the Africa Consortium for Value Based Care

As the majority of African countries pursue health systems reforms to achieve UHC, quality of health care services remains low and is considered the poorest performing indicator of UHC.  Evidence demonstrates that poor quality of care is a larger driver of mortality than poor access to care in many low- and middle income countries (LMICs). This is partly due to volume-based health systems that focus on the quantity of services provided and not quality or outcomes. As health systems strain to provide better access to affordable quality care, a growing number of leading health institutions throughout the world have undertaken Value-based Care (VBC) initiatives in areas as diverse as supply chain management, integrated care and academia. VBC has not been applied to the context of health systems and health service provision in Africa.  Particularly with the increasing prevalence of Universal Health Coverage (UHC) across the continent, VBC will be critical to achieving sustainable and equitable access to affordable quality care. There is limited understanding of  appropriate models of VBC in Africa and therefore adoption has been slow.

To address the knowledge gap and adoption gap, the establishment of the Africa Consortium for Value-Based Care (VBC) (henceforth "Consortium") is dedicated to the raising the awareness and understanding of VBC to propel the research, analysis and dissemination of the unique opportunities, challenges and solutions of VBC health systems and strengthening on the continent of Africa. Through Memorandum of Understandings (MoU's) theConsortium has already brought together international best-in-practice technical knowledge organisations to collaborate in creating a pathway for the development of African researchers and VBC Regional Consortium hubs. 

The target are populations are those served by national public health system.  UHC's goal is to provide quality health services that do not cause financial harm or destitution upon receiving health services. The challenge to date in the majority of African health systems is access but as systems evolve and access increases, considerations of the financial / payment schemes must come into focus and importance. In Africa more than 70% of health services are paid out-of-pocket with estimates, in some countries, as low as 20 per cent of the population having any type of health insurance. The Consortium's work is to improve public health policy and design. UHC for the Sustainable Development Goals (SDG) conditions could avert 8·6 million deaths per year but only if expansion of service coverage is accompanied by investments into high-quality health systems. VBH provides a core underpinning to gains in UHC and in addition to those underserved is the challenge of affordable access. 

I have opened clinics and a molecular laboratory in Kenya.  As a registered Kenya health service provider we innovated maternal health services by being the first in Kenya to implement a task-shifting nurse-midwife led limited obstetric screening as a core modality. We are accredited by the Nursing Council of Kenya as a Continuing Professional Development (CPD) provider in the obstetric screening, breast feeding with Nephrology and Chemotherapy nursing in development.  On Pan-Africa scope I am a Strategic Healthcare Consultant focused on strategy and innovation. The selection of partner is critical and ReaMedica has already signed an MoU with the International Consortium for Health Outcomes Measurements (ICHOM) as the technical knowledge partner.  We have also signed an MoU with the Rural Urban Private Hospital Association (RUPHA) of Kenya and are in MoU deliberations for potential hubs with universities in Kenya, South Africa and Ethiopia. A preliminary advisory board composed of  international and African based experts in academia, program implementation, industry and practice has been established to spearhead the defining of the scope of work for the Consortium.  We use a co-creation methodology in the workshops (face-to-face & virtual) as well as bilateral discussions. 

I have selected "prototype" based on the milestones listed:

1. ReaMedica has already signed key MoU's (ICHOM & RUPHA) and in deliberation with potential hub partner institutions. 
2. A Visioning workshop was conducted in Pretoria, South Africa with partner organisations.
3. The construction of the ReaMedica Training Centre which will house the Consortium in Nairobi, Kenya
4. Presenting the Consortium concept at the Africa satellite SRI Congress 2024 in Durban

The Solve community can accelerate the development and refinement of the Consortium rollout.  What we can bring to the community is an initiative the has not been attempted on a systems level. 

This Consortium brings a significant opportunity to engage key stakeholders in a joint manner  to transform health care based on high quality patient centred health systems. The initiative will be strategic in establishing linkages to promote VBH as a core approach to achieving UHC. This will build a framework of analysis and evaluation that captures the essence of value and efficacy across health systems and programmes as well as strengthen the expansion and adoption of VBC on the continent of Africa

The dearth of VBC research and examples in Africa is daunting. Increasing the understanding and implementation of VBC in Africa requires a multifaceted approach that originates from the unique healthcare landscape of the continent. A theory of change outlining the key steps would include:

1. Understanding and developing an Africa centric context: the hubs would start by conducting a comprehensive assessment of the current healthcare system in Kenya (for example) to understand the existing infrastructure, resources, prevalent diseases, and socio-economic factors affecting healthcare delivery and what the challenges are to implementing VBC programmes.

2. Stakeholder Engagement: Engage with all relevant stakeholders including government bodies, healthcare providers, insurers, patients, and community leaders. Build consensus and collaboration to ensure buy-in and support throughout the implementation process which we have already begun.

3. Capacity Building: Invest in healthcare workforce training and development programs to equip providers with the skills and knowledge required for VBC aligned service provision. This includes training on clinical protocols, data management, quality improvement, and patient-centered communication which ICHOM will play a critical role.

4. Infrastructure Development specific to digitisation: Upgrading healthcare facilities and investment in technology infrastructure to support data collection, analysis, and reporting. VBC requires comprehensive tracking of activities and costing of which electronic health record systems play a significant role. The facilitation of information exchange and coordination of care continuum across providers and settings will be required depending on VBC sets implemented.  At the very minimum at the facility level. 

5. Payment Reform: Transition from fee-for-service reimbursement models to value-based payment models such as bundled payments, pay-for-performance, and capitation. Kenya is in this process from a national payor perspective and there is high interest from the private medical insurance industry to tie reimbursement to patient outcomes and satisfaction.

6. Quality Measurement and Reporting: Develop standardized metrics and quality indicators to assess the effectiveness, efficiency, and safety of healthcare services. Establish mechanisms for regular monitoring, evaluation, and reporting of performance data to identify areas for improvement and drive continuous quality enhancement.

7. Patient Empowerment:  PROM's or Patient Reported Outcome Measures promotes shared decision-making, health literacy, and self-management skills to improve health outcomes and reduce healthcare disparities.

8. Community Engagement: Engage with local communities to understand their healthcare needs, preferences, and cultural norms. Tailor interventions to address social determinants of health and promote health equity by collaborating with community-based organizations and leveraging existing support networks. This is where the Rural Urban Private Hospital Association is critical.

9. Policy and Regulatory Support: Advocate for supportive policies and regulatory frameworks at the national and regional levels to facilitate the adoption of value-based care practices. Remove barriers to innovation, encourage experimentation, and ensure alignment with broader health system goals and priorities.  Case studies are a key enabler of evidence based decision making.

10. Continuous Learning and Adaptation: Foster a culture of learning, innovation, and adaptation by promoting knowledge sharing, peer collaboration, and continuous quality improvement cycles. Monitor progress, solicit feedback, and adjust strategies as needed to achieve sustainable impact and scale successful interventions over time. The Consortium and hubs will produce and institutionalise the learnings programmatically and systematically. 

The impact goals for the Consortium is the introduction of VBC with 2 facility level implementations in Kenya and case studies thereof. The immediate tracking would be measuring the patient impact and "value" created through the adoption of VBC in patient care and services provision. VBC is enormously difficult to implement and has rarely been attempted within a low resource setting.  Another impact is how ICHOM adjust or creates sets and implementation guidelines that reflect the challenges of the country's health system.  A first step is to increase the Africa representation of ICHOM working group participants. 

There are five Advisory Board members working on an ad hoc basis.  ReaMedica staff, 2 working at 15-20% capacity in the launch stage.

Since July of 2023

The Advisory Board, de facto leadership team includes 2 African female doctors, 1 African female nurse, 1 American female program manager, 2 American males.  The team is evenly slip from a gender representation perspective and African / non-African leadership team.  This will shift to predominately African leadership in the next 24 months.  The recruitment of the leadership team comes from current advisory members and supporters of the Consortium.  We are currently developing a SOP for the recruitment of the leadership team and hiring of full-time staff which is locally driven,

The Consortium is funded by ReaMedica Healthcare as we launch the minimum viable product (MVP).  Our key customers vary from knowledge partners implementors and practioners to analysis and recommendations. For each customer segment the products and services will differ.  For knowledge partners the value is iterating a VBC framework in a different context than the global north but taking the learnings to refine implementation packages.  The implementing providers have a new / different way to assess value not solely costs.  Over the past 10 months we have conducted interviews and convened stakeholder workshops to build and validate assumptions for the MVP.

Achieving financial sustainability for a research oriented entity is dependent upon the quality of the research and insights generated and measuring the impact of the research in a scalable model.  The vision is to spin off the Consortium, currently housed within ReaMedica, at a point when funds have been secured.  ReaMedica is able to cover the expenses of the launch and the forseeable 24 months period thereafter.