OpenMRS QI-Connect (QI-C)

As part of the Vision 2030 plan, the Government of Kenya (GOK) has committed to a “Big Four” Agenda which prioritizes development of Universal Health Coverage (UHC). UHC as defined by the World Health Organization, encompasses three components: equal access to healthcare, quality health services, and ability to receive healthcare services without incurring financial hardship. In Kenya, access to effective health services remains limited with only approximately 50% access to quality health services as measured by proxy maternal and child health indicators in 2014 (3, 4). Provision of quality health services in the public sector is impeded by health systems issues including frequent drug and commodity stock-outs, inadequate human resources, insufficient financial resources, and inefficient referral processes. Traditionally, support of the public health sector in Kenya has occurred through disease specific initiatives in areas such as HIV, TB and malaria. These siloed approaches often do not address underlying, cross-cutting health systems challenges that universally impact patient experiences and health outcomes. 

To address these health systems issues, AMPATH collaborators developed a novel and highly successful quality improvement (QI) program. The AMPATH QI program elevates the contributions of frontline healthcare workers by providing a systematic framework to identify challenges in healthcare delivery, diagnose the root causes of problems, propose innovative solutions, and measure if these solutions have the intended impact. Beginning in March of 2021, we initiated the QI program across all Ministry of Health (MOH) facilities in Bunyala Subcounty, Busia County, Kenya. Over 6 months, we conducted comprehensive QI training for all healthcare workers in Bunyala Subcounty, followed by ongoing mentorship by MOH leaders and a QI “coach” to support facility QI teams as they solved challenges in service delivery. 

Since the start of the program, 9 out of 9 health facilities in the Subcounty have established QI teams, prioritized health services for improvement, developed change ideas, and measured their impact on reproductive and maternal health indicators. Even more importantly, these QI initiatives developed by frontline healthcare workers have increased cervical cancer screening rates, increased the number of women delivering in health facilities, and improved the percentage of women completing recommended antenatal care visits. These results demonstrate the tremendous potential for QI when frontline health workers are supported with training, tools and MOH leadership. 

A recent qualitative process evaluation of the AMPATH QI program revealed that healthcare workers have embraced QI, gained a new appreciation for the value of data, and experienced renewed motivation in their work by seeing the impact of implementing their own change ideas. However, healthcare workers voice that the reporting of indicators required by the MOH on a paper-based system is inefficient. The current system of reporting aggregates data at the county level, where paper registers from individual health facilities are entered into an electronic system (KHIS -the Kenya Health Information System).  

In summary, a major barrier to improving the quality of healthcare in Kenya is the separation of health indicators from healthcare providers by inefficient paper systems designed for aggregate data summaries. Healthcare workers experience a heavy burden from duplicative data entry and reporting from a mix of paper and multiple, siloed electronic systems. Furthermore, most mid-level healthcare providers lack the knowledge and training of how to manage and utilize data for health service improvement and are not yet ready to transition to utilization of a full electronic medical record for patient care.

Inefficient data systems that separate outcomes and indicators from frontline healthcare workers prevent the development of innovative solutions by the providers best positioned to impact health system change, not only in Kenya but in many low-and middle income health systems worldwide.

 Citations: 

1. Reconstruction WHO. aIBf, Bank aDTW. Tracking universal health coverage: 2017 global monitoring report. 2017. 

2.Kruk ME, Larson E, Twum-Danso NA. Time for a quality revolution in global health. Lancet Glob Health. 2016;4(9):e594-6. 

3.Barasa E, Nguhiu P, McIntyre D. Measuring progress towards Sustainable Development Goal 3.8 on universal health coverage in Kenya. BMJ Glob Health. 2018;3(3):e000904. 

4.Nguhiu PK, Barasa EW, Chuma J. Determining the effective coverage of maternal and child health services in Kenya, using demographic and health survey data sets: tracking progress towards universal health coverage. Trop Med Int Health. 2017;22(4):442-53. 

OpenMRS is a user-driven, open source medical record platform that has historically been used to support direct patient care, reporting and research. However, one area of need that has been neglected is the use of indicators by providers to support quality improvement initiatives. QI initiatives serve on the interface between patient care and reporting where health care workers themselves decide on key data needed to be collected and aggregated to improve specific areas of care and service delivery. Although much has been accomplished within OpenMRS to support point-of-care integration into clinical work flows and support for downstream reporting, more needs to be done to enable frontline workers to create ad hoc indicators. Simple tools are needed to support basic data analysis and visualization for QI initiatives while also simultaneously integrating into MOH data systems such as KHIS that collect key health indicators for reports.

Our solution is simple: We will utilize AMPATH’s successful model of quality improvement mentorship to drive the creation of a novel OpenMRS module to integrate quality improvement initiatives at the point of care while also providing data visualization of QI indicators that are designed for frontline healthcare workers. We call this solution OpenMRS QI-Connect: Connecting QI training with a novel platform to support QI tools, connecting healthcare workers with the indicators they create and value, and connecting health facilities in the same region to the same platform to set benchmarks and drive competition for improved health outcomes.

In more than 40 countries worldwide, stakeholders and OpenMRS implementers seek to address human resource capacity gaps and alleviate healthcare workers' burdens by improving access to data through the use of locally owned, sustainable, interoperable, point of care systems that a) support multiple program areas to b) reduce the multiplicity of systems, c) support the continuum of care across sites, and d) encourage evidence based decision making. Today, more than 6,500 healthcare clinics worldwide are using OpenMRS to provide improved healthcare to 14.6 million patients. Since 2015, several countries, including Nigeria, Kenya, Uganda, Mozambique, have chosen to implement OpenMRS at scale.  

In Kenya, the OpenMRS platform is utilized for clinical care in at least 60 AMPATH HIV clinics, and is in the process of being integrated with the Kenya EMR, also built on the OpenMRS platform. We propose to leverage this platform by creating a new QI module to support facility-based QI teams, creating a replicable and scalable model for more than 1,400 health facilities across Kenya and in any of the 6,500+ other health facilities worldwide that currently use the OpenMRS platform. 

The OpenMRS 3 technology (described in more detail in technical section below) layered on AMPATH's QI mentorship program will enable health facilities to create, analyze and share their own QI indicators, while still fulfilling reporting requirements for the Kenya Health Information System (KHIS). 

Using a human centered design process, we would first build an OpenMRS QI module that supports processes for sending required indicators into KHIS.  After a pilot with a few facility quality improvement teams, we would expand (with additional funding from other sources) the QI program in parallel with the OpenMRS QI module to additional health facilities in Busia County in Kenya. 

This solution is simple, practical, and supports government endorsed digital systems for health indicator management rather than creating parallel systems that undermine or duplicate national efforts. This proposal builds on prior work in QI in the public sector in Kenya, directly addresses challenges voiced by healthcare workers on QI teams, and supports the current MOH reporting system (KHIS) as well as KenyaEMR through the OpenMRS platform. 

The flexibility in the OpenMRS module for individual health facilities to create and share QI indicators generates opportunities for health facilities to spread improvement projects, set benchmarks, engage in performance competition, and share learning. Healthcare outcomes and quality indicators that are developed, prioritized, and managed by frontline healthcare workers in an efficient electronic platform bridge a gap that currently prevents use of data for facility level innovation and health service improvement.

This proposed solution is designed to support frontline Kenyan healthcare workers in public health facilities, ranging from dispensaries to county hospitals. The healthcare workers participating in the AMPATH QI mentorship program have described how QI has led to increased teamwork and motivation for serving patients and have also stressed the need for improved data systems. By making the data for MOH indicators and QI work usable by frontline healthcare workers, we are building capacity for healthcare worker-led improvements in health services across the entire public health system while also improving job satisfaction for healthcare workers.

In Kenya, this innovation would initially improve health services for a population of 930,000 in Busia County. The initial AMPATH QI program has stimulated frontline healthcare workers to engage with their patients and communities and incorporate community feedback into health service delivery improvement. The community health facility dialogue stimulated by the QI program is an important step into providing quality health services that are responsive to community priorities. In addition, the QI program is being conducted in parallel with an effort to increase enrollment in the National Health Insurance Fund (NHIF), with the overall goal of supporting the MOH to offer quality health services that motivates patients to invest in a health insurance product through NHIF.  

At a national level, the OpenMRS QI-C module can be used with KenyaEMR (also powered by OpenMRS), which has the capability to communicate with the KHIS system, supporting multiple MOH data systems.  

At a global level, the QI module can be scaled for use by any of the additional 5,000+ health facilities using the OpenMRS platform in over 44 countries. 

Our solution team is a partnership between AMPATH Population Health and  OpenMRS. 

The Academic Model Providing Access to Healthcare (AMPATH) is uniquely positioned to design and deliver this solution to bring ownership of health service improvement data to frontline healthcare workers. AMPATH Kenya, established in 1989, is an alliance between Moi Teaching and Referral Hospital (MTRH) and Moi University (MU) in Eldoret, Kenya, and the AMPATH Consortium. AMPATH’s tripartite mission is to promote care, education, and research to improve the health of communities in western Kenya and beyond. For three decades, the Indiana University School of Medicine has supported faculty to work alongside their Kenyan colleagues to continuously strengthen the public health system and the medical school while also serving as the Kenyan MOH’s innovative engine through a robust research program focused on improving quality of care and health outcomes.  

Beginning in 2001, the AMPATH partnership successfully mounted a response to the HIV epidemic. From these humble beginnings and numerous partnerships, AMPATH has grown to become one of the largest providers of HIV care in all of Africa, providing care to over 165,000 active patients living with HIV in western Kenya. Over the past 7 years, AMPATH has built on programmatic experience in HIV and expanded to develop a community-based population health model that addresses the social determinants of health and provides a path to achieving UHC, focused in Busia County.  

This proposal builds on our work over the past year and a half to strengthen health systems through QI in Busia County and leverages our relationship with the Kenya National Quality Assurance Office and national efforts to expand the Kenya Quality Model for Health. The proposed solution to expand access to KHIS through IT infrastructure was designed based on input from healthcare workers regarding how to improve the QI across the county. 

The OpenMRS platform in its infancy began as AMPATH EHR, the first electronic medical record system to support clinical care, program evaluation and quality improvement for HIV patients in Kenya. With funding and support from the WHO, the Rockefeller Foundation, and Partners in Health, the AMRS was transformed into OpenMRS, now an open-source EHR platform supporting clinical care applications in low-resource settings around the world. In addition to being an open-source EMR, OpenMRS is an open-source community that functions as a consortium of OpenMRS implementing organizations and individual contributors worldwide. As of December 2021, at least 16 organizations committed to collaboratively develop OpenMRS functionality and features using the new OpenMRS 3 Framework with others in the community.

This challenge will help us overcome financial barriers required to invest in basic IT hardware for quality improvement such as desktop computers and tablets at pilot sites.

More importantly, it will support the funding required for the OpenMRS team to develop a novel QI module using a human centered design process, that meets the need of healthcare workers, and has the capability to feed indicators into the KHIS system and avoid duplication of data reporting.

Our approach is simple but practical. The innovation lies in connecting quality improvement training with a flexible digital platform that gives healthcare workers the knowledge and tools necessary to use data to improve health services and measure the impact while also fulfilling reporting requirements for the MOH. By developing a QI module in OpenMRS that can feed data into the KHIS system, we believe frontline healthcare workers can revolutionize the quality of health provided.

Our QI mentorship curriculum supported by improved data for improvement through the targeted Open-MRS QI-C module can be rapidly scaled to anywhere that the OpenMRS platform is used. 

At a national level in Kenya, the QI-C module could be integrated with the KenyaEMR (powered by OpenMRS) and has the capability to communicate with the Kenya Health Information System, supporting multiple MOH data systems.  

At a global level, the QI-C module can be scaled for use by any of the additional 5,000+ health facilities using the OpenMRS platform in over 44 countries.

After one year, we will have developed a novel and flexible OpenMRS QI-C module to support quality improvement initiatives at health facilities using a human centered design process. This module will enable healthcare workers to create their own QI indicators, visualize progress on run charts, and feed these indicators seamlessly into KHIS where applicable. The impact of this will be full integration of quality improvement initiatives, developed by healthcare workers and shared with other health facilities as well as the MOH through Kenya’s own version of OpenMRS (KenyaEMR), supporting local data reviews and national indicator reporting.

After 5 years, with additional funding we would scale integration of the QI training program with the OpenMRS QI-C module to additional counties in Kenya, as well as other countries using OpenMRS. The impact would be improvement in a variety of health outcomes. Currently the Busia Health QI teams are focusing on reproductive and maternal health indicators, including cervical cancer screening rates, completion of recommended antenatal care visits, and increasing births in healthcare facilities.  

Process indicators:

• Number of stakeholder meetings 

• Number of human centered design sessions with healthcare workers

• Completion of pilot health facility infrastructure assessment

• Completion of training and support for use of OpenMRS QI-C at pilot facilities

• Number of MOH health facilities piloting OpenMRS QI-C 

• Number of new  indicators created in OpenMRS QI-C for facility level quality improvement initiatives by healthcare workers

• Number of healthcare workers accessing the OpenMRS QI-C platform each week

• Number of QI indicators recorded in OpenMRS QI-C

• Number of facilities utilizing OpenMRS QI-C to report required indicators for KHIS 

Outcome indicators:

• Change in targeted QI indicators for improvement over 3 month, 6 month, and 12 month period 

  • Specific indicators will depend on facility quality improvement efforts, but based on current QI initiatives might include:

    • The number of women screened for cervical cancer per month

    • The % women with cervical abnormalities identified using VIA who received treatment with cryotherapy

    • The number of pregnant women completing at least 4 ANC visits prior to delivery

    • The percentage of women in ANC who completed recommended laboratory testing prior to delivery

• Number of QI indicators shared across health facilities as benchmarks 

• Number of quality improvement teams and work improvement teams active  in Busia county 

• Total Number of healthcare workers trained in quality improvement in Busia County

OpenMRS aims to improve patient level health outcomes and increase the efficiency of health service delivery. For over 15 years, we’ve achieved this goal by coordinating resources and activities across organizations and individuals to create and maintain OpenMRS, responding to health provider and implementer challenges. The proposed QI-C module is one of many examples of this theory of change at work.

OpenMRS is a flexible, modular, multi-layered system. One of its strengths is that its platform can be used in many different configurations. Countries can tailor OpenMRS to suit the needs of facilities with different use cases using “OpenMRS building blocks:” the core platform, concept dictionary as well as foundational, ready-to-use modules and OpenMRS packages. While a country’s requirements and development capacity often determine how much customization will be needed and how quickly an MVP can be implemented, the OpenMRS Community offers multiple distributions that reduce the need for significant customization.

To make customization and deployment faster and easier, the OpenMRS Community supports development and maintenance of the OpenMRS 3 Reference Application, a starter package that aims to provide 80% of what countries’ health facilities need. In 2019, the OpenMRS Community spearheaded an initiative to update the OpenMRS Reference Application frontend (OpenMRS 3) to more modern technologies and adopted collaborative, design-driven development processes. 

For providers, OpenMRS 3’s new design-driven approach means a more modern, user-friendly experience that works well on desktops as well as tablets. OpenMRS 3 makes it easier for UX designers and developers to share designs, content, and frontend modules by creating shelf-ready “OpenMRS packages,” such as a package of base EMR features that can be used with packages of program-specific content, functionality, and features (ie: HIV, MCH, MDR-TB). With proven interoperability solutions available, including those that leverage various parts of the OpenHIE architecture, local development teams have the means to implement OpenMRS as a part of a country’s health information exchange architecture.OpenMRS 3 is a configuration of the OpenMRS platform, key OpenMRS modules, program packages, and other integrated applications that can be installed and upgraded as a unit. 

Countries can also choose to start from other existing distributions that are built on the OpenMRS platform or OpenMRS 3 Reference Application. When OpenMRS implementers customize the OpenMRS platform in response to local user needs and within the context of a country's health information eco-system, the resulting OpenMRS implementation becomes an essential point-of-service system in a country's health information exchange architecture.

Healthcare workers on QI teams will create their own priorities and aims, develop their own indicators and measure them. They will then test their change ideas and evaluate if there is an impact on the chosen indicators. 

 Below is a list of direct quotations from healthcare workers in Busia shared as part of a qualitative process evaluation, which demonstrate their appreciation for data when applied to facility led improvement initiatives.  

The incentive to collect data is described best by Busia County healthcare workers in their own words: 

• Quality improvement data “it's making us work harder and we are, we are also appreciating and feeling motivated at our workplace.  Because once you've done this, we are motivated by our end results." 

• “the [quality improvement] training that our staff underwent, they were empowered so that everyone realized it's not just a matter of just coming on duty, doing your thing and going away. It's also important to find out what impact do you have in the community. So this created also self-motivation and as much as you just want to be there to serve, you have challenges, but within you're motivated. Because if I'm not doing well, why am I not doing well? What can I do? How can I improve? So you find our facilities, realized it's not just a matter of just coming on duty and you go away, but it's also good to look at what have I achieved, what impact have I created. So this has really motivated us.” 

• “So if they [ healthcare workers] were able to do that, get a hand of training of how they can analyze their data at their level, it would really help greatly in terms of achieving different QI projects. Then the other aspect would be automation of our [health indicator] registers. We tend to have a very big challenge in terms of data capture because we are still on the hard copies, which is quite costly in terms of printing. If we could manage to automate these registers and have facilities able to enter their own data to the system, then they can retrieve the data and again, do the analysis of that. So that would be quite helpful most of our facilities, if that would be, we could get external support in that angle, automate these tools and help them know what they're doing.” 

Equity and inclusion are core principles of AMPATH’s mission. In all aspects of our work, we seek to ensure collaborative and mutually beneficial relationships between Kenyan and North American personnel. These counterpart relationships have been foundational to AMPATH since the beginning of the partnership and are present in all disciplines and levels of engagement from student exchanges to faculty leadership. Collaborative capacity building enabled MTRH to become the prime recipient of USAID funding beginning in 2012 when it received the largest PEPFAR award directed to an African institution at the time. Currently, AMPATH’s lead Kenyan partners, Moi University College of Health Sciences and MTRH lead three USAID/PEPFAR grants totaling more than $120 million over five years.  

The AMPATH Kenya Executive Committee is comprised of a leader from three of the primary institutional partners in Kenya: Moi Teaching and Referral Hospital (MTRH), Moi University, and Indiana University. North American faculty work and live full-time in Kenya supporting AMPATH’s mission of care, training and research. The AMPATH Kenya partnership includes more than 16,000 Kenyans, who are official employees of MTRH, Moi University, or the Kenyan MOH. In addition, thousands of CHVs who live and work in Kenyan communities receive training and support from AMPATH. Implementation and care delivery in our communities are provided by individuals who reside in the surrounding area. Our hiring processes follow transparent protocols established by the Human Resources department of AMPATH and follow government standards.

Similar to many African countries, there remains a large disparity in gender equity in leadership within public institutions in Kenya. Gender equity is integrated into policies of AMPATH. Though our executive committee is composed of men, we have made significant progress among our junior leadership positions, who are in the pipeline as emergent leaders. Currently, our Population Health leadership team has a near-even ratio of men to women, 5:4, and our implementation team has a ratio of 2:3. In the Moi School of Medicine, women hold four Head of Department positions. 

Finally, we are committed to ensuring equitable access to and quality of care in our communities. We strive to serve the poorest individuals in our communities but aim for a quality that appeals across socioeconomic boundaries. Because access to non-communicable disease care is poor in western Kenya, we aim to ensure all those in need can benefit from our programs. In our communities, we have made a considerable effort to improve financial inclusion of women to give them opportunities to improve their health decision making capacity. For example, our microfinance groups, which aim to improve savings and generate income, primarily consist of women. By addressing the social determinants that lead to poor health outcomes, we ensure that our patients have both the wealth to improve their health and the health to generate wealth. 

OpenMRS coordinates a global community that creates a robust, scalable, user-driven and open-source medical record platform. We maintain a platform that countries and implementers use to create a customized EMR system in response to actual needs on the ground. In 2019, the OpenMRS Community supported the establishment of an OpenMRS Frontend Squad to update to more modern technologies that promote greater collaboration and re-use.  We will use this platform to meet the needs of healthcare workers engaged in QI, creating value through a platform that increases the efficiency of data for quality improvement, as well as data for MOH reporting. By supporting quality improvement, the health services provided will improve care for patients, creating improved patient satisfaction and better health outcomes.

OpenMRS was first launched at AMPATH in Kenya in 2004. Since then, OpenMRS has become a vibrant open source community and recognized Digital Public Good that sustains the OpenMRS software. The OpenMRS community, legally represented by OpenMRS Inc, functions as a consortium, with many organizations (including AMPATH) working in LMICs supporting the work of individual OpenMRS contributors. As such, the community seeks to engage and motivate both volunteers and supporting organizations to actively contribute to all aspects of the software development process. As a result of these efforts, the number of OpenMRS implementers committing to upstream contributions by members of their local development teams has grown from six in 2019 to sixteen in 2021.  

AMPATH, a key partner of OpenMRS, was launched 30 years ago on the foundation of partnership and a collective commitment to care, training and research with people in western Kenya. Ongoing operation in a resource challenged environment requires an ability and willingness to model, adapt and iterate. Long term sustainability will continue to be predicated on partnership with government, corporate, foundation and individual investment. Our health system strengthening work and quality improvement program in Busia County has been possible through a five year, 5-million dollar grant from the Abbvie Foundation, which supports a variety of AMPATH population health programs across several different counties.

The Government of Kenya has committed to a Big Four Action Plan including achieving 100% Universal Health Coverage by scaling the National Hospital Insurance Fund (NHIF) uptake by the year 2022. With support from long-time corporate, individual and foundation donors, we have been able to develop innovative health programs targeting hard to reach populations, implement innovative strategies to improve the public health sector, and build a partnership with the NHIF - ultimately leading to greater sustainability for our programs as well as the people and institutions we serve.

The AMPATH Population Health model prioritizes health and wealth creation by leveraging the national insurance product and scaling income generating activities. Through partnerships with Moi University, Moi Teaching and Referral Hospital and County Ministries of Health, we have established a county care network capable of providing the comprehensive benefit package delineated by the NHIF. As we've leveraged interest and funding in the Population Health model, our primary aim is to achieve sustainability by increasing enrollment in the national health insurance while improving the health service package provided to patients at ministry of health facilities through quality improvement.  This model ensures that families are protected from financial hardship through health insurance, and will sustain our programs with through primary care capitation payments made by NHIF for the insured population.

As a result of AMPATH’s focus on population health and non-communicable diseases (NCDs), we have been a partner and grantee of Access Accelerated and the World Bank, with a 3 year $2.5 million project to treat NCDs in two counties through community outreach and groups, expanding care both at local and specialized facilities, and educating communities on the benefits of health insurance.

Our key donors and partners include AbbVie, a leader in funding population health for several years; Abbott, supporting chronic disease management; Eli Lilly and Company and the Lilly Foundation, a long-term partner on diabetes, oncology, mental health and more; Celgene, Pfizer and Takeda, supporters of oncology treatment and preventative care; and others including the Bill & Melinda Gates Foundation, Astellas, and Corteva. AMPATH annually hosts a Partner Summit for supporters to leverage their work together and find innovative ways to collaborate.

Additionally, other key stakeholders include partner universities and health centers in North America and Sweden: Brown University, Duke University, the Icahn School of Medicine at Mount Sinai, Indiana University, Johns Hopkins University, Linkoping University, Kaiser Permanente School of Medicine, New York University, Purdue University, Stanford University,  the University of Alberta, University of California San Francisco, University of Texas at Austin, University of Toronto and the University of Virginia. 

We also rely heavily upon in-kind contributions to support the work of AMPATH Kenya as whole. We have established partnerships with many of our funding partners to help develop state of the art employee exchange programs that have helped AMPATH continue to push the boundaries of care. One example is our long-standing partnership with the Pfizer Global Health Fellows Program. 

Successes from this partnership can be seen from our ability to integrate Pfizer’s extensive expertise in supply chain management and quality improvement into our novel revolving fund pharmacy (a backup supply chain of medications for MOH hospitals and clinics). Pfizer worked with us in the early phase of developing this initiative by incorporating six sigma approaches into our workflows, training staff, and digitizing inventory management. Through their collaboration, we were able to derive mutual benefit as their contributions helped us grow our revolving fund pharmacies to over 70 clinical sites. 

Pfizer fellows were also instrumental in launching our innovative door-to-door screening for HIV across our catchment area. That program became the cornerstone of our HIV prevention strategy and guided numerous future efforts. These two efforts supported by Pfizer fellows serve as representative examples of the immense mutual benefit that exists with these types of partnerships.  

While we have the most experience with Pfizer and their Global Health Fellows Program, we have also developed additional programs which are tailored around partners’ needs and expertise. For example, within the Lilly Connecting Hearts Abroad program, we have facilitated one to two week observational visits from Lilly staff with expertise in different aspects of oncology to partner with on the ground Kenyan oncology staff to improve care. 

We have also had experience in working with industry partners from non-healthcare affiliated fields such as Dow Agrosciences (now Corteva). Through this partnership, we have been able to strengthen agricultural activities within our broader population health activities by working with Dow experts for 3-12 month assignments in Eldoret. That collaboration has helped us create larger agriculture cooperatives that are now demonstrating an increase in profits for shareholder farmers. Dow Agrosciences was also instrumental in helping AMPATH develop a more forward thinking strategy focused on advancing population health. Dow connected us to a partner, Root Artists, to create a unifying infographic which we could use to disseminate our strategy to partners.  

 This visualization and effort was subsequently turned into a published manuscript which specifically highlights the role our numerous partners have played in bringing up AMPATH’s comprehensive model of care (Mercer et al.  Leveraging the Power of Partnerships: Spreading the vision for a Population Health care delivery model in western Kenya.  Globalization and Health. 2018).

Ultimately, these programs which started as simple employee exchange programs have turned into long-lasting collaborative relationships that continue to benefit the participants within both institutions while, more importantly, advancing services for the underserved patients in western Kenya.