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
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