CASE STUDY

Model of health for primary care

Public-private partnership model transforms primary care for Kenya’s citizens.

Challenge
What We Did
People and Culture
Related Capabilities

Challenge

In Kenya, thousands of children die annually from preventable ailments, like diarrheal diseases. With a more robust health system, such conditions could be minimized or prevented altogether. The Kenyan government has long understood the importance of strengthening primary care as the most efficient and effective way to improve its health system. It seeks universal healthcare coverage (UHC) by 2022 and has made increasing access to essential primary care services a priority.

UHC provides the health services people need, when and where they need them, without financial hardship. And it could prove a significant means for Kenya to achieve sustainable development goal 3⁽¹⁾ and ensure healthy lives and well-being for all. But how could the country expand capacity and funding for such an initiative, while reducing reliance on foreign aid? To improve health outcomes, quality and accessibility, Kenyan health leaders explored innovative primary care models and blended financing.

In Kenya’s Makueni county, the Ministry of Health sought public and private sector actors to support its UHC journey. It joined forces with Amref Health Africa, Africa’s largest health NGO, and Philips, the health technology company, to improve primary care outcomes. Together they imagined a public-private partnership (PPP), the Partnership for Primary Care, that would draw on Amref’s strengths in capacity building and health worker training, as well as Philips’ experience in health technology and infrastructure. Given the complexity of the task, they needed expertise in bringing the new model to life and improving primary care for Kenya’s citizens.

"The Partnership for Primary Care program brought together multisectoral stakeholders with a big ambition. The Accenture team supported the project in different phases, from designing the feasibility study to developing the financial model for scale."

— DANNY DUBBELDEMAN, Manager – Amref Ventures NL

What we did

Accenture assembled a team of strategists and global health experts to co-create the PPP model in collaboration with the Ministry of Health, Amref, and Philips. We aligned around the partnership vision and established clear roles and responsibilities, based on each partner’s capabilities. Working alongside these diverse actors, we developed a business case, financial model, and governance structure for the partnership with a focus on community engagement and patient-centered care.

To help the county’s healthcare workforce maximize care efficiency and effectiveness, the team identified 15 priority interventions. For example, we established a community healthcare unit powered by community health volunteers (CHVs) to engage with patients close to their homes. CHVs used a mobile learning platform co-developed by Accenture, called LEAP, to get essential health information, tools and services on-demand. A team also identified where health dispensaries and clinics could improve infrastructure and services to drive appropriate investments in equipment, IT and health personnel.

The PPP model launched at three sites and was tested over an 18-month pilot. Based on early results, the partnership team reassembled to plan scaling from 3 to 224 facilities throughout the rest of the county. We assessed critical interventions to scale the program and refined the business and financial model. Our team also helped coordinate involvement and buy-in from key stakeholders including the Kenyan government, the United Nations Sustainable Development Goals Partnership Platform, and Kenya’s National Hospital Insurance Fund (NHIF) to ensure additional technical and financial support as the model scaled across the county.

"The Accenture team showed amazing dedication to the project. They were able to accelerate the project development process through designing and managing a process that enabled decision making involving all relevant stakeholders."

— TIES KROEZEN, Venture Leader – Primary Care Philips

People and culture

With improved collaboration and coordination, many different stakeholders—from Philips’ health center designers and medical technology experts to Amref’s program managers, statisticians and doctors to government officials and community health workers—are working efficiently to deliver new quality healthcare services to underserved populations. An efficient organizational structure and pilot team were put in place to best serve citizens’ needs locally. Each pilot facility has the number and types of healthcare workers needed to meet shortages.

Ongoing community consultations in Makueni County helped generate community buy-in and a sense of ownership for the new services among prospective patients. Management training, a robust community health referral network and new digital tools helped staff access critical health information needed to provide quality care. Staff also voiced greater satisfaction and motivation to deliver better quality of care thanks to essential equipment, improved management, and regular training to enhance their careers.

These activities aligned workers around the vision and maintained momentum to translate the program’s goals into something tangible. Workers now feel empowered to identify challenges, make changes, seek support from qualified staff and partners to improve the quality and cost efficiency of care.

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Value delivered

The new healthcare model is the first of its kind in Kenya where an open and transparent PPP directly benefits citizens’ health. It is revolutionizing primary care in Kenya, and patients are getting the quality care they need to thrive. Patients can access needed facility equipment like ultrasounds and well-trained healthcare teams locally, without travelling long distances and overcrowding advanced care facilities.

Emali Health Center, one of the three pilot facilities, has received multiple awards for improving quality of care and facility management, including the subcounty Nurse of the Year, County Clinical Officer of the Year, and recognition for a Skilled Birth Attendants program.

"I was most impressed by the way team was able to manage the process, adapt to the cultures of the different stakeholders and secured alignment of all parties’ goals and ambitions throughout the process."

— DANNY DUBBELDEMAN, Manager – Amref Ventures NL

The pilot has shown how Kenya can improve healthcare quality and access with better facility management, operations and clinical financial performance.

15%

increase in enrollment in Kenya’s national health insurance system

31%

increase in prenatal visits

78%

increase in births attended by skilled practitioners

Thanks to the primary care facility assessment and design supported through this work, 85 out of 224 primary care facilities in Makueni County will upgrade infrastructure, equipment and IT. The project has enabled Kenya’s Ministry of Health to innovate new models of partnership in primary care. The model is being closely monitored by the National government as it considers rolling it out to millions of other citizens in Kenya and pursues its goal to provide UHC by 2022.

Reference:

¹Good health and well-being

"The consultants supported the project at multiple levels from strategy through business and financial modeling to facilitating meetings and writing project reports. The ability of the team to adapt to the culture in Kenya was impressive."

— TIES KROEZEN, Venture Leader – Primary Care Philips