Microfinance as an entry point to community health care – a new Healthcare Innovation Programme partnership with AMPATH launches

PCI is excited to have launched a new partnership with AMPATH in rural Western Kenya as part of our Healthcare Innovation Programme. Through the Healthcare Innovation Programme, PCI partners with organizations which provide chronic disease care at community level in innovative, sustainable ways. Such programs are crucial to finding new ways to manage diseases like diabetes and heart disease.

This project will see PCI work with AMPATH to pilot and extend a model of care called BIGPIC in which microfinance groups serve as an entry point in a comprehensive range of economic and health services. This approach incentivizes take up of and adherence to NCD treatment as well as breaking the cycle of poverty. Working closely with county Ministry of Health public services, the groups promote both linkage of at risk patients to care, ongoing attendance at clinics and access to affordable treatment.

This is an innovative, financially sustainable approach, that brings NCD management to a severely underserved population. Led by Dr Sonak Pastakia, who recently joined us for our annual PCI Team Day in Oxford, the AMPATH team will develop the pilot project over the next 12 months.  A recent article published in the Lancet on diabetes in Western Kenya, authored by Dr Pastakia and others who will be involved in implementing this project gives useful background to the challenges and learning opportunities that this project will provide.

A recent planning visit by Karen Bevan-Mogg, one of PCI’s clinical team members, also served to further develop our ideas together. Here’s what she had to say about the experience…

Last month, I visited the first Letshego Healthcare Innovation Program (HIP) project. It is called BIGPIC and is led by a very dedicated team at Moi University, Eldoret, in western Kenya. The BIGPIC (Bridging Income Generation with grouP Integrated Care) seeks to provide affordable good quality chronic disease care at community level and in doing so, demonstrate the value of Family Medicine doctors in strengthening primary care.

This is groundbreaking in several ways. In rural Kenya, access to healthcare is difficult, physically and financially. Most people live on less than $2/day and cannot afford medicine on a regular basis. The government has a health insurance scheme which would cover chronic disease care but uptake to this scheme is limited. Instead, using microfinance groups (which enable participants to borrow and repay sums of money to invest in and grow their small businesses) as an entry point, community members are screened for a range of health issues. BIGPIC also supports these groups with agricultural and business expertise. Once a month, a Clinical Officer (training grade between nurse and doctor) visits the group to provide chronic disease care and health education, which patients pay for from their profits if they wish. They may also choose to pay for health insurance, which obviates the need for cash payouts. Of course, not everyone is an entrepreneur, but the model has worked so well in nearby pilot sites that groups have invested in larger scale ventures and bought national health insurance cover for their families.

The Clinical Officer is supported by a trainee or qualified doctor from the Faculty of Family Medicine. In Kenya, the concept of Family Medicine is new. So new, in fact, that the faculty has a low profile and is only slowly becoming recognised. There is not yet a clear career path for those doctors currently training. PCI will support this fledgling speciality in Milo to demonstrate how important good generalist care in the community can be. I met some of the current trainees at various stages of the 4 year programme, joining them on ward rounds in Webuye Teaching Hospital and in the outpatient clinic. They have a tough road ahead, with few opportunities to serve their communities in the holistic role that they are being trained for. As I drove the two hours along dirt road to Milo with Dr Akiruga, who graduated last year, I was impressed by his dedication and passion to make the Milo programme work, despite the challenges they face and the scarce resources available. He gives his time and fuel for free, in order to supervise junior colleagues away from the hospital environment and show them what Family Medicine is really about – as they currently have no example to follow.

This is the very beginning of the BIGPIC program in Milo, following successful pilots nearby. As it develops, we look forward to being part of this novel approach to chronic disease care and hope that its success will lead to replication across the whole region…and eventually nationwide.