Project Elixir

Despite government-led efforts to optimize Primary Health Care (PHC) in Kenya, most poor and vulnerable populations cannot access it on demand due to high out-of-pocket expenditure when seeking healthcare. Globally, a study by World Health Organization (WHO) reported that by 2021 more than half a billion people have been pushed or pushed further into extreme poverty due to health care costs. In Africa, about half of the continent's population does not have access to PHC. In Kenya, access to primary healthcare is through insurance or out-of-pocket expenditure. The Ministry of Health indicates that 12.7% of the population cannot access PHC due to costs. Kenya Medical Research Institute (KEMRI) reports that only 3% of the poor and vulnerable households have health insurance. In rural Siaya County in Kenya, the County Government says that PHC access is still abysmal. This affects 1,114,735 persons living in the area and is characterized by high mortalities caused by preventable and treatable infectious diseases such as diarrhea and unacceptably high maternal mortality rates. While the pressure is on every African country to achieve Universal Health Coverage (UHC) by 2030, this is impossible without 100% access to PHC. The rising cost of living, which a global pandemic has worsened, will increase the percentage of persons unable to access PHC. Ideally, healthcare is a coproduction of government and people as equal partners. However, in Kenya, the people are passive consumers and not part of the design or policy formulation process. The WHO reported that optimizing PHC towards UHC requires a shift from health systems designed around diseases and institutions towards health systems designed for people, with people. Without community participation in PHC towards UHC, peoples’ real needs are not captured during policy formulation; hence service providers, administrators, and funders cannot provide actionable, accountable, and accessible insights to optimize the performance of PHC. 

Project Elixir is a digital health solution that employs a people-centered approach in primary healthcare delivery towards UHC where government, private sector, and community can work together as equal partners through a public-private partnership (PPP). Empowering the people to understand better how PHC systems work will activate a people-centered PHC system. This is a better method because it allows communities to understand, own, and invest in their health systems and solve their health needs. Proactive community participation as equal partners provides actionable, accountable, and accessible insights for health care providers, administrators, and funders that can be used to optimize the performance of PHC. The system leverages google cloud technology to enable individuals to key in their health, social, and bio data on a web-based platform with the assistance of trained community health volunteers who live and work within the community. 

Project Elixir targets the poor and vulnerable lower- and middle-income bracket and serves 15 households within Kisumu City and two households in Bondo sub-county in Siaya County. The Siaya County Government reports that the county has high levels of poverty and HIV/AIDS prevalence and suffers the effects of the skewed implementation of devolution. The poor can neither afford out-of-pocket expenditure nor can they keep up with regular insurance premium payments and depend on fundraising to meet health costs. The vulnerable lower-and-middle-income bracket work in the informal sector, which seldom provides an income guarantee; hence affected persons cannot keep up with regular insurance payments and therefore considers affordability and Convenience when seeking PHC. Project Elixir will impact their health and well-being by providing access to holistic primary healthcare towards UHC through a people-centered approach.

The team in project Elixir are community members who have grown up and worked within the target community. The team has faced the same challenges the people endure and understand the scope of the problem they face. The project incorporates community input, ideas, and agenda by reviewing user experiences to improve the solution to fit every household need. The team has held focus group discussions with some community leaders and members to fine-tune the project to meet community demand. The team conducted a feasibility study of project Elixir in Nairobi County in November 2019 then did a preliminary study in Kisumu and Siaya Counties between August 2020 and June 2021 to test results and improve the solution. We tried the solution with one family in 2019, focusing on individual health, and in 2020/2021, with 16 families focused on people-centered care.

Project Elixir faces financial, technical, legal, cultural, and market barriers to succeed. The project requires financial investment to acquire major items like mobile clinics, mobile medical equipment, medicines, ambulance, electric bicycles, and operating capital to enable us fully establish the system and officially launch operations within the community. The cloud technology requires a professional web-based android and USSD application to be more user-friendly. This requires financial investment to hire a professional with technical skills to build. The project also requires legal expertise to protect intellectual property, navigate government bureaucracy and enable a public-private partnership. The cultural barrier is caused by project support for sexual minority groups. Access to healthcare is a right for all humans, irrespective of sexual orientation. The market barrier is caused by medical insurance companies who misconstrue the project as a threat to their businesses. Public recognition and support from the challenge will enable us to win community, government, and insurance companies' confidence and support to succeed.

Community ownership and participation will change people's attitudes towards healthcare. Attitude change will create domestic investment in and responsible consumption of health services, impacting their health and well-being. Community commitment through a public-private partnership will attract different stakeholders in healthcare who will bring more resources and expertise to the project. The cloud technology established within the mobile medical clinics will increase community uptake of digital healthcare in the region, starting with rural, underdeveloped areas of Siaya County. 

To impact the health and well-being of 80% of the population within Siaya County by improving access to holistic quality, affordable and convenient PHC within one year.

Within five years, end poverty among 20% of the participants within Siaya County by improving access to holistic quality, affordable and convenient PHC within one year.

To impact the health and well-being of 80% of the population within the Republic of Kenya by improving access to holistic quality, affordable and convenient PHC through a public-private partnership within five years.

End preventable deaths of under-five by 2030. We managed to grant 64% of children participants access to holistic primary healthcare on-demand in hard-to-reach areas within Kisumu County in 2021.

We are ending the HIV pandemic by 2030 by improving access to antiretroviral therapy for infected patients. This will enable them to attain viral suppression and end transmission. During the preliminary studies in Kisumu County in 2021, 6% of participants had AIDS because they had defaulted on treatment. We managed to reinitiate them back to care.

Early diagnosis and treatment reduce the premature mortality rate attributed to cardiovascular disease. 5% of patients were diagnosed with hypertension, and treatment was initiated in time. Only 1% had already developed a heart condition due to hypertension and were put on treatment.

We are promoting mental health and well-being. 30% of participants had mental health consultations and received mental health treatment and support.

Coverage of essential services. 19% of participants could access holistic essential health services with financial protection during the preliminary studies.

Activity 1: Promote awareness.

Community sensitization training for 380 community members and 20 service providers in Siaya county.

Community members register to participate in the project.

Share health experiences from 20% of participants with 80% of the population in Siaya county. 

Evidence: Abrahamson, C. E., (1988) supports storytelling as the foundation of the teaching profession in impacting learners, and Sarriot E., Shar A.N., 2020 describes the impact of community participation in community ownership in primary health care.

Output

Informed community on health rights and role in primary healthcare towards UHC.

Outcome

Public engagement and community participation. Media coverage.

Impact

Increased public interest and participation. Community ownership.

Activity 2: Community entry.

Establish community medical camps using mobile, low-cost, prefabricated container clinics within a 500-meter radius with home-based care extension using electric bicycles.

Share health experiences from 20% of participants with 80% of the population in Siaya county. 

Evidence: 2020/2021 preliminary studies taught us the value of convenient health service provision in influencing the community. We also learned that the community preferred private and convenient home-based care for primary healthcare.

Output

PHC services are available within reach. Community receiving specialized services

Outcome

Word of mouth publicity. Community advocacy 

Impact

Attitude change People-centered health

Activity 3: Draft for health policy change.

Trained service providers to conduct community medical durbars to discuss project progress. The durbar will bring together the local administration, local health stakeholders, and the community to deliberate on community health. 

Evidence: Sabo, S., Flores, M., Wennerstrom, A. et al. 2017 describe healthcare workers' impact on influencing policy 

Output

Increased public interest and participation 

Outcome

Support from local political leaders

Impact

Proactive society about health issues and personal health.

Community commitment and willingness to pay.

Health policy change towards people-centred public-private partnership

We use SMS for new user registration and google cloud technology to save and protect patient information. The patient data is recorded on google docs which is safely stored using google cloud technology. The information is shared with the primary healthcare provider using safe links, enabling a view only to avoid manipulation of data by 3rd party. Telemedicine consultations are done using WhatsApp, zoom, or SMS, depending on user preference. The service provider has a digital doctor’s bag to access patient information, carry essential medicines, basic medical tools, and equipment, and uses mountain bicycles to reach patients within a 500-meter radius. Google cloud technology is convenient because it can work online and offline and requires less bandwidth to save data online. We want to upgrade to the cloud-based web, android, and USSD technology to enable user-friendly registrations, electric bicycles technology to enable faster and safer home-based visits, and drone technology for medicine delivery in hard-to-reach areas. 

The patient/beneficiary registers and provides biodata and other medical and social histories. A trustee appointed by a patient can also enter records on behalf of the patient. The trustees will also be trained as community health volunteers living within the community. Family clinical data is collected by the assigned primary healthcare provider in charge of the participating households who work shifts and are compensated hourly or trained community health volunteers. Incentives such as written recognition for participation, scholarships, and stipend will be used to motivate volunteers. 

We have developed core values and ethical principles over the three years we have worked together. Each member makes an equal contribution based on expertise. 

The business model is a people-centered subscription-based model that acknowledges patients as equal partners. Households will pay or co-pay an annual subscription fee to access holistic quality, affordable and convenient primary health services towards UHC. This will enable them to own and commit to paying for healthcare under a Public-Private Partnership without coercion. Surplus revenue will be committed to addressing community social needs affecting their health. This will address social determinants of health, reducing costs associated with curative healthcare.

Project Elixir will provide primary health care services on a cash basis and in partnership with medical insurance providers. Raise investment capital to provide people-centered health services targeting the poor, low-and-middle-income households, elderly, and sexual minorities. We will also continue seeking sustained donations to assist poor and vulnerable households’ co-pay for UHC insurance. Transitioning into a public private partnership will attract investment from government, private stakeholders and other sectors, bringing in more financial resources and technical expertise. 

Revenue generated in 2019 working with one patient household was 1000 US dollars, and revenue generated in 2020/2021 working with 16 families was 200 dollars. The project has raised investment funding of 10000 US dollars within the community, which has constructed the project office. The project has also received an in-kind donation from the community in the form of land. In 2022, the project received 828 USD in donations from Digital Lift, USA to advance the project's mission through educating communities on people-centred health care towards UHC.