Afya Bora: An Approach to Global Health Leadership

Afya Bora: An Approach to Global Health Leadership

Afya Bora: An Approach to Global Health Leadership

Aliza Monroe-Wise, MD, MScCarey Farquhar, MD, MPH

Aliza Monroe-Wise, MD, MScCarey Farquhar, MD, MPH

OverviewOverview

Afya Bora: The Concept, Participants, Timeline, and Activities

Structure 3 week modulesAttachment sitesMentorship

My experiencesAttachment siteActivitiesGO Health Project




Afya Bora: The ConceptAfya Bora: The Concept

4 US Academic Institutions partnered with 4 African InstitutionsUW - University of Nairobi (Kenya)UCSF - Makerere University (Uganda)UPenn - University of BotswanaJohns Hopkins - Muhimbili University

(Tanzania)

Participants chosen from 85 applicants in medicine, nursing, and public health

4 US Academic Institutions partnered with 4 African InstitutionsUW - University of Nairobi (Kenya)UCSF - Makerere University (Uganda)UPenn - University of BotswanaJohns Hopkins - Muhimbili University

(Tanzania)

Participants chosen from 85 applicants in medicine, nursing, and public health

Afya Bora: The ParticipantsAfya Bora: The Participants

23 Fellows selected7 Kenya, 4 Tanzania, 4 Uganda, 4

Botswana, 4 USMultidisciplinary group

10 Medical post-graduates and post-residency physicians

13 Graduate nurses9 with public health degrees (2

PhD; 6 MPH)7 men and 16 women

23 Fellows selected7 Kenya, 4 Tanzania, 4 Uganda, 4

Botswana, 4 USMultidisciplinary group

10 Medical post-graduates and post-residency physicians

13 Graduate nurses9 with public health degrees (2

PhD; 6 MPH)7 men and 16 women

Afya Bora: Timeline and Activities


2-day Orientation and Responsible Conduct of Research Training

Core Curriculum 3 one-week modules

Attachment I

(~3 months) Independent Projects at

Attachment Sites

1-day workshop for Mentoring Teams within first 2 weeks

Weekly meetings with primary mentor

Semi-monthly meetings with Country Lead and Fellows in-country

Monthly meetings with Mentoring Team

Project report due last day of rotation

January 7-28 January 31-April 28

OverviewOverview







Module 1: Leadership Skills Module 1: Leadership Skills

Leadership attributes Definitions of leadership Leaders vs. Managers

Strategic thinking Thinking vs. Planning SWOT analysis

Consensus building Modalities, steps

Mentorship Mentoring vs. training vs. coaching The learning contract model Roles, benefits

Leadership attributes Definitions of leadership Leaders vs. Managers

Strategic thinking Thinking vs. Planning SWOT analysis

Consensus building Modalities, steps

Mentorship Mentoring vs. training vs. coaching The learning contract model Roles, benefits

Module 2: Implementation Science & Health Systems Module 2: Implementation Science & Health Systems

Stakeholder and policy analysis Polio eradication case

Measuring impact and effectiveness (surveillance, metrics)

Operations research Qualitative Health Systems Research

Sex worker case

Cost effectiveness and economic analysis Motor vehicle injury prevention case

Social marketing Group Case Discussion

Stakeholder and policy analysis Polio eradication case

Measuring impact and effectiveness (surveillance, metrics)

Operations research Qualitative Health Systems Research

Sex worker case

Cost effectiveness and economic analysis Motor vehicle injury prevention case

Social marketing Group Case Discussion

Module 3: Project Management & Research

Coordination

Module 3: Project Management & Research

CoordinationFederal and international ethics regulationsExamples and cases from US, Kenya, etc

Budget and financial managementCase: how to develop a budget

Personnel managementCase: the SHARE projectSubject recruitment and retention

Data ManagementCreating questionnaires and databases

Federal and international ethics regulationsExamples and cases from US, Kenya, etc

Budget and financial managementCase: how to develop a budget

Personnel managementCase: the SHARE projectSubject recruitment and retention

Data ManagementCreating questionnaires and databases



2-day Orientation and Responsible Conduct of Research Training

Core Curriculum 3 one-week modules

Attachment I

(~3 months) Independent Projects at

Attachment Sites

1-day workshop for Mentoring Teams within first 2 weeks

Weekly meetings with primary mentor

Semi-monthly meetings with Country Lead and Fellows in-country

Monthly meetings with Mentoring Team

Project report due last day of rotation

January 7-28 January 31-April 28

Attachment SitesAttachment Sites

Kenya: MoH, AMREF, Kenyatta Hospital, Kenya Medical Research Institute

Uganda: Joint Clinical Research Center, MoH

Botswana: University of Botswana, i-TECH, Botswana-USA CDC

Tanzania: Ben Williams HIV/AIDS Found, AMREF,

Kenya: MoH, AMREF, Kenyatta Hospital, Kenya Medical Research Institute

Uganda: Joint Clinical Research Center, MoH

Botswana: University of Botswana, i-TECH, Botswana-USA CDC

Tanzania: Ben Williams HIV/AIDS Found, AMREF,

MentoringMentoring

1-day workshop for Mentoring Teams within first 2 weeks, includes fellows

As needed meetings with Attachment Site Mentor

Weekly meetings with Primary MentorSemi-monthly meetings with Country

Lead and Fellows in-countryMonthly meetings with Mentoring TeamProject report and evaluation due last

day of rotation

1-day workshop for Mentoring Teams within first 2 weeks, includes fellows

As needed meetings with Attachment Site Mentor

Weekly meetings with Primary MentorSemi-monthly meetings with Country

Lead and Fellows in-countryMonthly meetings with Mentoring TeamProject report and evaluation due last

day of rotation

OverviewOverview







Attachment Site: AMREFAttachment Site: AMREF

Founded in 1950s by British DoctorsEmphasis on flights to remote areasInternational organization with

operations in 29 African countries, as well as offices in UK and USA

Vision: Better health for AfricaStrategic foci:

Community partnering for better healthHealth systems and policy researchCapacity Building

Founded in 1950s by British DoctorsEmphasis on flights to remote areasInternational organization with

operations in 29 African countries, as well as offices in UK and USA

Vision: Better health for AfricaStrategic foci:

Community partnering for better healthHealth systems and policy researchCapacity Building

AMREF: KenyaAMREF: Kenya

HIV/AIDS integrative approach Sanitation and basic servicesMaternal and child healthNursing clinical skills coursesCommunity health worker

trainingWork in remote rural areas, and

urban slums

HIV/AIDS integrative approach Sanitation and basic servicesMaternal and child healthNursing clinical skills coursesCommunity health worker

trainingWork in remote rural areas, and

urban slums

KiberaKibera Urban slum with ~2.5 million residents;

60% of Nairobi population (gov’t estimate 170,000)

?Largest slum in Africa 2 water pipes, 20% electricity, no sewage

Urban slum with ~2.5 million residents; 60% of Nairobi population (gov’t estimate 170,000)

?Largest slum in Africa 2 water pipes, 20% electricity, no sewage

AMREF: KiberaAMREF: Kibera

Full care clinic in KiberaMaternal health carePediatric clinicAdult clinicHIV testing/careTB clinicLaboratorySocial workPharmacy

Full care clinic in KiberaMaternal health carePediatric clinicAdult clinicHIV testing/careTB clinicLaboratorySocial workPharmacy

AMREF: KiberaAMREF: Kibera

HIV counseling and testing programOver 3,800 HIV-positive patients

have enrolled to dateAlmost 2000 on ARVs823 defaulters identified (no

return to clinic in >90 days)Tracking in progress

HIV counseling and testing programOver 3,800 HIV-positive patients

have enrolled to dateAlmost 2000 on ARVs823 defaulters identified (no

return to clinic in >90 days)Tracking in progress

ActivitiesActivities

Evaluation of clinical practice by Clinical Officers in the adult medicine clinicHIV testing, counseling, group information

session, enrollment, follow-up

Evaluation of procedures in laboratoryHIV rapid tests, CD4 count, malaria blood

smears, stool O&P, UA

Evaluation of tracking activities performed by the clinic Social WorkerHIV “social assessment,” tracking defaulters

Evaluation of clinical practice by Clinical Officers in the adult medicine clinicHIV testing, counseling, group information

session, enrollment, follow-up

Evaluation of procedures in laboratoryHIV rapid tests, CD4 count, malaria blood

smears, stool O&P, UA

Evaluation of tracking activities performed by the clinic Social WorkerHIV “social assessment,” tracking defaulters

ActivitiesActivities

Review of HIV/ART databaseLarge longitudinal database from all

HIV positive patients in the clinicPreliminary literature review

Several studies published regarding HIV positive cohort in Kibera slum

Attendance at meetings of ART program staff and clinical providers

Review of HIV/ART databaseLarge longitudinal database from all

HIV positive patients in the clinicPreliminary literature review

Several studies published regarding HIV positive cohort in Kibera slum

Attendance at meetings of ART program staff and clinical providers

Project: Goals & HopesProject: Goals & Hopes

Afya Bora FellowshipLearn GH leadership skillsGain valuable GH experience with

international organizationAMREF Management

Data analysis of existing dataJournal publication

AMREF Kibera EmployeesImprove working conditions in clinicServe as advocate & liaison with

managementPersonal Goals

Afya Bora FellowshipLearn GH leadership skillsGain valuable GH experience with

international organizationAMREF Management

Data analysis of existing dataJournal publication

AMREF Kibera EmployeesImprove working conditions in clinicServe as advocate & liaison with

managementPersonal Goals

Project OverviewProject Overview

Quantitative Data analysisEvaluation of overall project retentionTiming between visitsFactors affecting time between visits

Value Stream MappingSteps taken in clinic visitsValue in individual steps analyzed

Time in Motion AnalysisTiming of steps taken in clinic

Quantitative Data analysisEvaluation of overall project retentionTiming between visitsFactors affecting time between visits

Value Stream MappingSteps taken in clinic visitsValue in individual steps analyzed

Time in Motion AnalysisTiming of steps taken in clinic

Preliminary Data AnalysisPreliminary Data Analysis

Major BottlenecksMajor Bottlenecks

3848HIV+

310881%

303198%

236178%

202586%

194096%

111758%

Eligible for

Program

CD4Testing

Retention >90 days

#ExtraIf

Eliminated

270 320 823

Time and Motion AnalysisTime and Motion Analysis

One observer watches all patients coming to the clinic

Records of wait times at each step taken in clinic

Overall bottleneck steps can be evaluated

Can be used in conjunction with value stream mapping

One observer watches all patients coming to the clinic

Records of wait times at each step taken in clinic

Overall bottleneck steps can be evaluated

Can be used in conjunction with value stream mapping

Documents

Afya Bora: An Approach to Global Health Leadership