our solution the the triad for health equity is a patient-centered model that prioritizes the patient - the patient, the health worker, and the available working time to determine a standard workload for a worker per day. This ensures and guarantees access to quality safe and equitable health services.   The model provides an all-in-one means to measure, analyze, and interpret workforce requirements for optimal health systems performance. provides data-driven evidence for decision-making by all health stakeholders. It also models solutions for access and availability of quality acceptable and safe health service delivery especially for vulnerable and underserved populations including primary health. In addition, we provide technical support capacity building and means to track monitor, and evaluate the performance of the entire health system. Our triad for health equity model is a novel health workforce measurement approach that uses the WHO's Workload indicator of staffing needs model concepts. The model links the worker and the client/patient through workload. Available working time is calculated and together with the standard operating procedure (the time it takes a health worker to deliver service to a client is documented. The two are then used to compute the standard workload that is used to compute the needed number of workers for the actual daily facility workload. Workers' absence a major contributor to the non-availability of workers is addressed by automation where workers' bio-metrics are used to monitor their presence by clocking in and out. Automation and use of electronic medical records provide the health worker a tool to account for the use of their time and the service they provide. Also, reports are generated in real time thus saving time spent on some of the support services. The model can be used to inform training institutions about the community needs that are not met by the current curriculum. Also, the model is used to identify tasks that do not require highly technical skills that can be transferred to other cadres after short training. The model places the worker and the patient at the center of the health action thus it's a people-centered approach to health care. Several systems can be Linked using workload as the anchor district health information systems (DHIS2)  the electronic medical records and the WHO's international classification of diseases (ICD 11). Overall our solution is versatile and can be used by most health stakeholders to meet their specific requirements. The model has the potential for upscaling for Global use with collaboration from the solve community

Our solution targets all health stakeholders. Our prototype targets is public primary health facilities in Kakamega Country. There are about 50 health centers with a catchment population of 30,000 each. About 105 dispensaries with a catchment population of about 10,000. 443 community units with a catchment population of about 5,000 each. The population is served by about 2590 assorted cadres of health workers, Several partners and Government institution within kakamega County. The Care is provided majorly by these Government facilities . We  Provide data driven evidence to empower health managers and Government to make the right decision regarding the health workforce that supports Access, Availability , quality and safety health services. Health workers benefit since the working environment is improved through our modelling. Medical errors reduce and patients get the promised constitutional highest attainable health standard . Our objective is to support stake holders achieve universal health coverage and attain sustainable development goal of health and well-being for all ages and foster a good working environment that is equitable safe and enjoyable to all.Our solution quantifies   

1) The Health standard to measure quality

 2) Workload to measure utilization and demand for health care

 3) Available working time to measure availability of the health worker.

 This makes it a precision science that can be used to bring efficiency and effectiveness to workforce planning including tracking of wastage. More benefits can be derived from the analytics and modelling if improved through collaboration with experts in analytics and artificial intelligence

This is a Front-line health workers initiative that seeks to answer the following questions 

1. Why is it difficult to access quality acceptable safe health service public Primary Health facilities

2. What can be done to improve the situation in the public health facilities 

3. How can it be  done 

4.Who is responsible for what health action

 Our team is made up of experienced Front-line health workers, professional experts, experience health managers and experienced researchers working both at the University and the Country Governments Department of Health Services. This is a research project for our team lead supported through mentorship  by university lecturers and fellow workers. The model has a big potential for growth and scale up beyond Kenya. The tools and the model is a collaborative effort from clients/patients, Health workers Health managers from the county Government and the University to build capacity for the right decision regarding the community's health. Their input  is incorporated in the final tool for use in the projects analytics.

our solution is still a prototype and is in the process of getting intial feedback and testing with users (i.e. running a pilot). 

Working in primary public health facilities in Kenya is quite challenging because of several inadequacies :

1. The infrastructure is either lacking or inadequate requiring improvisation
2. Extremely low levels of staffing compromise quality endangering both the patient and the workers.
3.  Many patients go home unattended risking complications and even death 
4. lack or Inadequate essential Medicine including emergency drugs makes the working environment  difficult to work in 
5. No data-driven evidence to inform decisions that affect patients and workers alike

we are applying to fund the testing and validation of our prototype with the stake-holders. Equity can only be achieved through policy and affirmative action from Government . we intend to provide evidence for informed action through several partinership forums  and knowledge and insights sharing meeting . organizing for this meetings is quite costly thus our application for support. Also the challenge will indeed help us test and validate our prototype  and model for improvement and scale up from web-based  and mobile phone applications to other software applications. Also, capacity building in Big data analytics and artificial intelligence can improve our capacity to scale up the model beyond Kenya. The University is in the process of strengthening its program of health information and informatics, therefore, collaboration with MIT through mentorship and fellowship programs will help in building the University's capacity to deliver its mandate of providing solutions to society's problems. Since this is a MPH of Public Health project the challenge can help the University to set up a consultancy in health information systems and informatics. Networking with other solvers will help improve the model for the world as a public good

The triad for health equity is a simplified generic of the WHO's workload indicator of staffing needs (WISN) that uses the concepts to develop a mobile app and automates the analytical and the process of workforce deployment  distribution and re-distribution in our healthcare system

We will measure the impact using a blend of logical and logistic framework works. The following figures and tables will provide the illustration for progress tracking Monitoring and Evaluation. The framework looks at the process output outcome and then the impact. In addition, the logical framework provides the indicator and the means of verification .

our solution is based on a simple moile app in the form of a calculator for the standard workload at a given health standard and at the national available working time 

The solution is masters of public health for the team lead. it has no full-time nor part-time workers . The team has seven members from both the university and the county government where the team lead works 

we have been working on this solution for last one year . intialy we worked on exel techinology the the last sx months we transitioned it to web - based prototype for testing and validation 

As a subsidiary of a public university, the department of public health and the health  informatics program we will rely on the government grants and through sustained donations and grants to sell our services and provide service contracts to Government partners and private entities