Idea: Portable irrigation technology helping sub-Saharan smallholder farmers grow crops out of season.
Problem: When it comes to food supply, Africa faces enormous instability due to unpredictable climate and poor resources. Method: Kick Start , a not-for-profit organisation that specialises in irrigation technology, is making portable water pumps accessible to farming communities across Africa — most significantly in Kenya, Tanzania and Mali. Solution: Kick Start told The Atlantic that, since , their pumps have lifted , people out of poverty, helping to "create an entrepreneurial middle class, starting with the family farm". They have pumped new revenues equivalent to 0. Idea: A computer tablet diagnoses heart disease in rural households with limited access to medical services.
Problem: Cardiovascular diseases kill some 17 million worldwide annually. In many African countries, those at risk often have to spend huge amounts of money and travel hundreds of miles to reach heart specialists concentrated in main urban centres. Electrodes are fixed near the patient's heart. Idea: The Inye computer tablet that can connect to the internet via a dongle surmounts the price and infrastructure barriers in one go. Problem: Tech-savvy youths, who make up the bulk of the continent's population, face being left behind by a growing "digital divide".
While much of Africa has skipped the desktop internet era and gone straight to mobile tech, big name brands retail in price ranges that remain out of reach for a majority in sub-Saharan Africa. Infrastructure is also straining under rapid population growth, and wireless and broadband technology is not yet widely available in many public places. Run on Android systems, it can be connected to the internet via widely used dongles rather than wirelessly. IT provider Encipher also offers add-on bundles from games to specifically tailored apps. Local developers are designing apps that address issues such as HIV, water and sanitation and education.
Verdict: The group is now retailing its Inye 2 model to popular demand. Long-term, there are plans to expand beyond Africa's most populous country. Idea: Refining locally sourced cassava into ethanol fuel to provide cleaner cooking fuel. Problem: Forests in Africa are being cut down at a rate of 4m hectares a year, more than twice the worldwide average rate.
The smoke from cooking using these solid fuels also triggers respiratory problems that cause nearly 2 million deaths in the developing world each year.
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Method: CleanStar Mozambique , a partnership between CleanStar and Danish industrial enzymes producer Novozymes , has opened the world's first sustainable cooking-fuel plant in Mozambique. CleanStar has steered clear of monoculture crops in favour of sustainable farming methods. One-sixth of the final yield comes from locally harvested cassava, which requires farmers to plant in rotation with other edible crops to keep the soil fertile. A Sofala Province-based plant transforms the products into ethanol, which is sold on the local market along with adapted cooking stoves also produced by the company.
Verdict: "City women are tired of watching charcoal prices rise, carrying dirty fuel, and waiting for the day that they can afford a safe gas stove and a reliable supply of imported cylinders," CleanStar marketing director Thelma Venichand said. Idea: Danish brothers David and Christopher Mikkelsen founded Refugees United in after they helped a young Afghan refugee in Copenhagen search for lost family members.
Realising the futile paper trail that many refugees were faced with when looking for missing relatives, the brothers wanted to find an easier way that refugees could trace their families. Problem: There are 43 million forcibly displaced people worldwide with hundreds of thousands of refugee families scattered across the globe. Before all family tracing was done by refugee agencies, which still rely on paper forms and postal systems to try to locate people. There was no online global data bank that could be accessed or used by refugees themselves.
Technique: Refugees United is an online search tool, where refugees can create a free profile and start their search for family via an online database using the internet or a mobile phone. Verdict: More than , people are registered on the Refugees United family tracing platform. It is available in dozens of different languages and contains searchable information on refugees from more than 82 countries. It is currently helping 15, people trace family in the Kakuma refugee camp, home to 80, refugees and asylum-seekers, in Kenya.
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The main challenge is actually reaching the refugees, often the poorest of the poor, who don't have ready access to computers or mobile phones. Annie Kelly. Problem: For a continent so in need of quick, affordable emergency relief, not to mention so riddled with unemployment, there's a cruel irony about the provenance of emergency supplies.
Smaller African manufacturers have traditionally been unable to compete with Chinese prices, or to meet the vast demand for emergency goods within Africa. As a result, aid agencies such as Unicef have forged links with foreign producers better able to produce these supplies at the scale, cost and quality required. Yet this inevitably requires longer lead times and higher transportation costs than sourcing goods locally — and Africans lose out on the work. Method: Advance Aid is an organisation that wants to make aid destined for Africa available within Africa, from blankets and mosquito nets to basic cooking equipment and hygiene kits.
The organisation acts as an intermediary between large aid agencies and African producers, putting together packages of aid supplies sourced locally. This has been very effective in Kenya, where Advance Aid have supplied 5, locally sourced emergency kits to World Vision and another 14, jerry cans to Catholic Relief Services , who distributed them in Dadaab, the refugee camp near the Somalian border.
Founder David Dickie says: "Aid is not working. I'm trying to turn the market on its head by creating jobs in Africa. Building this capacity in Africa will make a real difference to agencies, to the beneficiaries of the aid and to local businesses… [It] is a very efficient way of bringing together the development and humanitarian agendas. Idea: To carry out scientific research on sickle cell disease SCD and show that large-scale, cutting-edge genomic studies are possible in Africa.
Problem: Every year, , children worldwide are born with SCD, a genetic blood disorder that can result in severe anaemia. Seventy percent of these children, or ,, are born in Africa. However, many of these deaths could be prevented by early diagnosis and treatment. The Muhimbili Wellcome Programme originally aimed to follow children but is now following 2,, making it one of the largest, biomedical SCD resources in the world. Dr Makani says that the work "provides validation that it is possible to conduct genomic research in Africa". Dr Makani stands as a role model for other young African scientists wishing to make a difference.
Idea: To offer emergency credit through mobile phones to people who don't have access to credit cards or bank loans. Problem: Credit cards are still rarely available to Kenyans and bank loans are only authorised for large amounts of cash or as investments for buying homes or starting businesses.
M-Pepea was launched to try to bridge this gap. Method: M-Pepea, set up in late , provides its customers with emergency funds within a few hours. The money is accessed through their mobile phones, with M-Pepea sending a special pin code to be used in cash machines.
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Verdict: M-Pepea has currently partnered with 20 businesses and has around subscribers, and is hoping to have increased this to 20, by the end of Its partnership with Safaricom is encouraging but the company has run into problems with businesses defaulting. The right to the highest attainable standard of health is a fundamental human right and, central to this right within a hierarchical health system, is the existence of a well-functioning referral system that allows for continuity of care across the different tiers of care. A referral system enables management of client health needs comprehensively with resources locally unavailable.
This study sought to establish challenges facing implementation of the referral system for quality health care services in Kiambu County, Kenya. Specifically, investigated the influence of infrastructure, capacity of health care workers, health information systems and financial resources on implementation of health care referral system. A crosssectional research design was done targeting health care workers in public health care facilities Tier 2 and Tier 3 in Kiambu County and two hundred and seventy one respondents took part in the study. Both questionnaires and interview guide were employed as data collection tools which attained quantitative and qualitative data.
Inferential statistics was used to conduct regression analysis. From the findings of the study it was established there existed a relationship between independent and dependent variables as revealed by infrastructure with coefficient 4. The study concluded that infrastructure, health information systems, capacity of health care workers, and financial resources are challenges in implementation of health care referral system in Kiambu County and should be strengthened.
One of those building blocks is health service delivery. For the referral system to be functional, it needs to operate in a functional health system, and the Kenya draft RSPHS — identifies various health system requirements for a well functioning referral system [ 1 ]. For successful referral, there must be geographical access to referral care facilities. Provided referral services are accessible, referral staff must be trained to provide quality care, services must be affordable and must have essential drugs, supplies, and equipment.
This is often determined by a variety of factors, including the perceived need of a referral like the disease severity, caretaker or community experience with and the impressions of the referral facility, and the cost time and resources. In most countries there are two major types of health facilities— primary care facilities and hospitals. Health care systems are often designed to encourage caretakers to first seek care at the primary level and then be referred, if necessary, to a higher level of care.
If this reflects actual care seeking behavior, then health care costs for the caretaker will be minimized [ 2 ]. In many countries, however, caretakers often bypass primary care facilities and seek care directly at referral care hospitals for illnesses that could be easily treated at the primary care facility [ 3 ].
This can overburden the referral facility, and is often costlier for the caretaker and the health care system. The right to the highest attainable standard of health is a fundamental human right [ 4 ]. Central to this right in the delivery of health care in a hierarchical health system is the existence of a well-functioning referral system that allows for continuity of care across different tiers of care.
Public attitudes towards regional integration
Most health systems in the world are hierarchical, starting with primary care, to secondary care facilities, to the highest level of care, which consists of tertiarylevel facilities that provide highly specialized services. In most developing countries, however, health referral systems across the various levels of care are weak, which affects the overall performance of the health system and contributes to negative health outcomes. The Kenyan health system is organized around six levels of care that fit into four tiers of care, based on the scope and complexity of the services offered.
Tier 1 community units, Tier 2 dispensaries and health Centres, Tier 3 County health facilities and Tier 4 national referrals. In Kenya, found that the location of healthcare facilities far away from the population affects the level of use of health services. He found that the more accessible one is to a health facility the more one is able to make use of it [ 5 ]. The mandate of the Counties includes, among others, the provision of health services and management of referrals in County Health facilities and pharmacies.
The Kenya Health Policy — has identified the need to strengthen the referral system in Kenya as a way of improving efficiency in the health system and improving health outcomes [ 5 ]. Some of the critical investment priorities for the referral system outlined in KHSSP — include updated referral tools and guidelines at all levels, orientation of the management teams on their referral roles and functions, and tools for referral allowances for expertise movement and fuel for travel. The health sector has developed a referral strategy, standard guidelines, and forms to guide the sector in building an effective system that responds to the needs of rural and poor populations.
There are only two types of referrals: emergencies and elective for both types of referrals, prognosis is the most important criteria [ 6 ]. It is preferable to initiate medical referral at the early stages of illness when the prognosis has a higher probability of being favorable. Kiambu County is one of the 47 Counties under the Constitution of Kenya. It is located in the central region and has a population of 1,, million as per the Census. Its headquarters is in Kiambu Town and the largest town is Thika.
Has a workforce of from different medical cadres. Most of them work in public health facilities ; it also has non-medical and staff and has a total of health facilities 80 of them public. Common barriers to successful referral are generally known, the relative importance of these constraints should be assessed in each country or region to guide the design of targeted, appropriate interventions to improve referral.
The Kenya Health Policy — [ 6 ] has identified the need to strengthen the referral system in Kenya as a way of improving efficiency in the health system and improving patient outcomes..
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The Kenyan health sector has developed a referral strategy, with standard, guidelines, and forms to guide the sector in building an effective system that responds to the needs of rural and poor populations. Kiambu County has a large population 1,, with doctor patient ratio of , as opposed and nurse patient ratio of 1; 7, as opposed and 1 clinical officer per patients [ 7 ]. Despite the efforts by the government to improve the referral system in Kenya in order to improve efficiency in the health system and health outcomes, no evaluation has been carried out by the government or scholars to determine the challenges facing implementation of heath care referral system for quality health care service delivery in Kiambu County.
Therefore, this study sought to bridge the knowledge gap by establishing the challenges facing implementation of referral system for quality health care services in Kiambu County. The study was carried out to investigate the challenges facing implementation of referral system for quality health care services in Kiambu County.
Most countries in the world have two major types of health facilities primary care facilities and hospitals. A study in Uganda also showed that of those who accessed the referral site, only half did so the same day Peterson et al Health workers also perceived cost and the availability of transport as the main barriers, although in reality the cost of medical care at the referral hospital was the principal constraint for caretakers not accessing referral.
Very little is known about what happens to severely ill children who do not comply with referral. There were no deaths reported among the children who complied with referral the same day the recommendation was made [ 11 ]. Although common barriers to successful referral are generally known, the relative importance of these constraints should be assessed in each country or region to guide the design of targeted, appropriate interventions to improve referral.
The Kenyan health system is organized around four tiers of care, based on the scope and complexity of the services offered [ 5 ]. The second tier consists of primary care health facilities that have dispensaries and health centres run by nurses and clinical officers respectively. The third tier consists of the County Referral facilities, which include the former primary and secondary hospitals [ 5 ].
The fourth tier, the National Referral facilities that offer highly specialized care, is used for training and support research. Some of the challenges in health referral systems in most developing countries include noncompliance with referrals [ 12 ] delays in referral completion [ 9 ], high numbers of self-referrals to higher-level referral facilities [ 13 ] weak health information systems to capture referral data, poor transport arrangements for emergency referrals [ 14 ] and inadequately resourced referral facilities [ 13 ].
According to Ramdas [ 15 ], communication to both the users of the service and their families are mandatory when the referrals related to the users are being made to the various levels of services. The use of a provincially standardized referral letters that would serve to channel clinical information both upward and downwards in the referral chain is obligatory. All institutions must be knowledgeable of the contact details of the key managers and the key clinicians on duty.
Transport is identified as a key constraint on achieving the child and maternal health goals in many of the developing countries in Africa. There must be smooth and prompt vehicles to address emergency cases and referral cases at every level of health care. From literature review transport causes delay in deciding to seek care and receiving care at health facilities identified as contributing to deaths among women with obstetric complications Farm, ; Maine, Studies on the accessibility of referral hospital care have repeatedly confirmed the existence of a steep distancedecay function, in countries such as Ethiopia [ 16 ] and Nigeria, indicating that individuals with a given need for a clinical service will be less likely to access that service the farther away from the referral center they live.
In general, physicians receive little training on when to make a referral [ 17 ]. While providing feedback to providers, improving training, or holding regular meetings between providers might help in improving referrals. Other studies have looked at the benefits of physicians training on how to write referral letters. Few studies have examined the effect of electronic medical records EMRs on care coordination in general or on referral process in particular [ 18 ].
Computer access to compare notes has been associated with increased communication between referring physicians and specialists. Specialists receive written or e-mail referral letters twice as often than by telephone or other verbal communication [ 19 ]. In most developing countries appropriate allocation of resources to referral hospitals within the national health system has long been a controversial issue in health system planning according to [ 20 ].
Perhaps the most frequent theme in research literature on referral hospitals in developing countries is the inappropriate utilization of higher-level facilities and the apparent failure of most referral systems in developing countries to function as intended [ 21 ]. The study was be based on theoretical model of Referral- Pathway which explains how the Referral process actually takes place in a given country.
Frontiers | Congenital Heart Disease in East Africa | Pediatrics
In most countries there are tiered systems of health care, often having three levels [ 22 ]. Kenya follows in this category. Cross-sectional research design was used on this study that was carried out in the month of June The study was carried out in Kiambu County Kenya. It is located in the central region and has a population of 1,, milliom as per the Census. The researcher used random sampling to get a target population of 5 Sub Counties whose health workers were sampled from dispensaries, Health Centres and Hospitals [ 24 ].
The researcher purposively chose to interview the following stratified cadres nurses, medical doctors, consultants, health record officer, medical laboratory technologists and facility administrators. These were considered as the cadres with pertinent information on referrals Table 1. Kiambu County public health facilities have a total workforce of different medical cadres, from a total of 80 public health facilities [ 25 ]. The study adopted stratified random sampling.
Analysis of the data was done using SPSS version To carry out the study, formal clearance was received from Kenya Methodist University as well as Kiambu County Health Research department, head of the institution where the study was carried out. The researcher explained to the respondents about the research and that the study was for academic purposes only.
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