Our action for health
Aga Khan Health Services and French agencies partner to improve Palliative Care in Kenya and Tanzania
The Aga Khan Health Services (AKHS), an agency of the Aga Khan Development Network (AKDN) and Expertise France today signed an agreement to enhance the quality of palliative care services in the Aga Khan Hospitals in both Kenya and Tanzania. The programme is being grant funded by the Agence Francaise de Developpement under which AKHS will receive 250,000 € to conduct specialised training for 4 doctors and 4 nurses – also known as “champions” through the Institut Curie.
The Euros 250,000 grant will go towards the implementation of a pilot palliative care training project for professionals from four hospitals of the Aga Khan Health Services in Kenya (Nairobi, Kisumu and Mombasa) and Tanzania (Dar Es Salaam). The programme will be implemented by Institut Curie, world renowned for their technical expertise in palliative and supportive care and their pragmatic, tailor-made trainings. Expertise France has been instrumental in working with the Aga Khan Health Services and Institut Curie to develop the overall implementation plan.
According to Dr Alexis Burnod, the project’s key expert and responsible for implementing Institut Curie’s training activities, « The spread of palliative care culture as a criterion of healthcare excellence towards patients and their families is a universal invitation. It is the result of the work of an entire team dedicated to promote a comprehensive care focused on the patient. This partnership programme with our Kenyan and Tanzanian counterparts reinforces this international humanist dynamic”.
“Our 15 years of experience creating partnerships and exchanges between hospitals in the North and the South have shown the value of giving healthcare professionals the opportunity to learn from one another – improving not only skills, but also the organisation and the continuum of care” added Mr Sebastien Mosneron Dupin, CEO of expertise France.
The partnership will bring Kenya and Tanzania closer to their goal of establishing palliative care services in the region by providing specialised clinical training as well as by enabling hospital professionals to establish designated palliative care units. Experts from Institut Curie and Expertise France will provide continual support and feedback throughout the process, resulting in invaluable information for advocacy, policy changes and scaling-up of the programme.
Palliative care in low-income countries
The quality of life of patients and their families facing life-limiting illness is a growing concern in low-income countries, particularly in Africa. Low income countries are disproportionately burdened with chronic diseases such as cancer, HIV-AIDS, kidney, heart and respiratory disease and face particular challenges in providing palliative care.
According to WHO and the World Palliative Care Alliance, a staggering 78% of the 19.2 million adults requiring palliative care are estimated to be in middle- and low-income countries. Often, health facilities in these countries lack pain medication, adequate hospital facilities, specially-trained medical staff, designated palliative care units and government or policy support. In particular, opioid pain-relief is very limited, and often prohibited from importation in a large number of African and Central/South Asian countries: an estimated 80% of the world’s population currently lacks access to opioids for pain relief at the end of one’s life.
“This partnership comes at a time when there is a large unmet need for palliative care within the health systems in Kenya and Tanzania,” said Dr. Gijs Walraven, Director of Health, signing the agreement on behalf of the Aga Khan Development Network. “There is an urgent need for education, and for advocacy with decision makers to take action and create enabling environments for palliative care at the national level.”
Improving palliative care in Kenya and Tanzania
The enhancement of palliative care in middle and low-income countries is a key priority for the Aga Khan Development Network (AKDN), working mainly in Africa, Asia and the Middle East. Expertise France has also responded to the burden of chronic and non-transmissible diseases in its strategy for improving health in middle- and low-income countries. The Institut Curie is a leading French institution for cancer care and research and has developed an innovative, multidisciplinary and comprehensive approach to palliative care.
About Aga Khan Health Services
The Aga Khan Health Services (AKHS) is one of three agencies of the Aga Khan Development Network (AKDN) that support activities in health. The others are the Aga Khan Foundation (AKF) and the Aga Khan University (AKU). Together, the three agencies provide quality health care to five million people annually and work closely on planning, training and resource development. AKHS also works with the Aga Khan Education Services (AKES) and the Aga Khan Agency for Habitat (AKAH) on the integration of health issues into specific projects. The AKDN health system has been operating in East Africa for over 80 years. Its expanding East Africa Integrated Health System is dedicated to providing high-quality health coverage at affordable prices to an economically diverse population.
About Expertise France
Expertise France is the French public agency for international technical assistance. It aims at contributing to sustainable development based on solidarity and inclusiveness, mainly through enhancing the quality of public policies within the partner countries. Expertise France designs and implements cooperation projects addressing skills transfers between professionals. The agency also develops integrated offers, assembling public and private expertise in order to respond to the partner countries' needs. ► www.expertisefrance.fr
About the Institut Curie
A leading player in the fight against cancer, Institut Curie brings together an internationally-renowned research centre and an advanced hospital group that provides care for all types of cancer – including the rarest forms. Founded in 1909 by Nobel laureate Marie Curie, Institut Curie comprises three sites (Paris, Saint-Cloud and Orsay), where more than 3,300 members of staff are dedicated to achieving three objectives: hospital care; scientific research; and the sharing of knowledge and the preserving of legacy. As a private charitable foundation since 1921 that is recognised as serving the public interest, Institut Curie is supported by donations and grants. This support is used to fund discoveries that will improve treatment and the quality of life of cancer patients.
Access to healthcare – and to high-quality care – is a challenge for a large section of the population in Sub-Saharan Africa. It is often small private structures which meet needs in rural areas and for the poorest. The Medical Credit Fund foundation works alongside them and demonstrates that in the health sector, it is possible to effectively combine a social purpose with entrepreneurial projects.
Sub-Saharan Africa has 16% of the world’s population, but only accounts for 2% of global health expenditure. Yet over the years, population growth, the rise in chronic diseases, but also socioeconomic progress, have created an increasingly pressing demand for healthcare. But the African subcontinent suffers from a clear lack of investment.
In this extremely tense context, some 50% of total healthcare delivery is already provided by the private sector, which plays a key role at all levels, from healthcare provision to retail trade. It even has a predominant place in certain countries, such as Uganda or Ghana, with over 60% of total healthcare provision. “Contrary to common belief, the private sector is sometimes the only healthcare provider in rural areas and deprived urban areas”, explains Aurore Lambert, health project manager at AFD. “It is a far cry from provision just for rich people!”.
These structures are often small or medium-sized, yet they face two major problems which are intrinsically linked: the poor quality of healthcare and the difficulty of gaining access to financing to allow investments to address this. In reality, the banking sector generally considers that their activities are risky.
Some 600 health centers financed
Medical Credit Fund (MCF) is a foundation whose purpose is precisely to facilitate financing for these structures, while helping to improve their quality standards. The foundation is based in the Netherlands and is, for the time being, the only one of its kind. Since it was set up 5 years ago, MCF has financed 586 health centers, mainly in Kenya and Ghana, but also in Nigeria and Tanzania.
The average loan amount stands at EUR 20,000 and loans are mainly used to renovate buildings or purchase equipment. For example, a few months ago, South B Hospital, a small hospital structure with 45 beds located in a popular neighborhood of Nairobi, benefited from a loan to finance the creation of intensive care, nephrology and hemodialysis units. The hospital teams will follow a healthcare quality improvement program throughout the duration of the loan.
Photo Dorte Hopmans © Diorte
MCF is a not-for-profit foundation, but it is also a private actor: MCF does not allocate grants, but aims to grow in order to achieve financial equilibrium. Equilibrium ensures that the project is autonomous and gains in strength. “It is a social business”, explains Selvan Pajaniradja, who develops this sector of operations at AFD, “The aim is indeed to build high-quality health service provision for all at an affordable price. MCF consequently works for development, but at the same time generates the revenue which is essential for the sustainability of the project!”.
French-speaking Africa for tomorrow?
The originality of MCF can be seen in its inclusive and partnership-based method. The foundation works with local financial institutions, providing them with its knowledge of the health sector and assisting them in the appraisal and follow-up of files. “The aim is to work with local partners and help them develop their range of loans for the sector”, adds Aurore Lambert, “It involves showing that financing health services in Africa can be a profitable activity.”
As the MCF project fits in with its core objectives for health and social business, in December 2016, AFD decided to take part in a funding round, via a EUR 3m concessional loan and EUR 1m grant from its social business facility. It has thereby joined up with the
International Finance Corporation (IFC)
. AFD’s long-term objective is to help MCF establish itself in French-speaking Africa, in particular in Côte d’Ivoire, Cameroon and Senegal, where there are also considerable needs. “Given its expertise in the health and financial sectors in a number of countries”, points out Arjan Poels, Chief Executive Officer of MCF, “AFD is a key partner in supporting our project to improve the financing capacity of health structures and, more generally, healthcare quality in Africa.”