Building Strong Health Systems in Kenya

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Dr. David Wanjala, Medical Officer in Charge at Tudor District Hospital in Mombasa, Kenya, recently sat down with Linda Suttenfield, Pathfinder International’s Director of Communications, to share how the APHIAplus Nairobi-Coast project,* led by Pathfinder and funded by USAID, has made a difference at his health facility.

Can you tell me a little bit about the Tudor Hospital?
This is a district hospital with skilled senior staff. We have staff who work in the hospital, as well as those who are part of the ‘district management health team.’ APHIAplus provides both of them with support—to better supervise staff at our institution and at lower-level health facilities within the Mombasa health jurisdiction.

How has APHIAplus helped improve health services here?
APHIAplus trained most of our staff to provide integrated services related to reproductive health and HIV and AIDS. Before APHIAplus, a person visiting the hospital might have to move from one department to another, because the services were not well integrated. Now they can visit just one department and get what they need. For example, someone visiting a comprehensive care center, can get everything they need right there without going to another department. This is one of the greatest steps we have made with support of APHIAplus.

In what other ways has the project built the capacity of your staff?
APHIAplus trained them on logistics. I remember we used to have issues with data collection. APHIAplus worked with us to identify data clerks and determine how to motivate them financially. Recently, one of our clerks was so hard working that she was promoted to district health records information officer.

Also, APHIAplus trained our heads of departments to better supervise their juniors and coordinate with other institutions. Actually, I am one of the beneficiaries of this training.

Why is supervision—and mentorship—so important?
APHIAplus assists us with mentorship, which we never had before. They train experts—pharmacists; lab technologists; and clinicians in many disciplines, including HIV counseling and testing—to mentor staff at facilities in our district.

There was a site with HIV-positive clients who needed to start their antiretroviral treatment, but the health office did not have the capacity to assist them. The mentors sat down with staff and taught them about clinical diagnoses; how to start the treatment; how to monitor and document their work. They took their mentees through the entire process until they were confident and able to deliver the services. Then the mentors moved to another facility—in the spirit of decentralization.

Also, twice a month at this institution, there is continuing medical education. These experts train health workers for 1-2 hours per session to expand their skills.

How has APHIAplus strengthened the health system here?
If you look at health systems building blocks—there are six—APHIAplus has covered all six in this hospital. In addition to the health worker training and supervision, and the training of department heads in supportive supervision, APHIAplus has provided financial assistance in the form of renovations and equipment—examining beds and lamps, weight scales, tables, screens, blood pressure machines, autoclaves, and a pharmacy dispensing booth. These have been excellent; they have made service provision very easy.

Before, staff would have to come from one department to another to borrow equipment. Or they might send a weak patient to another department to be weighed or have their blood pressure taken. Now there is much less burden on patients. All departments are equipped with necessary items and skilled staff. In terms of technology, APHIAplus has assisted with new software to improve data collection and storage. We have three new computers on the way.

With all of these improvements, what kinds of results do you see?
There has been a great change. Because of the smooth provision of services, the numbers of patients visiting the institution is very high. We are attracting people from other institutions to come to our hospital. The waiting time has been reduced and is now low. Client satisfaction has also increased.

About client satisfaction—APHIAplus taught us how to confidently communicate with patients. For example, we have the new pharmacy dispensing booths, which give patients confidentiality. Now they can get their medicines privately and really take in the instructions, without fear that others are listening.
In an average month at Tudor District Hospital, 5-10 babies are born to women living with HIV. According to Nursing Matron Dorah M Kiplagat, in past six months, not a single one of them has been born with HIV thanks to support from APHIAplus Nairobi-Coast.
Also, in terms of outcomes, just look at the prevention of mother-to-child transmission of HIV services in the last two years. The quality of the services the mothers and infants are getting, as well as the follow-up they are receiving through our linkages with vibrant community structures, has improved. More people are accessing antiretroviral treatment and utilizing support groups that decrease stigma.

Overall, APHIAplus has made the health system in this institution much better than it was three years ago, and we expect this assistance will continue.

You can see more photos from Linda's trip to Tudor District Hospital on Storify.

*The APHIAplus Nairobi-Coast Service Delivery project is funded by USAID and implemented through a partnership between Pathfinder International, ChildFund International, Cooperative League of the USA, Population Services International, and the Network of AIDS Researchers of Eastern and Southern Africa. The project provides large-scale support to six county health systems. In very close collaboration with the Ministries of Health and through a coordinated approach with several partners, it carries out activities at every level—from province to county and district level and reaching down to the district health facilities and their communities.

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