From its inception, community experiences molded the vision and structure of the PatientPower model. We conducted focus groups with all sectors in our community—leaders, parents, and youth, asking: What are our healthcare needs? Where are the gaps in existing systems? This feedback, coupled with best practices, informed the underlying philosophy and program design of the clinic and social services.
First, ccommunity leaders played an active role in hiring a clinic staff possessing both the highest medical qualifications and a commitment to community-ownership. We assembled 20 local residents with traditional care-giving skills into a team of trained community health workers. The clinic blueprints themselves incorporated community input; full of color, books, and games, the structure fosters an environment of patient ownership and dignity. The clinic construction was overseen and completed by future clinic users. And finally, to ensure sustainability, we established long-term sources of subsidized pharmaceuticals, medical supplies, equipment, and an electronic medical records system, and set up the income-generating social services that are the core financial model.
By committing to executive-level community leadership, exemplary standards of care, and provision of social services, we augment the impact of direct medical services. As clients utilize our preventative health programs, frequency of clinic visits and need for emergency care will be greatly reduced. At our clinic each client receives the individual attention they deserve, resulting in an increase in accurate diagnosis and decrease of unnecessary treatment. Our model makes patients empowered participants in their own care— improving treatment adherence. By linking bio-medical care with other social services (e.g. sanitary toilets, hand-washing stations, vertical gardens, and education), we tackle the root cause of much disease in Kibera: extreme poverty. When compared to well-matched controls—we expect PatientPower clients to experience significant decline in overall disease burden due to preventative care, as well as decreases in maternal mortality, infant mortality, STI transmission, disease transmission within families, and rates of unwanted pregnancy. Our clients will also report a significant improvement in subjective life-satisfaction, and control over their own health.
What will it take for your project to be successful over the next three years? Please address each year separately, if possible.
Year 1: With construction completed and the clinic fully-staffed, SHC’s first priority will be to test operating procedures and educate the public about available services. Next, to ensure long-term executive-level community control and high-quality service provision, we will formalize systems for community input and governance. In addition to the executive leadership itself, we will institute a community advisory board to oversee daily operations and synthesize community feedback to relay to medical staff. In order to track the longitudinal impact of the PatientPower model, in Year 1 we will spearhead a participatory, community baseline health assessment. And finally, to lay the groundwork for long-term financial sustainability, the clinic will link with SHC’s already-established income-generating service initiatives (IGSIs) such as the bio-latrine facility and vertical gardens. At the clinic, patients pay a nominal fee for services and medications because we know as a community that when patients make a monetary investment in their health, they are more likely to follow up their care. However, to ensure accessibility, clinic services must be subsidized beyond small user-fees. Thus the IGSIs provide two-fold support: these initiatives provide desperately needed (and otherwise unavailable) services to the community, and they improve health outcomes as well as generate profit to subsidize costs of clinic medications, supplies, equipment and salaries.
Year 2: We will continue to integrate both the advice from our community board and from clients into programs and protocols, altering them as needed. We will also spearhead a follow-up assessment to measure one-year impact and adjust our clinical programs if health and subjective targets are not met. IGSIs will expand also serve more people, increasing social service participation and further subsidizing the cost of high-quality clinical care.
Year 3: PatientPower will expand. Using the data collected and the refined systems we’ve developed in Year 1 and 2, we will be able to facilitate the adoption of the model at other health facilities operating in similar communities. We will facilitate the adoption of our model at other institutions and grassroots communities, consulting and disseminating information on how health systems can respond more efficiently to patient needs.
What would prevent your project from being a success?
1. Risk: Building both community and formal support. Communities in places like Kibera often do not accept foreign organizations. By the same token, community groups struggle to obtain institutional support—both are necessary for long-term success.
Mitigation: SHC’s innovative leadership model recognizes the importance of strong ties to both grassroots communities and to institutions such as government. From my experience as a community leader in Kibera, I understand how to build unparalleled credibility at the grassroots level. I also know how to bring marginalized people together to leverage collective their power and establish strong ties with larger institutions.
2. Risk: Securing long-term financial support.
Mitigation: Outside SHC’s broad donor base and extensive partner network, PatientPower’s business plan utilizes IGSIs to ensure the program’s long-term sustainability. Net IGSI profit keeps patient fees low- fees cover 28% of the clinic’s operating costs, and IGSI profits provide the remaining 72%. Surplus IGSI profits fund the creation of IGSIs in replication sites. Providing necessary services that are otherwise unavailable ensures long-term community participation and thus program income.
3, Risk: Resistance to collaboration from health professionals. PatientPower implicitly challenges deeply entrenched power dynamics in the healthcare system. Significant gaps in education, class, and professional training often cause tensions, as skilled professionals may resist directives from inevitably less skilled community leaders.
Mitigation: PatientPower’s structure shows how this tension can yield positive results. Using their experiences as patients, community members provide insight into the gaps in health delivery. This feedback informs overall healthcare delivery, impacting systems and shaping the clinic’s philosophy. Next, community members play an active role in hiring highly qualified medical professionals with a genuine desire to implement