Global health policy Opinion - 22/March/2022

The Journey to Create a Cross-Sector Partnership for NCDs in Kenya

It started with the aim of enabling national and local health systems in Kenya to manage chronic diseases for all patients. The partnership between Medtronic LABS and Kenya’s Ministry of Health has resulted in a tech-enabled, hyper-local care model that has reached over 40,000 patients and is expanding nationally.

The views expressed are those of the author and do not necessarily reflect the position of FORESIGHT Global Health.


The partnership between Medtronic LABS and the Kenyan health system was born under a coconut tree in 2018. During a site visit to a rural health center in Mombasa County, Medtronic LABS and facility staff sat outside and informally discussed the biggest barriers to better health for chronic disease patients.

First, patients were not identified early enough. Second, when patients were diagnosed there was no way to follow-up with them or to track their progress over time. Third, many patients were not receiving medications, but without data, there wasn’t a clear picture of health system gaps. While listening to doctors and nurses at the health facility, the Medtronic LABS team became motivated to dive deeper.

Meanwhile, the Department of Non-communicable Diseases (NCDs) at the Ministry of Health was working to improve access to care in Kenya. The Ministry of Health had already started spearheading pilots in key counties geared at achieving Universal Health Coverage, including coverage for NCDs like hypertension and diabetes. During the process, the department identified key gaps in data collection, digital technology, and community-based services that were key to translating policy into better health outcomes for the population.

Fast forward to 2022, and Medtronic LABS, the Kenyan Ministry of Health, and local governments have co-designed a tech-enabled service delivery model for hypertension and diabetes and have deployed the solution across six counties. Today, the collaboration is poised to scale nationally and become a benchmark for excellence in NCD care in the region, with generous donor support.

In addition to offering high-quality, comprehensive care to diabetes and hypertension patients, the program has “reduced bulk paperwork, and streamlined reporting functions to the Kenya Health Information System,” says Esha Bakari, NCD Coordinator for Mombasa County, Kenya, adding that

the active digital linkage from community to facility through strengthened community units is something to applaud

 The journey from a casual conversation under the coconut tree to a national chronic disease care model was not easy, and we learned many lessons along the way.

 

Start Small and Co-Design Along the Way

Instead of immediately rolling out a solution on a grand scale, the model was launched in select localities to gather feedback from stakeholders in real-time. Since a digital, community-based NCD delivery model had never been deployed, it was important to remember that there were no tried-and-tested solutions. Frequent knowledge exchange, and open-minded collaboration were critical. Along the journey, each partner shared their expertise and learned from each other. Medtronic LABS contributed digital health and field operation capabilities and the Ministry of Health and facility partners contributed their clinical, policy, and regulatory know-how. This agile methodology enabled all partners to jointly co-create and develop the solution.

 

Human and System Centered Design

The voice of the patient and community is often left out when developing healthcare systems. We wanted to break this pattern and develop a care model centered around the needs and desires of patients, families, and communities.

Yet, to make systemic change, we had to think beyond the individual. We combined human and system-centered design methods, to ensure that we met the needs at every level: from patient and provider to government and donor. By understanding the system, we were able to develop a model that could scale across facilities and integrate into the existing infrastructure.

Through many pivots, we engaged a wide spectrum of stakeholders for continual feedback. Patients, communities, and caregivers were engaged to build in-person and digitally accessible patient support groups, NCD curricula, and a tele-counseling solution. Clinicians and facility staff drove the development of new workflows and clinical decision support tools. Local government and Ministry of Health officials worked to improve program design and digitise reporting indicators.

The insight gained from these stakeholders helped build out a comprehensive model to screen, diagnose, risk-stratify, manage, and improve clinical outcomes for patients as early and as efficiently as possible.

 

Empower Health: A Localized and Sustainable Program

Working together, Medtronic LABS and the Kenyan Ministry of Health created Empower Health. The program offers patients screening, diagnosis, and disease management, as well as education, tele-counseling, and peer support groups – all at the community level.

Behind the scenes, SPICE, the Medtronic LABS’ digital health platform, powers the program. Community Health Volunteers leverage SPICE to monitor blood glucose, blood pressure, and risk factors at patients’ villages and homes. Meanwhile, care teams have access to real-time, longitudinal data for enhanced chronic disease management. To improve outcomes, doctors follow-up with patients and edit prescriptions and care plans – all digitally. Today, Empower Health is poised to be the tech-enabled standard of care for chronic disease in Kenya.

Dr. Alex Chai of Malindi Sub-County Hospital in Kenya called the program a “game changer” that has had a significant impact on the management of diabetes and hypertensive patients, supported by a rich body of data.”

 

Foster Empathy to Build Trust

Looking back, it’s important to remember that success didn’t happen overnight. From the initial discussion, the partnership took two years of planning and two more years of piloting and fundraising before we reached an inflection point. Anyone who works in partnerships knows that it all comes down to trust. But to build trust, we needed to start with empathy, because each partner organization operates in a vastly different environment.

For Medtronic LABS, working with the Kenyan Government was new territory. We quickly learned that the “Kenyan Government” is not a single entity, but rather a complex set of Ministries and departments, county, and local governments, each with their own domains. On the flip side, the Kenyan government needed to build an understanding of Medtronic LABS, a fast-moving and often changing start-up trying to do something that had never been done before.

In 2018, sitting under the coconut tree, we never imagined that we would develop a tech-enabled program to address NCDs at a national scale. Ultimately, strong relationships were the foundation of our success. Together, we saw how localized services could improve the lives of those with NCDs and developed a care model and digital health platform accessible to underserved patients. Through the power of cross-sector partnership, Medtronic LABS and the Kenyan Ministry of Health created a benchmark model for NCD care in Africa, and perhaps across the world. •

 

TEXT – Eric Angula, Head of Partnerships and Business Development, Africa and Anne Stake, Chief Strategy and Product Officer

 

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