African Health Care Initiative: Methodology

The African Health Care Initiative has been intentionally structured in a phased approach, whereby each subsequent phase builds on the progress achieved via earlier phases, in which project achievement is enhanced.

Current Reality

Effective health care in Africa faces a number of challenges perhaps most significant of which is the sustainable provision of adequate and effective primary health care in the rural environment. It is well recognized that rural health care facilities play a crucial role in contributing towards rural health in Africa via inter alia.

•  Provision of general health care
• Child care, including immunization against measles, tetanus, TB
• Health and hygiene education
• Prevention and addressment of chronic conditions, including HIV Aids

Like their global cousins, Africa’s health clinics battle with the rapidly increasing rate of health center acquired infections from multi-drug resistance pathogens. As an example, deaths arising from hospital acquired infections in the USA and UK are around 150,000 per annum.  Whilst no similar figures are available for most African countries, it is clear that similar health threats exist and are exacerbated by further challenges result from:

• The high proportion of immuno-compromised patients
• High incidence and impact of TB and HIV
• Limited resources for cleaning and disinfection
• Less effective hygiene controls at community health centres and clinics
• Infrastructure poverty, capacity poverty and information poverty
• Specific additional challenges include poor drinking water quality, variable energy availability, restricted local economic development opportunities

Desired Future Reality – a Long Term Vision

By 2020, at least 80% of the rural people of Africa are serviced by safe and sustainable health clinics through the copper enabled provision of electric power, clean potable water, and antimicrobial touch surfaces, driven via community based enterprise.

Critical Success Factors

Meeting the Long Term Vision requires an African initiative, supported by international best practices and appropriate technologies, that creates effective and sustainable African rural health clinics.  Key critical success factors include an holistic approach that recognizes and seeks to utilize the following needs:

• Adequate and reliable electric power – Health and energy are interdependent factors, with energy required to meet basic needs such as vaccine refrigeration, lighting, communications and computers, sterilization, etc. 92% of rural Africans live without electricity (International Energy Agency, 2002).

• Clean water – Safe, clean water is the cornerstone to human health.  Even in relatively well developed South Africa, 59% of rural clinics lack acceptable sanitation and 48% lack safe drinking water (World Water Development Report, 2006).

• Health care infection control – Health care-associated infections take a high toll in human lives and affect hundreds of millions of patients worldwide each year.  Between 5% and 10% of patients admitted to hospitals in developed countries acquire infections, whilst in some developing country settings, the proportion of patients affected can exceed 25%.  (World Health Organization, 2005). Added to the considerable human suffering is the economic impact of these infections. Studies in three OECD countries, one of which is a middle-income country, have shown that a total of 7.0-8.2 billion dollars are lost by the three countries every year because of health care-associated infections. The importance of providing non-threatening health care is captured in the WHO slogan "Clean Care is Safer Care".

• Project Sustainability – Securing effective project sustainability is a priority objective , and is best achieved by including local economic development (LED) components.  LED involves the public, business and non-governmental sector partners collectively creating better conditions for economic growth and employment generation and in turn assuring local “project ownership”.  

• Information dissemination and distribution – the importance of information sharing and dissemination of learning amongst rural health clinics and specialist support teams is acknowledged as a key contributor to achieving an effective and sustainable initiative.

• Supportive Alignment – between Development Organisations, Funders, Governments, Regional Organisations, and the regional forming of partnerships.

• Corporate Social Responsibility – twinning of public rural health clinics with similar Corporate Social Responsibility (CSR) based industry initiatives in each country, the critical mass of local and regional know-how and knowledge sharing is extended
  
  

Phased Approach

The African Health Care Initiative is structured in a phased approach, whereby each subsequent phase builds on the progress achieved via earlier phases.  The successfully completed Phases I and II (period 2006-2007), in which the International Copper Association funded African based scientific and technical work, comprised the following key deliverables.

      Phase I: Foundation Phase (completed)

• Formation of a Specialist Nosocomial Infection Control team in South Africa under the leadership of internationally respected Professor Shaheen Mehtar, University of Stellenbosch.

• Confirmation as to the effectiveness of copper’s biostatic capabilities on clinical isolates of problematic pathogens in a nosocomial environment (e.g. tests with clinical strains of MRSA, E. coli and Acinetobacter baumanii).

• Formation of a Specialist Safe Drinking Water Team in South Africa, under the leadership of internationally respected Bettina Genthe, Council for Scientific and Industrial Research.

• Formation of a Specialist Electrical Supply Team under the leadership of Dr Lemba Nyirenda, Zambia.

• Facilitating a “Biostatic Characteristics of Copper” session at the 7th International Conference of the International Federation of Infection Control, Cape Town, South Africa.

• Hosting of the African Health Care Initiative Workshop in Johannesburg, South Africa.

      Phase II: Control Systems Development Phase (near completion) builds on Phase 1 by:

• Initiation of Infection Control Studies at Tygerberg Academic Hospital and Grabouw Community Health Centre, South Africa, including the development of the necessary protocols and retrofitting know-how for consideration and use in Phase 3.

• Confirmation as to the effectiveness of copper’s biostatic capabilities on clinical isolates of problematic pathogens in a drinking water environment by Bettina Genthe, CSIR.

• Initiation of a generic Local Economic Development model via interactions with and sponsorship of the Overberg Training Centre, South Africa.

• Activation and utilization of an African Health Care web-based communication portal and Project Issue Tracker.

      Phase III: Southern Africa Region Piloting Phase (currently running)

A ring-fenced regional piloting phase in which the African Health Care Initiative is extended to six pilot clinics through the Southern African region, including Botswana, Lesotho, Mozambique, Namibia, South Africa and Zambia.

      Phase IV: African Roll-Out Phase (2011 to 2020, and beyond)

The proven approaches, solutions and technologies of Phase III, will enable successful replication across Africa.  The cost per clinic will be reduced as economies of scale and effective regional Centers of Excellence develop.  Funding will be via the leveraging of the investments in the Phase III pilot projects into large scale grants and loan financing from governments, development banks, foundations and other donors.

Train the Trainer

A “train the trainer” approach will be used throughout the various phases of the project, and particularly during Phases III and IV, via the establishment and expansion of “Centers of Excellence” by which to drive the country based Rural Health Care Working Models.  The initial establishment thereof will be in South Africa, and thereafter in each country in alignment with the phased roll-out.

Managing Sustainability Risk

Ensuring sustainability of the initiative at each clinic is of the utmost importance and will be proactively managed by the project team.  A “Sustainability Check” self management and consultative auditing tool, located on Communication Portal, will be used for each clinic.  Each of the key legs of sustainability will be regularly assessed and managed.

Twinning with CSR initiative in each country

Each public rural health clinic will be “twinned” with a similar Corporate Social Responsibility (CSR) based industry initiative in the same country. Indications are that this would be readily achievable in South Africa, Namibia, Botswana, and Zambia during Phase III.  In this manner, the critical mass of local and regional know-how and knowledge sharing is extended. 

Guiding Local Economic Development

The effective establishment of LED is critical to future sustainability and regional economic welfare.  This concept has already been successfully realized in the Phase II clinic in South Africa in which the Overberg Training Center of Grabouw is being used for conversion of the Grabouw Community Health Centre. (The trainees include petty criminals whom were given the option by the local Magistrate to undergo structured skills development as opposed to a fine or jail time).