What is AIHT?
The African Institute for Health Transformation (AIHT) is a non-profit entity established by the Kisumu Medical and Education Trust (KMET), Massachusetts General Hospital (MGH) and Sagam Community Hospital (SCH). The goal of this Institute is to strengthen the health system in western Kenya – and beyond – via development of an entrepreneurial platform that fosters the design and development of scalable innovations for health transformation in resource-limited environments.
The centerpiece of AIHT is the new Family and Emergency Medicine Residency (FEM) program, in collaboration with Maseno University School of Medicine, which will, for the first time ever, train Kenyan and Eastern African medical school graduates to become future leaders in Family and Emergency Medicine. (Figure 1 shows our four residents in a class on approaches to emergency care.) Ophthalmic care and diagnosis services as an important pillar under the curriculum.
In addition, AIHT has executed several initiatives towards the creation of model eye centre that focuses on prevention, care and treatment. Most recently, an eye camp was held at SCH in June 2015 (in collaboration with the Innovation Eye Centre and Siaya County Referral Hospital) where over 100 patients received outpatient services and 28 cataract surgeries were conducted. Such initiatives, strengthened by strategic partnerships and Memorandum of Understanding (‘MOU’) signed with Siaya County, put AIHT in a unique position in the provision of affordable and quality ophthalmic care services in the region.
Furthermore, AIHT has key technical experience in conducting research studies in the region and in counties covered under the proposed project. Currently, AIHT has several other additional innovations and research studies in its expanding portfolio (not limited to but including the following):
- Every Second Matters for Mothers and Babies Ketamine (ESM-Ketamine)™ Anesthesia Training Program: The training program for this life-saving, award-winning safe anesthesia solution in areas of Kenya with limited access to anesthesia services – it won the prestigious Saving Lives at Birth global competition in 2014 – is housed at AIHT. The ESM-Ketamine Program has accomplished several milestones since then, including hosting a successful regional stakeholders meeting in December 2015 and receiving full endorsement from the Kenyan Obstetrics and Gynaecological Society (KOGS) in February 2016. The training programme has sites in Siaya, Kisumu and Homa Bay counties. Ketamine Providers visit our online forum.
- Every Second Matters for Mothers and Babies Uterine Balloon Tamponade (ESM-UBT)™’: This initiative is a best-evidence package of targeted trainings, checklists and commodities that educates health workers in resource-poor settings on best-evidence postpartum haemorrhage care, including how to use a life-saving, innovative $5 device to stop uncontrolled and life-threatening uterine bleeding after childbirth; postpartum haemorrhage is the leading pregnancy-related killer worldwide. This initiative has already trained more than 1,000 health workers in Africa, and over 200 women’s lives have been saved to date. ESM-UBT also received a full endorsement from KOGS in February 2016.
- Every Second Matters for Mothers and Babies Fistula (ESM-Fistula)™: This initiative arose from the discovery that a significant proportion of women suffering from symptoms consistent with obstetric fistula have unrepaired third- and fourth-degree tears from birth trauma. Therefore, with basic skills training and improved community health system coordination, these debilitating injuries should be repairable at the local level. ESM-Fistula is a best-evidence package that consists of two essential cornerstones: one being skills-based training, and the second being regional organization and sensitization. Midwives and doctors at the community level are now being trained to properly diagnose and repair acute third- and fourth-degree obstetric tears, while referring more complex cases. The assessment was conducted in several health facilities in Siaya County.
- Noncommunicable Diseases (‘NCD’)/Palliative Care Study: Under this study, we are assessing the capabilities of healthcare facilities to manage diabetes, hypertension and heart failure in Western Kenya. Twenty-one (21) facilities in Siaya County have been surveyed including all district and sub district facilities as well as a sampling of other dispensaries and health centres. Data analysis is currently underway; however, preliminary results show that access to adequate equipment and awareness remain important barriers to optimal care of these diseases. Once data analysis is complete, interventions targeting specific limitations will be piloted at these facilities with the goal of improving NCD care throughout Siaya County.
- Emergency Department Registry Study: This is a study to review the Emergency Department (ED) registry of all the patients that have been managed by the ED at SCH since its inauguration in April 2015. Through this study, we hope to gain a better understanding of the epidemiological trends of emergent and non-emergent conditions in Western Kenya, evaluate and expose barriers, analyze overall management from initial triage to discharge, as well as extrapolate characteristics that define rural emergency care.
- HARK Trial: This clinical trial, funded by the Project High Hopes Foundation, tests whether a novel enzyme (hyaluronidase) can accelerate rehydration among patients who are moderately-to-severely dehydrated, in low- and middle-income countries. This is currently being implemented in several health facilities in Siaya County.
- E-Learning Tablet Program for Kenyan Medical Students: We have developed a low-cost Android tablet called connecTAB, which is preloaded with video lessons on cardiovascular and abdominal clinical examinations. The tablets are designed as training tools for medical students who live in low-internet bandwidth areas like western Kenya. This tablet is being tested among Maseno University medical students to determine whether the device improves clinical knowledge over time.
- Post Abortion Care (PAC) A randomized control trial to study the safety, efficacy and effectiveness of medical treatment of incomplete abortion provided to women by physicians or midwives in Kenya. Also to study the outcome of post abortion contraceptive counselling provided by midwives; providers’ perspective on PAC and contraception and to explore women’s experiences of post abortion contraceptive use and the treatment for induced incomplete abortion.
- Huduma Poa Social Franchise: is a network of 80 clinics run on a fractional social franchise model to deliver high quality health services. The network strategy eliminates missed opportunities in HIV testing and cervical cancer screening; assures provision of high quality family planning services; promotes child health by adoption of the recommended IMCI protocols; and provides linkages for tertiary care. KMET uses a three pronged approach in managing the network; Quality services are guaranteed by Quality Assurance Officers who oversee clinical services in the network, a marketing team composed of program officers and community health workers ensure sustained demand for services in the targeted communities. The third prong is the health financing supported by the medical credit fund (MCF) with a primary objective is to increase the delivery of affordable quality healthcare services.
AIHT is expanding into a new physical space – in the renovated Sagam Community Hospital – that will provide an innovative environment for education and research.
About Massachussetts General Hospital
The Massachusetts General Hospital (MGH) is the oldest and largest teaching affiliate of Harvard Medical School. The mission of the MGH Division of Global Health and Human Rights (GHHR) is to care for the world’s most vulnerable by developing and facilitating healthcare delivery, research, education and capacity-building initiatives. GHHR has extensive experience working in resource-poor settings – it has current or completed programs in Mali, Rwanda, Zambia, Liberia, Sierra Leone, Tanzania, Senegal, South Sudan, Kenya, Uganda, and Ghana – on initiatives designed to strengthen health systems through innovative solutions. The GHHR team comprises a diverse group of experts in maternal, newborn and child health, emergency medicine, economics/business, public health/public policy, and other salient fields to global health and development.
GHHR has received grant support from diverse funders, ranging from private foundations (e.g., Bill and Melinda Gates Foundation) to World Bank managed multi-donor trust funds as well as governments. GHHR is a three-time winner of grants from the global Saving Lives at Birth competition: (1) a $2 million award to scale up its Every Second Matters-Uterine Balloon Tamponade (ESM-UBT) system for post-partum hemorrhage in Kenya and Sierra Leone; (2) a $250,000 award to roll out its ESM-Ketamine package for emergency/life-improving surgery in western Kenya; and (3) GHHR is subcontractor on a 2011 Saving Lives at Birth grant: “Low-Cost, Point-of-Care Paper-Based Microfluidic Diagnostics for Improving the Identification and Treatment of High-Risk Pregnancies in Resource-limited Rural Settings.” Other programs include emergency care registry and innovations, non-communicable diseases and palliative care implementation research, alternative rehydration methods for severe dehydration, Africa’s first residency program in Emergency and Family Medicine, and surgical training collaboration development with COSECSA.
GHHR also hosts a Harvard Summer Program in Kenya on innovations for healthcare transformation, and is a founding collaborator on the new Kenya-based African Institute for Health Transformation (AIHT), which acts as an accelerator of innovations to improve population health. AIHT serves as the research hub where GHHR and its partners collaborate on multiple research and training programs. GHHR has strong and well-established partnerships with the Kenyan Ministry of Health, University of Nairobi, UNICEF, PATH, Pathfinder, Jhpiego, Sagam Community Hospital, Maseno School of Medicine and the Kisumu Medical and Educational Trust (KMET) among others.
About Kisumu Medical and Education Trust
KMET is a non-profit, non-governmental organization founded in 1995 and registered under the Kenyan Trustees Act in 1996. It was formed to create, establish and manage health, education and development programs; promote and manage medical institutions to provide and sustain comprehensive clinical and educational facilities and services of the highest quality throughout Kenya. KMET is managed through a Board of Trustees which ensures that the project is managed according to KMET policies and procedures of KMET and the laws of Kenya. KMET envisions communities with accessible quality, sustainable reproductive health and education services that promote human rights. Our Mission is to promote innovative and sustainable health and education programs among underserved communities. KMET’s Goal is to integrate reproductive health (RH) into core community development activities (This was one of the key resolutions at ICPD Cairo 1994). KMET’s Core Values are encapsulated in the acronym CHIGAID where: C – Community participation, H- Human rights promotion, I – Innovation, G – Gender Equity, A –Accountability, I – Integrity, D – Diversity. KMET’s comprehensive integrated RH model was identified as a best practice internationally leading to the Margaret Sanger Award (2004) by Planned Parenthood Federation of America (PPFA) for leadership and courage in advocating for Reproductive Health Rights, the first time for the award to come to Africa. KMET’s Comprehensive Integrated Reproductive Health Services model is based on the following principles: 1) Targeting Public and Private health providers to improve access to comprehensive RH services; 2) Establishing a Network of Providers (Huduma Poa); 3) Establishing a Medical Credit Fund to improve the capacity of facilities to provide RH services and Microfinance (through the KMET SACCO) as a service to motivate/sustain CHWs as volunteers; 4) Community oriented health access insurance plan for the provision of quality health services at the most affordable rate; 5) Targeting underserved adolescent and young girls (ages 10-24 years) through provision of life and vocational skills and economic empowerment as a strategy to prevent unwanted/unplanned pregnancies, unsafe abortion and HIV/AIDS; producing and distributing rewashable sanitary towels to disadvantaged girls in schools; and 6) Production and distribution of enriched Nutri-flour to chronically ill especially People Living with AIDS (PLWAs).
For more information on these research projects, visit the MGH Division of Global Health and Human Rights webpage.