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Access to heart attack care in Kenya

 
Philips Foundation partnered with the initiative Heart Attack Concern Kenya (HACK) to increase the access to heart attack care

    About

     

    A heart attack is one of the most serious manifestations of coronary artery disease, and can result in serious health complications and death. In Kenya, it is estimated that 50% of patients who suffer a heart attack die before reaching a hospital. Heart attack care in underserved communities faces major challenges that include lack of adequate interventions, lack of early detection, and poor treatment methods, including misdiagnosis and ineffective referral processes. These challenges are more visible where socioeconomic barriers and inequalities in accessing treatment are more common.

     

    The partnership between the Heart Attack Concern Kenya (HACK) and the Philips Foundation tries to address the root causes of ineffective heart attack care by improving the recognition of symptoms, diagnosis and treatment, with the aim of enhancing good outcomes among patient who suffer a heart attack in the community.

     

    Partners

    How

     

    The project aims to improve the quality of heart attack care at county hospitals by improving diagnosis and through establishing prompt and appropriate treatment for patients who suffer a heart attack in the community. The project tries to reach these goals by implementing the following initiatives:

     

    1.  Training: targets frontline healthcare workers to help them recognize patients with a suspected heart attack, and consequently be able to provide sufficient treatment.
    2.  ECG implementation: increase access to ECG while also educating health care staff on appropriate indications and interpretation for performing ECG.
    3.  County survey and preparedness: referral network where diagnosed patients can be managed and referred to partner institutions for necessary care. 
    4.  Education: creating awareness of member of the public on  heart attacks and cardiac arrests through infographics and additionally a network of local community health workers to reach remote areas.
    5.  Creation of WhatsApp-based platform to provide an avenue for mentorship, knowledge sharing and support for diagnosis and management of of the conditions identified.

     

    The project was implemented in Garissa, Embu and Kiambu counties, and aimed to develop insights and models that can be scaled further.

    Results

     

    The results have shown that outcomes have been improved on short, intermediate and long term timelines in each county. The first short term tangible results include:

     

    1. Set-up of three heart attack centres
    2. Provide ECG access
    3. Training of 25 healthcare workers in each of the three counties
    4. Establishment of heart attack protocols
    5. Set-up of a referral system to 6 target county hospitals

     

    Additionally, 495 total healthcare workers were trained through virtual training sessions during a 5 month training program. After the training, most healthcare workers were able to interpret ECGs and diagnose STEMI  . Overall, the combination of health worker training and public education has led to improvements in awareness, recognition and diagnosis of acute cardiac conditions and heart attacks. 

     

    Most importantly, all these actions resulted in an increase of of heart conditions diagnoses and institution of appropriate treatment and referral. The aim is to reduce premature heart attack mortality and potential complications in underserved communities.

    Learnings and next steps

     

    One of the main components of the HACK Project is gathering learnings and sharing best practices for policy and investments advocacy. There were several important learnings derived from the project implementation, that include:

     

    1. Importance of capacity building: essential skills such as ECG examination and interpretation were initially lacking among the different levels of healthcare workers working in the target facilities. STEMI services preparedness depends on healthcare workers having the capacity to recognize symptoms, diagnose and manage the disease. For sustained impact and continuity there should be focus on continuous capacity building. 
    2. Importance of governance: good governance can help promote effective health service delivery, especially when informed by data and evidence. The project supported the development of STEMI protocols which were initially non-existent in the target facilities. Guidelines and protocols are necessary to guide health care workers on diagnosis, optimal treatment options and form the basis for quality improvement audits and improvements at the hospital level.  
    3. Equipping health facilities and proper implementation of policies: while the cardiovascular guidelines in Kenya outline the suite of cardiovascular disease services that should be available at each level of care, there are gaps both in the services offered and in the equipment available to offer these services. Gaps in the operationalization and implementation of policies will often result in decreased efficiency of health systems. 
    4. Stakeholder management: The insights from the implementation process highlight the need to involve key decision makers, as well as the importance of government support and political good   to ensure successful implementation and sustainability.

     

    The project provides important lessons on the level of preparedness for heart attack care in  Kenya, the type of investments needed, and provides tools for scaling such models. The pilot in the three counties can therefore be seen as a prototype that hopefully will later be implemented to more counties in Kenya and beyond.

    Status

    In progress

    When

    2020 - 2022

    Where

    Kenya

    Care to collaborate, or want to learn more about this project?  
    Do not hesitate to contact us.

    In line with Sustainable Development Goal 17 (partnerships for the goals), we believe we can make a real difference in providing access to quality healthcare if we work together.

    Project report
    Resources

    [1Base line report

    [2Presentation “HACK training of Healthcare workers” given at the PASCAR conference, November 2021

    [3Presentation “County level heart attack preparedness” given at the PASCAR conference, November 2021

    Relevant links

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