Amref's Giant LEAP to Transform Healthcare in Sub Saharan Africa

Through multi-sectoral partnerships, Amref has developed LEAP, an interactive, adaptable, customisable (multi-lingual) and scalable mobile learning solution for community health workers. 

The platform delivers content through SMS and Interactive Voice Recordings (IVRs) through basic phones using m-Pedagogy that leverages on engagement, knowledge sharing, application, reinforcement and recognition.

Caroline Mbindyo - CEO, Amref Health Innovations

With 15+ years experience in running and growing entrepreneurial ventures in the non profit and commercial space to create positive change in Africa.

The global health worker crisis is particularly acute in rural and hard-to-reach regions of Sub-Saharan Africa where about 80% of the population lives.

The use of Community Health Workers (CHWs) has been identified as one strategy to address the growing shortage of health workers, particularly in low-income countries.

The emergence of COVID-19 globally has refocused attention to CHWs as the most easily accessible and available workforce to step in to support preparedness and response, and to turn off the tap of community transmission. 

Community transmission has increasingly been seen as aggravating the devastating effects of the disease on the economy and social fabric of the society world over.

For CHWs to be effective, they need to be from their communities, continuously trained and supported, and remunerated. At Amref Health Africa, we believe that digital technology is a critical component of effective CHW programs and have deployed digital tool to facilitate capacity building, service provision, and supervision of CHWs.

The World Health Organisation targets to reach 1 billion more people to be better protected from health emergencies and majority of this need lies in the last mile, where our CHWs operate from.

Our primary persona is the Community Health Worker, and their learning outcomes then positively impact the secondary persona who is the program's beneficiary - the community.

The umbrella term ‘Community Health Worker’ embraces a variety of community health aides selected, trained and working in the communities from which they come. 

Generalization about the profile of Community Health Workers internationally is difficult. While there are some broad trends, CHWs can be men or women, young or old, literate or illiterate. More important is an acknowledgement that the definition of CHWs must respond to local societal and cultural norms and customs to ensure community acceptance and ownership.

Trained CHWs in turn are able to sensitise households under them through different approaches. With the onset of the pandemic, we have seen a shift from household visits to engagement through the group chat option with households registered under the CHWs through a multilingual approach using not only English but local dialect and pushing audio files with contextualised messaging for households that experience literacy challenges - thus limiting data access bias and barriers.

1. Better equipped health workers provide better care and have higher performance, leading to improved community health

2. Strengthened health system due to higher skilled health workers and stronger supervision connection

3. Create strong communities and increase retention of health workers

4. Rapidly mobilise community in response to diseases or health events

Strong community health structures are the foundation for disease prevention and health promotion and hence reduction in the burden of disease. Amref Health Africa has supported Ministries of Health, the Centers for Disease Control and the WHO during outbreak interventions including theEbola outbreaks in Uganda 2000 and 2012, Ebola outbreaks in Senegal and Guinea 2014, Cholera outbreak in Kenya 2017, and Lassa fever in Nigeria 2018. As Kenya and Africa combats the COVID-19, community health structures have become critical in ensuring that all households are reached with correct information on COVID-19 as well as with prevention measures. 

Digital health tools have played a critical role in community engagement, education, data collection, surveillance, contact tracing, referral, home-based care support, etc.

From our work, we have seen the importance of having effective human and technology infrastructure that can reach households quickly and effectively. We would like to expand the Leap platform to additional countries to help strengthen their community health systems and to ensure they equipped to respond to future crisis.

For Partners:

- Strengthen workforce management with supervisory tools

- Access a growing library of high-quality learning content pre-approved by the MoH

- Reduce face-to-face learning requirements; save time and resources

- Connect CHWs to the formal health system and create digital records of their training and career development

For Learners/CHWs:

- On-demand access to essential information, tools and services

- Access collaboration tools for knowledge sharing & support

- Increase motivation, job satisfaction and retention

- Learn more consistently, providing first-line healthcare

Summary on LEAP: https://www.wvi.org/sites/defa...

Success of LEAP: https://www.accenture.com/be-e...

We are asking for USD 2M to enable us effectively respond to the following three core areas by:

• Expanding the Leap platform to additional countries to build CHW (and eventually household) capacity and help strengthen their community health systems and to ensure they equipped to respond to future crisis.
• Continue to develop the Leap platform to strengthen its capability to support simple but effective early warning systems and inform creation, rollout and monitoring of a response that is fit for context and purpose.
• Expand effective monitoring of socio-economic data and household level and use of that to raise red flags, track progress, and inform actions required to support the most vulnerable.

We want to continue to build the Leap platform to strengthen its capability to support simple but effective early warning systems and inform creation, rollout and monitoring of a response that is fit for context and purpose.

One way we have used to address this challenge is to work to collect socio-economic date from households with the goal of 

(i) develop and deploy a national tool to identify the most vulnerable households that require social support; 

(ii) link this household to existing social safety nets; 

(iii) use the data to support immediate and long tern planning for local and national governments; and 

(iv) periodically update the household data to see if, how, and why households are moving out of vulnerability to inform local and national plans and strategies. 

To date we have set up systems and collected this data for over 2Million households in Kenya. Counties have used this data to provide health insurance subsidies to their most residents. Some are already using this data to determine who should receive support to access agricultural inputs to uplift livelihoods. 

Eventually we will have longitudinal data that can provide rich insights, facilitate evidence-based planning and action, and enable red-flagging based on certain baseline.

We would like to expand this work in Kenya and across the region and incorporate machine learning capability including predictive algorithms.

Economic stress on families due to the outbreak can put children, and in particular girls, at greater risk of exploitation, child labour and gender-based violence. An increase in post-traumatic stress disorder, anxiety, depression, and other symptoms of distress has been associated with COVID-19[1]. Further, essential services such as prevention and treatment services for noncommunicable diseases (NCDs) have been severely disrupted since the COVID-19 pandemic began. A global survey led by WHO indicates that the impact is global, but that low-income countries are most affected[2]. Clearly the effects of the pandemic are far-reaching and likely long term. How do we ensure the systems that we build today can mitigate this? 

[1] The Psychological and Social Impact of COVID-19: New Perspectives of Well-Being

[2] COVID-19 significantly impacts health services for noncommunicable diseases

Save the Children, 

Ampath 

World Vision, 

Ministries of Health, 

Mezzanineware 

Accenture

Safaricom

GSK amongst others

Aligned with the Trinity Challenge, Amref Health Africa has been rolling out initiatives focused on supporting local and national governments and stakeholders: (a) determine and limit diseases and the risks they pose to communities;

-Shortage of Medical Professionals:  

•There is an increased demand for health workers attributed to the following reasons:
•Population growth
•Increased purchasing power for health services 
•Increased life expectancy
•Rise of chronic disease 
•Spread of HIV 
•Health workers’ skills in demand in diverse settings 
•The global shortage of health workers is estimated at 4 million + (counting doctors, nurses and midwives) 
•The use of community health workers (CHW) has been identified as one strategy bridge the shortage. 

Upskilling of the CHWs

AMREF trains more than 10,000 community health workers in 22 countries in Sub-Saharan Africa

CHWs currently have poor access to information and continuing education, and other resources to be effective.

More than 75% of Kenyan population lives in rural areas. Generally the main source of income is from agriculture 

A CHW typically has to support an approximate area of 30 km² to treat on average 1057 patients

After initial training has been completed, there is little support after the program

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