In Nairobi, a chain of micro-clinics delivers health care where it’s needed most

The Access Afya micro-clinic in Nairobi's Kiambiu settlement provides medical treatment for 90 people a day. (Justus Wanzala)

NAIROBI, Kenya — On a humid afternoon at a health clinic in the informal settlement of Kiambiu, medic Mercy Wanza is busy taking the vital signs of new patients and entering their data into a computer system.

The clinic Wanza works at is called Access Afya. It’s part of a chain of three clinics located in some of Nairobi’s largest slums. The clean white walls inside the clinic are a stark contrast with the dusty unpaved street outside.

Although on this afternoon the number of patients at the clinic is small, Wanza says she has served some 70 patients since morning, including many children. She and the other staff can test and treat for diseases common in the area, such as malaria, diabetes and typhoid, screen for cervical and prostate cancer, and perform minor surgeries.

Health facilities like this are rare in Nairobi’s sprawling informal settlements, where an estimated 60 percent of the Kenyan capital’s 6 million people live. And most residents are too poor to afford health services in well-equipped private medical institutions. As a result, communities like Kiambiu score poorly on common health indicators such as child mortality and prevalence of disease.

But Access Afya, a social enterprise founded in 2012, is offering an alternative. Its chain of micro-clinics offers essential health services to slum dwellers, supplementing the efforts of the government and other health providers, and offering a model that could work in other developing cities surrounded by fast-growing informal areas.

Melissa Menke, the founder and chief executive officer, says Access Afya works under a belief that every Kenyan should have a safe first access point into the health system. Most of the patients are uninsured. They pay modest sums for services — a well baby visit costs 10 shillings, or USD 10 cents — and donors pick up the tab for some services. Menke says the model is designed to be self-sustaining.

In return, patients get access to quality healthcare close to where they live and work, as well as digital diagnostic tools that can save costly visits with specialists. The clinics also use a phone-based follow-up service to remind patients to take medications and to monitor how they are responding to treatments.

“The clinics are digital and run on electronic systems that are designed for scale,” Menke says.

Improving health on Africa’s ‘own terms’

Access Afya is an innovative attempt to improve health care in the areas that need it most.

Speaking in Nairobi during the recent launch of a Lancet report on health in sub-Saharan Africa,  Nelson Sewankambo, a professor at Uganda’s Makerere University College of Health Sciences and co-author of the report, said urban slums and rural areas are the worst-hit by health inequities. “But the evidence shows us that there is a clear opportunity for Africa to improve health on its own terms,” he said, “and largely with its own resources.”

The report stresses use of mobile technology and innovation to overcome some of the human-resource and structural barriers in healthcare provision. Bright Simons, a co-author of the report and creator of a tool for identifying counterfeit medicine, said there are now three mobile phones for every four people in sub-Saharan Africa. Mobile-phone penetration can enhance health care provision in poor communities.

“By adopting more advanced, but appropriate technologies,” Simons said, “African countries can realize the potential for leapfrogging opportunities for health better healthcare.”

The Access Afya clinics provide consultations, lab testing, diagnosis, chronic-condition management, immunizations, family planning and first aid. Services are available 12 hours daily. The Kiambiu location has two clinical officers, two assistants and a nurse, and treats an average of 90 people a day, including many women and children.

Menke says Access Afya uses data it gathers to improve and evolve its operations and the quality of care it provides. Unlike public hospitals, she says, the clinics have a customer-care team devoted to making sure patients are happy.

Increasingly, the clinics are taking these services deeper into the community. Access Afya runs a health programme in primary schools located within informal settlements. The programme has worked with 15 schools and performed health screenings with more than 1,000 students. Menke says bringing care directly to the students helped drive down the price point to just a dollar per child per month.

Meanwhile, one of Access Afya’s new clinics was located in a settlement close to Nairobi’s industrial sector. Many breadwinners of local families work in factories where injuries are common but proper medical care is not. Access Afya designed a programme targeting factory workers, including emergency evacuation and treatment for common machine-operation injuries.

Access Afya works with various partners, both international and local. They include Kenya’s Ministry of Health to plan for new clinics and to deliver essential public health services such as immunization. Another key partner is Kenya’s National Hospital Insurance Fund and a mobile-phone service known as M-Tiba which facilitates payments for medical care.

“This combination of evidence, data systems, friendly frontline health staff and customer care ensure that our patients feel cared about,” Menke says. “And that their health care actually works.”

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Justus Wanzala is a Kenyan freelance journalist and a postgraduate student of development studies. He writes extensively on sustainable development, climate change and science policy, as well urban and rural development. Full bio

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