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Afya Bora: An Approach to Global Health Leadership. Aliza Monroe-Wise, MD, MSc Carey Farquhar, MD, MPH. Overview. Afya Bora: The Concept, Participants, Timeline, and Activities Structure 3 week modules Attachment sites Mentorship My experiences Attachment site Activities GO Health - PowerPoint PPT Presentation
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Afya Bora: An Approach to Global Health Leadership
Afya Bora: An Approach to Global Health Leadership
Aliza Monroe-Wise, MD, MScCarey Farquhar, MD, MPH
Aliza Monroe-Wise, MD, MScCarey Farquhar, MD, MPH
OverviewOverview
Afya Bora: The Concept, Participants, Timeline, and Activities
Structure 3 week modulesAttachment sitesMentorship
My experiencesAttachment siteActivitiesGO Health Project
Afya Bora: The Concept, Participants, Timeline, and Activities
Structure 3 week modulesAttachment sitesMentorship
My experiencesAttachment siteActivitiesGO Health Project
Afya Bora: The ConceptAfya Bora: The Concept
4 US Academic Institutions partnered with 4 African InstitutionsUW - University of Nairobi (Kenya)UCSF - Makerere University (Uganda)UPenn - University of BotswanaJohns Hopkins - Muhimbili University
(Tanzania)
Participants chosen from 85 applicants in medicine, nursing, and public health
4 US Academic Institutions partnered with 4 African InstitutionsUW - University of Nairobi (Kenya)UCSF - Makerere University (Uganda)UPenn - University of BotswanaJohns Hopkins - Muhimbili University
(Tanzania)
Participants chosen from 85 applicants in medicine, nursing, and public health
Afya Bora: The ParticipantsAfya Bora: The Participants
23 Fellows selected7 Kenya, 4 Tanzania, 4 Uganda, 4
Botswana, 4 USMultidisciplinary group
10 Medical post-graduates and post-residency physicians
13 Graduate nurses9 with public health degrees (2
PhD; 6 MPH)7 men and 16 women
23 Fellows selected7 Kenya, 4 Tanzania, 4 Uganda, 4
Botswana, 4 USMultidisciplinary group
10 Medical post-graduates and post-residency physicians
13 Graduate nurses9 with public health degrees (2
PhD; 6 MPH)7 men and 16 women
Afya Bora: Timeline and Activities
Afya Bora: Timeline and Activities
2-day Orientation and Responsible Conduct of Research Training
Core Curriculum 3 one-week modules
Attachment I
(~3 months) Independent Projects at
Attachment Sites
1-day workshop for Mentoring Teams within first 2 weeks
Weekly meetings with primary mentor
Semi-monthly meetings with Country Lead and Fellows in-country
Monthly meetings with Mentoring Team
Project report due last day of rotation
January 7-28 January 31-April 28
OverviewOverview
Afya Bora: The Concept, Participants, Timeline, and Activities
Structure 3 week modulesAttachment sitesMentorship
My experiencesAttachment siteActivitiesGO Health Project
Afya Bora: The Concept, Participants, Timeline, and Activities
Structure 3 week modulesAttachment sitesMentorship
My experiencesAttachment siteActivitiesGO Health Project
Module 1: Leadership Skills Module 1: Leadership Skills
Leadership attributes Definitions of leadership Leaders vs. Managers
Strategic thinking Thinking vs. Planning SWOT analysis
Consensus building Modalities, steps
Mentorship Mentoring vs. training vs. coaching The learning contract model Roles, benefits
Leadership attributes Definitions of leadership Leaders vs. Managers
Strategic thinking Thinking vs. Planning SWOT analysis
Consensus building Modalities, steps
Mentorship Mentoring vs. training vs. coaching The learning contract model Roles, benefits
Module 2: Implementation Science & Health Systems Module 2: Implementation Science & Health Systems
Stakeholder and policy analysis Polio eradication case
Measuring impact and effectiveness (surveillance, metrics)
Operations research Qualitative Health Systems Research
Sex worker case
Cost effectiveness and economic analysis Motor vehicle injury prevention case
Social marketing Group Case Discussion
Stakeholder and policy analysis Polio eradication case
Measuring impact and effectiveness (surveillance, metrics)
Operations research Qualitative Health Systems Research
Sex worker case
Cost effectiveness and economic analysis Motor vehicle injury prevention case
Social marketing Group Case Discussion
Module 3: Project Management & Research
Coordination
Module 3: Project Management & Research
CoordinationFederal and international ethics regulationsExamples and cases from US, Kenya, etc
Budget and financial managementCase: how to develop a budget
Personnel managementCase: the SHARE projectSubject recruitment and retention
Data ManagementCreating questionnaires and databases
Federal and international ethics regulationsExamples and cases from US, Kenya, etc
Budget and financial managementCase: how to develop a budget
Personnel managementCase: the SHARE projectSubject recruitment and retention
Data ManagementCreating questionnaires and databases
Afya Bora: Timeline and Activities
Afya Bora: Timeline and Activities
2-day Orientation and Responsible Conduct of Research Training
Core Curriculum 3 one-week modules
Attachment I
(~3 months) Independent Projects at
Attachment Sites
1-day workshop for Mentoring Teams within first 2 weeks
Weekly meetings with primary mentor
Semi-monthly meetings with Country Lead and Fellows in-country
Monthly meetings with Mentoring Team
Project report due last day of rotation
January 7-28 January 31-April 28
Attachment SitesAttachment Sites
Kenya: MoH, AMREF, Kenyatta Hospital, Kenya Medical Research Institute
Uganda: Joint Clinical Research Center, MoH
Botswana: University of Botswana, i-TECH, Botswana-USA CDC
Tanzania: Ben Williams HIV/AIDS Found, AMREF,
Kenya: MoH, AMREF, Kenyatta Hospital, Kenya Medical Research Institute
Uganda: Joint Clinical Research Center, MoH
Botswana: University of Botswana, i-TECH, Botswana-USA CDC
Tanzania: Ben Williams HIV/AIDS Found, AMREF,
MentoringMentoring
1-day workshop for Mentoring Teams within first 2 weeks, includes fellows
As needed meetings with Attachment Site Mentor
Weekly meetings with Primary MentorSemi-monthly meetings with Country
Lead and Fellows in-countryMonthly meetings with Mentoring TeamProject report and evaluation due last
day of rotation
1-day workshop for Mentoring Teams within first 2 weeks, includes fellows
As needed meetings with Attachment Site Mentor
Weekly meetings with Primary MentorSemi-monthly meetings with Country
Lead and Fellows in-countryMonthly meetings with Mentoring TeamProject report and evaluation due last
day of rotation
OverviewOverview
Afya Bora: The Concept, Participants, Timeline, and Activities
Structure 3 week modulesAttachment sitesMentorship
My experiencesAttachment siteActivitiesGO Health Project
Afya Bora: The Concept, Participants, Timeline, and Activities
Structure 3 week modulesAttachment sitesMentorship
My experiencesAttachment siteActivitiesGO Health Project
Attachment Site: AMREFAttachment Site: AMREF
Founded in 1950s by British DoctorsEmphasis on flights to remote areasInternational organization with
operations in 29 African countries, as well as offices in UK and USA
Vision: Better health for AfricaStrategic foci:
Community partnering for better healthHealth systems and policy researchCapacity Building
Founded in 1950s by British DoctorsEmphasis on flights to remote areasInternational organization with
operations in 29 African countries, as well as offices in UK and USA
Vision: Better health for AfricaStrategic foci:
Community partnering for better healthHealth systems and policy researchCapacity Building
AMREF: KenyaAMREF: Kenya
HIV/AIDS integrative approach Sanitation and basic servicesMaternal and child healthNursing clinical skills coursesCommunity health worker
trainingWork in remote rural areas, and
urban slums
HIV/AIDS integrative approach Sanitation and basic servicesMaternal and child healthNursing clinical skills coursesCommunity health worker
trainingWork in remote rural areas, and
urban slums
KiberaKibera Urban slum with ~2.5 million residents;
60% of Nairobi population (gov’t estimate 170,000)
?Largest slum in Africa 2 water pipes, 20% electricity, no sewage
Urban slum with ~2.5 million residents; 60% of Nairobi population (gov’t estimate 170,000)
?Largest slum in Africa 2 water pipes, 20% electricity, no sewage
AMREF: KiberaAMREF: Kibera
Full care clinic in KiberaMaternal health carePediatric clinicAdult clinicHIV testing/careTB clinicLaboratorySocial workPharmacy
Full care clinic in KiberaMaternal health carePediatric clinicAdult clinicHIV testing/careTB clinicLaboratorySocial workPharmacy
AMREF: KiberaAMREF: Kibera
HIV counseling and testing programOver 3,800 HIV-positive patients
have enrolled to dateAlmost 2000 on ARVs823 defaulters identified (no
return to clinic in >90 days)Tracking in progress
HIV counseling and testing programOver 3,800 HIV-positive patients
have enrolled to dateAlmost 2000 on ARVs823 defaulters identified (no
return to clinic in >90 days)Tracking in progress
ActivitiesActivities
Evaluation of clinical practice by Clinical Officers in the adult medicine clinicHIV testing, counseling, group information
session, enrollment, follow-up
Evaluation of procedures in laboratoryHIV rapid tests, CD4 count, malaria blood
smears, stool O&P, UA
Evaluation of tracking activities performed by the clinic Social WorkerHIV “social assessment,” tracking defaulters
Evaluation of clinical practice by Clinical Officers in the adult medicine clinicHIV testing, counseling, group information
session, enrollment, follow-up
Evaluation of procedures in laboratoryHIV rapid tests, CD4 count, malaria blood
smears, stool O&P, UA
Evaluation of tracking activities performed by the clinic Social WorkerHIV “social assessment,” tracking defaulters
ActivitiesActivities
Review of HIV/ART databaseLarge longitudinal database from all
HIV positive patients in the clinicPreliminary literature review
Several studies published regarding HIV positive cohort in Kibera slum
Attendance at meetings of ART program staff and clinical providers
Review of HIV/ART databaseLarge longitudinal database from all
HIV positive patients in the clinicPreliminary literature review
Several studies published regarding HIV positive cohort in Kibera slum
Attendance at meetings of ART program staff and clinical providers
Project: Goals & HopesProject: Goals & Hopes
Afya Bora FellowshipLearn GH leadership skillsGain valuable GH experience with
international organizationAMREF Management
Data analysis of existing dataJournal publication
AMREF Kibera EmployeesImprove working conditions in clinicServe as advocate & liaison with
managementPersonal Goals
Afya Bora FellowshipLearn GH leadership skillsGain valuable GH experience with
international organizationAMREF Management
Data analysis of existing dataJournal publication
AMREF Kibera EmployeesImprove working conditions in clinicServe as advocate & liaison with
managementPersonal Goals
Project OverviewProject Overview
Quantitative Data analysisEvaluation of overall project retentionTiming between visitsFactors affecting time between visits
Value Stream MappingSteps taken in clinic visitsValue in individual steps analyzed
Time in Motion AnalysisTiming of steps taken in clinic
Quantitative Data analysisEvaluation of overall project retentionTiming between visitsFactors affecting time between visits
Value Stream MappingSteps taken in clinic visitsValue in individual steps analyzed
Time in Motion AnalysisTiming of steps taken in clinic
Preliminary Data AnalysisPreliminary Data Analysis
Major BottlenecksMajor Bottlenecks
3848HIV+
310881%
303198%
236178%
202586%
194096%
111758%
Eligible for
Program
CD4Testing
Retention >90 days
#ExtraIf
Eliminated
270 320 823
Time and Motion AnalysisTime and Motion Analysis
One observer watches all patients coming to the clinic
Records of wait times at each step taken in clinic
Overall bottleneck steps can be evaluated
Can be used in conjunction with value stream mapping
One observer watches all patients coming to the clinic
Records of wait times at each step taken in clinic
Overall bottleneck steps can be evaluated
Can be used in conjunction with value stream mapping