Uwezo Rheumatology Community based Project Kenya Lillian Mwaniki, Secretary of Arthritis and Rheumatic Diseases of Kenya (AARD), Advocate of the High Court of Kenya, Member of the International Coordinating Council, Bone & Joint Decade 11 13th July 2013 The Bone and Joint Decade Global Alliance for Musculoskeletal Health, NAN Program, World Network Conference, Rio De Janeiro, Brazil. 1
Outline General Background Objectives of the Uwezo Project Key Outcomes Challenges Successes Way Forward 2
General Background Critical gap in provision of general healthcare and musculoskeletal health services exists in Kenya because; Kenya whose population stands at 41 million does not fulfil WHO standard of 20 doctors per 100,000 people. There are 4 rheumatologists serving the country and only 2 on fulltime basis. Kenya is affected by brain drain Educated skilled professionals emigrate to look for "greener pastures". Tendency for students joining Universities to look for bigger income specialisations e.g. Cardiology. 3
General Background Continued Unaffordability of fees charged by the Universities. Kenyan healthcare system has also been to a large extent burdened by a big refugee population. Diseases like HIV, Malaria and TB consume the largest part of the healthcare budgetary allocation.
Objectives of the Uwezo Project The Uwezo project was initiated in response to this yawning gap and to supplement rheumatological skills in rural communities some of which do not have access to hospitals nearby. This was a collaborative project between following organisations; Royal Cornwall Hospital United Kingdom Arthrheuma Society of Kenya University of Nairobi Kenya Association for Arthritis & Rheumatic Diseases Kenya Reumatikerforbundet Sweden. University of Bondo. 5
Objectives of the Uwezo Project Continued Aimed to develop an innovative sustainable training programme for health professionals that are the first point of contact for patients in the community. Planned to equip the health providers with skills and knowledge to enable them diagnose, treat and manage musculoskeletal needs in the community. 6
Objectives of the Uwezo Project Continued Incorporated patients in the programme to form Doctor/patient team in training other patients and health providers in 10 locations. Training patients to participate in their own treatment, promotion of advocacy skills, value of exercises and self care. 7
Objectives of the Uwezo Project Continued Phase One targeted training of approximate 500 health professionals comprising physicians, clinical officers, nurses, physiotherapists, occupational therapists and patients across Kenya.
Key Outcomes Eight stations across Kenya were covered including one which was not originally on the schedule and three are outstanding. Majority of participants in the train the trainer sessions rated the overall content of the course as very good or excellent. Most patients had a boost of self confidence after participation in training. From initial training of nine doctors and nine patients about 416 healthcare professionals have been trained in the field. 9
Challenges Experienced (Uwezo Project) Lack of means of transport for patients to reach training sites. Budget deficit hence three stations not covered. Venue suitability in terms of access for patients with mobility problems. Course content rated very good but needed extra time. Patients found some of the sessions too technical. Some patients could not participate fully as they became unwell in between. 10
Successes Uwezo project (as pilot) was highly successful and a good model on what partnership and collaboration can achieve. The partnership between international and local experts created a good forum for sharing of best practices. The project touched several parts of Kenya including some remote areas where access to healthcare is a challenge. 11
Successes Continued Positive feedback and good attendance from the train the trainer sessions cementing teamwork between doctors, patients and other health professionals. Health professionals acquired a better understanding of the impact of musculoskeletal diseases on patients. Participation by patients with doctors in same forum was a great success as it helped patients to participate in their own treatment, boosted their confidence as they understood their medical problems better. 12
Successes Continued The participation of doctors, clinical officers, nurses, physiotherapists, occupational therapists and patients in one forum was also a good platform for showing how teamwork and multi disciplinary approach can produce better outcome. Project provided a good platform for education and creating more awareness on musculoskeletal diseases some of the key priorities of BJD. 13
Way Forward Training more health care professionals on musculoskeletal health if possible to reach all 47 counties in Kenya. Promote research via collection of data in District hospitals. Patient empowerment through self management and advocacy skills are needed. Need to expand participants to include pharmacists and orthopaedic surgeons. Secure governmental support for prioritization of musculoskeletal diseases. Roll out the programme in neighbouring countries. 14
Acknowledgement UK Experts Prof. Anthony Woolf, Prof. Josephine Erwin, Ms. Katie Edwards Sweden Experts Ms. Ingrid Cederlund Kenya Experts Dr. Omondi Oyoo, Dr. Paul Etau, Dr. Syokau Ilovi. THANK YOU 15