Population Health Delivery Pilot in Turbo
On February 28th, 2018, the population health screening team was in Jua Kali town, Turbo Sub-county offering screening services in groups like they do every Wednesday. The team offers integrated screening for diabetes, hypertension, HIV and soon will include mental health and cancer. We visited Angaza group, a community GISHE group that meets within the market in a small temporary structure that offers the group some level of privacy and protection from weather elements. Angaza group has 22 members. On this sunny midmorning the health team prepared their equipments and booths ready to offer services to the group members and the droves of people turning up as news had spread of the arrival of AMPATH health providers. Having completed the main agenda of savings and loaning, the group settled down to receive health education and be sensitized about the national Insurance, NHIF.
Lillian, a health Liaison officer employed by AMPATH, took the crowd through the benefits of NHIF and the steps to enrollment. Judging from the questions that followed her session, it was clear that a lot needs to be done to increase information about NHIF and increase uptake - a task AMPATH has taken up working with NHIF. A quick assessment of the enrollment within the group revealed a less than 2% membership amongst the people present in the gathering.
Miriam aged 39 with three children is one of the 3 people who were still active members of NHIF. She has been a member of NHIF since 2013. Neither she nor any of her family members have been hospitalized for illness. Miriam still pays her premiums faithfully despite the fact that neither she nor any of her family members have had to use the service. She understands the benefits of health insurance and fears losing her hard earned investments to cover the high cost of treatment in case of illness or accidents. "I know many people who have had to sell their property or businesses to pay hospital bills. I work hard in my grain and miller business and I would not want to risk." Miriam is also part of a GISHE group where she and 21 other men and women save and loan to each other.
Miriam was later screened for hypertension, diabetes and HIV and while her blood pressure and RBS reading was normal, she was informed that her BMI and age puts her at a greater risk of developing hypertension or diabetes. She was counseled on how to stay healthy and reduce her risks.
Seated next to her was Selly. Selly doesn't have NHIF insurance and hopes to enroll after the sensitization she received. She believes that her small vegetable stand can give her the returns that would enable her to enroll for NHIF. She has been a member of the GISHE group since 2017 and has seen the importance of savings. A single mother herself, she is able to put her three kids through school and provide for them. Health insurance would give her added security of knowing she is covered in the case of illness in the family. She already borrows from the group to restock her stall and plans to take a loan to pay for her NHIF premiums soon. Sheila, who runs a small salon next to Selly's vegetable stand also hopes to sign up for NHIF and is a member of the same group.
The group and community members were happy to have health services and teaching brought close to them and they all benefitted from the questions other members asked in the marathon. 14 out of the 38 screened were Angaza group members. 11 people had elevated pressures and sugars and were referred to Cheramei dispensary for further investigation and treatment. AMPATH supports a monthly diabetes and hypertension clinic in Cheramei dispensary, a small level II dispensary within Jua Kali town. On that clinic day, a team of care providers from Turbo Sub County Hospital joined the nurse and clinical officer in Cheramei to offer hypertensive and diabetes care to the clients booked on that day. The facility is manned by nurses and clinical officers trained and mentored to offer chronic disease care. When the team encounters difficult cases they tele-consult with the clinical team in Turbo Sub-county Hospital. A mini revolving fund pharmacy within the facility pharmacy has been equipped with medication to manage diabetes and hypertension offering a back up to the facility pharmacy that also stocks the medication.
Difficult cases are referred up to the next level health facility, Turbo Sub County Hospital to be seen by clinical officers or physicians who visit the clinic from MTRH from time to time in the reverse referral system.