Strengthed Neglected COVID-19 Management

The current Kenyan COVID-19 management is mainly focussing on symptoms  management and neglecting crutial aspects including palliative care, legal aspects and self care for health care workers. Lack of integration of these critical areas have led to the following; burnout among health care workers, emational and spyschological trauma among patinets and their families. 

The project will empower health care workers provide palliative care services inclusing end of life and breavement support, address legal challenges facing patients and their loved ones. The project will also equip them health care professionals with skills to manage work related stress and burnout. The empowerment will be done through online training and mentorship follow up by experts. 

The material developed will be made public to enable other stakeholders adapt them to fit their sutuations especially in resource limited countries.

The current Kenya national guidelines for managing COVID- 19 patients have not factored in palliative care, legal and bereavement support.  This has negatively affected the care given to patients and families. Recently it was reported in the media that some individuals who turned positive for COVID- 19 were stigmatised by the communities. The families that lost their loved ones from COVID-19 did not have time to say good bye and even attend burial, this led to alot of psychological suffering. In a recent incident in Kenya, a patient died and was buried at night in a body bag with very limited family involvement. Kenyan health care workers’ unions have expressed that their members have not been fully equipped to deal with COVID-19 pandemic from patient management, self care and protection.  From the above challenges, it is evident that there are critical gaps that need to be addressed to improve COVID-19 patients’ outcome as well as protect the welfare of the health care providers.  

Most countries in developing world are starting to experience an increase in COVID -19 cases hence the need to strengthen the workforce to deal with this emerging challenges.

Health care in Kenya has been devolved and is currently managed by county governments. Kenya Hospices and Palliative Care Association (KEHPCA) has established working relationship with 30 counties and these counties have well established palliative care units. KEHPCA will work with palliative care teams in these counties to identify health care workers and legal specialists in their region to be trained on the identified gaps.The legal experts must be wiling to volunteer theiur time to provide legal care on pro bono basis.The training will be through online platforms using webners and other platsorms.  A total of 180 participants will be trained. These individuals will also be trained to become trainers so that they can disseminate the knowledge gained to other healthcare workers in their region.  Each county team will train at least 10% of their health care providers targeting at least 1,000 health care workers.    

KEHPCA will set up a platform where health care workers can report their challenges and needs while respecting their privacy. They will be linked to different providers including counsellors based on their needs. The information will also be used to advocate for improvement of health care workers welfare.

The primary beneficiaries of this initiatives are health care workers  providing medical care to COVID-19 patients. The secondary beneficiaries are patients and families diagnosed with COVID-19 disease.  KEHPCA is engaging health care workers through online short sessions to identify their challenges and gaps in delivery of health care. Recently KEHPCA undertook a survey to identify fears and concerns of both health care workers and patients accessing palliative care services in Kenya. The information gathered has informed development of this proposal.

This challenge is well aligned to the problem, soulution and target population. 

Lack of integration of palliative care services and legal support has lead to the gap in COVID-19 management. Health care workers don`t feel adequately equiped to communicate with patinets and their loved ones, manage spyschosocial and spritual issues, address legal dilemas and provide breavement support. The initiative will empower them to improve their capacity in these areas. 

With limited ICU beds and ventilators in resource limited settings their is need to develop a rational allocation of these scarce resources while adhering to ethical and legal aspects.  

Our solution is innovative since it is addressing criticalas areas in COVID-19 management that has been neglected by majority of policy makers especially in limited resource countries. The solution will embrace use of technology including virtual training instead of traditional face to face classrooms.  The solution is timely since majority of developing countries especially in Africa are starting to experince an increase in number of individuals affected by COVID-19, it will preppare the health care workers manage themselsves, patients and their families effectively.

The solution will utilize digital platforms like webners to deliver online training, emails to distribute training materials, zoom or skype or WhatssApp to communicate between health care workers and patients. 

KEHPCA will also incorporate online training platforms on their website.

Digital platforms like skype, zoom and WhatssApp have been used to conduct virtual meeting and training. There have been an increase in utilisation of these platforms during this COVID -19 pandemic due to restriction of movements. 

Several training institutions have developed online platforms which they have used to train in the past.

In Kenya, there is limited integration of palliative care services. The Lancet commission report (2018) estimates that only 10% of patients in need of palliative care receive these services. With the COVID- 19 pandemic we estimate that the need for these services will triple and hence the need to scale up the capacity. The current Kenya national guidelines for managing COVID- 19 patients have not factored in palliative care, legal and bereavement support

Persons Living With Palliative Care Needs including patients suffering from COVID-19 are disadvantaged and experience various legal and human rights challenges. These include custody of children, property, inheritance and burial rights. In most cases, advanced directives and wills are not available and when present are not honored.

This innovation seeks to contribute to sustainable development goal 3 by ensuring that there are knowledgeable healthcare workers providing palliative care services including bereavement support. Patients and families will be empowered on their human rights and given legal support by paralegals as well as pro bono lawyers.

Training will be virtual as face to face sessions in the current pandemic state are impossible to hold. KEHPCA will maintain a database of all trainer of trainers (TOT) as well as trainees. Interactions and follow up will be through telephone calls, emails, video conferencing and the online training platform. The target is 180 TOTs and at-least 1000 trainees reached during the project period. A pre and post-test will be administered to assess knowledge change.

The Ministry of health has a palliative care reporting tool where counties directly report on palliative care services offered within the facilities. It is expected that the number of patients attended to during the project period will increase for the 30 counties targeted.

KEHPCA has a well-structured Monitoring, Evaluation and Learning framework that will be used to monitor the implementation of this project.  Services will be integrated into the county government structure hence ensuring sustainability.

KEHPCA through our members we are reaching approximately 30,000 patinets and families in need of palliative care.  We are scaling up access to palliative care services to reach to 35,000 in one year and double this number to 70,000 in 5 years. 

KEHPCA initiatives are driven by the vision; palliative care for all in Kenya.  The asssociation has a strategic plan that has identified key priority areas including; Advocacy and Communication, Research, Scaling Cancer care and palliative care services, Strengthening internal organisation strucure.  Implementation of these strategic plan will lead to doubling of current palliative care providers from 70 to 140 hence reaching out to more patients and family members. 

The following are current barriers that are limiting KEHPCA`s activities; reduced donors funding and restricted movement due to COVID-19 pandemic. Political instability in the year 2022 during the general election in Kenya.

KEHPCA is applying different approached to address the above challenges including: 

1) Financial challenge- Increased grant writing, forming consortiums to apply for large grans and undertaking fundrainignactivities

2)Restricted movement due to COVID-19 pandemic- KEHPCA has adopted technology to communicate with her partners including virtual meeting and training

3) Political instability- KEHPCA is empowering county champios to promote palliaitve care services, this will ensure there is minimal disruption of services during election period.

KEHPCA has 8 staff engaged on full time contracts, the association is working closely with approximately 140 county palliative care champions who are employed by county goverments.

Dr. Zipporah Ali; she is the Executive Director, she is a palliative care and public health specialist

Dr. Asaph Kinyanjui; he is a medical doctor with vast experience in training, program management and clinical care

Dr. Esther Muinga; she is a medical doctor with rich experience in clinical care including pain management, training and project management

David Musyoki; he is a palliative care nurse, with a lot of experience in advocacy, capacity building and project management

Miriam Igobwa; She has a wealth of experience in administration and finance

Josphine Muya; She has vast experience in administration and planning 

Howard Nyaga: He is a communication expert and has IT and videography experience 

Kenya Hospices and Palliative Care Association has partnerd with severalm organisation sto scale up palliative care servives including: 

1. Ministry of Health and County governments to develp guidelines, mobilize resources and set policies

2. American Cancer Society to promote access to pain management and oncology services

3. Open Society Foundation to promote advocacy and empower patients to demand for services

4. True Colours Trust to promote integrationn of palliaitve care services in the public health facilities

KEHPCA is manadated to scale up palliaitve care services  in the country to ensure individuals and families affected by hard to cure and life threatening conditions benefit. Plalliative care ficusses on holistic care of both the patients and families including; physical, social, psychological and spiritual. 

KEHPCA promotes access to palliative care by empowering passionate health care workers within counties to advocate and provide the services. KEHPCA also engages both national and county governments to ensure they allocate adequate resources to ensure the services are available. 

KEHPCA has several revenue generating avenues including prosal writting, formation of consortiums, charging for services including training, selling merchadise and undertaking fundraising initiatives like fundraising dinners. 

KEHPCA is applying to solve to gaing both financial and technical support to be able to empower health care workers to provide palliative care services, breavement and legal support as well equip them with self care coping mechanisms.

KEHPCA is seeking partnership in funding, technology as well as monitoring and evaluation.

We are seeking to partner with foundations, pharmaceutical industries, MUT faculty and Solve members

KEHPCA is recognised as the national leader for palliaitve care in Kenya, the association has been supporting integration of palliative care services in the country for over 10 years. KEHPCA uses different approached including advocacy, capacity buidling, supporting seting up of services to scale up. 

The funding will enable KEHPCA address this urgent need hence improving quality of life of both health care providers, patients and families. This initiative is sustainable once it is integrated.

Palliative care is a human right and should be acceesible to all in need.  Majority of patients with life threatening conditions experience severe physical pain, uncontroled symptoms, psychological and spiritual pain. KEHPCA is leading in the integration of palliaitve care services to all those in need in line with Universal Health Coverage. Palliative care patients should not be left behind.

Palliative care is inline with UN Sustainable Development Goals especially goal number 3. Investement in promoting accessible palliaitve care services will contribute to improvement of health and well being especially individuals affected by COVID-19.