the Philips Viewpoint on Amref Health Africa

ViewPoint
An Amref Health
Africa and Fabric of
Africa collaboration
Philips_Africa_repor_V5.indd 1
18/11/2014 14:54
Contents
Welcome3
Community healthcare strategies at the country level:
Kenya4
The Community Life Center in Kiambu County, Kenya:
a mother’s perspective6
The Mama Ni Uhai Women’s Healthcare Screening Program
8
Esther Madudu:
still standing up for African mothers10
Some Uganda statistics
10
Looking ahead to Uganda 2030:
the scale of the challenges for midwives11
Improving care through mHealth
12
13
Common mHealth applications
Viewpoints:
a final word14
2
Philips_Africa_repor_V5.indd 2
18/11/2014 14:54
Welcome
Welcome to Fabric of Africa ViewPoint for
November, 2014. As the target date for the
Millennium Development Goals approaches,
we turn our attention to East Africa.
Strategic partnerships between
governments, NGOs, and the private sector
have an essential role in removing the
barriers to good health in poor communities
by closing the gap that separates rural and
urban poor inhabitants from formal health
systems. Specifically, Amref Health Africa
strives to work with communities to develop
African solutions to African problems.
Amref Health Africa has partnered with
Philips Healthcare to invigorate private/
public sector cooperation with the goal
of establishing strong leadership capable
of building bridges between communities
and healthcare providers. In this Fabric of
Africa ViewPoint you’ll hear from caregivers,
patients, and organizers about current
initiatives that exemplify the positive
outlook for East Africa.
Enjoy!
Roelof Assies
General Manager,
Kenya Philips
Philips Healthcare
Dr. Peter Ngatia
Director of
Capacity Building
Amref Health Africa
3
Philips_Africa_repor_V5.indd 3
18/11/2014 14:54
From community to facility:
Revitalizing healthcare
in East Africa
The provision of efficient, affordable, equitable healthcare
in East Africa presents many specific challenges that do
not exist in developed countries. Often the lack of basic
amenities, challenges at the municipal level, and weak
healthcare infrastructures, result in healthcare systems that
are inaccessible for large segments of populations.
In many countries, the bulk of the population lives in rural
settings far from the healthcare infrastructures of the major
urban hubs. Most of these people are removed, both
physically and economically, from what could be described as
the formal healthcare sector. Providing even the most basic of
healthcare services for such communities, such as antenatal
care and trained midwives to attend births, requires creative,
multi-level approaches.
Strategic partnerships between governments, NGOs, and the
private sector have an essential role in removing the barriers
to good health in poor communities by closing the gap that
separates rural inhabitants from formal health systems.
For example, Kenyan government programs are currently
underway to find ways to provide community health workers
with much-needed resources. In Uganda, the government
is working together with national associations for midwifery
and nursing to improve policies and wages, and steps are
being taken by the Ugandan Ministry for Health to ensure that
all healthcare facilities are provided with electricity. Further,
the Tanzanian Ministry of Health and Social Welfare recently
implemented the “Healthy Pregnancy, Healthy Baby” project,
providing important information for expecting mothers via
personalized text messages.
Spurred on by the setting of the Millenium Development
Goals (MDGs) by the United Nations in the year 2000, many
diverse initiatives have been introduced in countries across
sub-Saharan Africa. This Fabric of Africa ViewPoint presents
some small snapshots, providing glimpses, from different
viewpoints, of various aspects of the situation towards the
end of 2014, as the target date for the MDGs approaches.
Interviews with key stakeholders, sharing their experiences at
different levels of healthcare, provide insights into the aims of
strategic partnerships and the impact they are having in the
strengthening of healthcare systems.
Like many organizations, both Amref Health Africa and
Philips Healthcare recognize that one of the major barriers
to good health for people living in resource-limited settings
is the gap between communities and formal health systems,
which is exacerbated by the low quality of peripheral health
systems. To bridge this gap, Amref Health Africa and Philips
are developing sustainable, innovative, and communitybased programs that build bridges between communities
and formal health systems. Moreover, both Philips and Amref
Health Africa recognize the need for continuous education to
advance and maintain the clinical competencies of healthcare
professionals on the ground.
4
Philips_Africa_repor_V5.indd 4
18/11/2014 14:54
• Dr. Meshack Ndirangu, acting Country Director at
Amref Health Africa in Kenya, provides insights
from an NGO perspective into the strategic
implementation of initiatives that are building
bridges to facilitate the interface between informal
and formal health sectors.
• A perspective from the healthcare sector is given by
Ms. Esther Madudu, a midwife in eastern Uganda,
who speaks about the challenges of recruiting
midwives to meet the needs of a rapidly growing
rural population, and the simple logistical barriers
that are part of her daily life as a care worker.
• From the female patient perspective, we talk with
Ms. Josephine Bosibori whose fourth child was born
at the newly established Community Life Center that
was built near her home in rural Kenya.
• The increasing role and impact of mobile health
technologies (mHealth) in Africa is highlighted in an
article looking at how mHealth is helping to widen
and improve access to patient information and
high-quality surgical training.
5
Philips_Africa_repor_V5.indd 5
18/11/2014 14:54
Community healthcare strategies
at the country level: Kenya
The view from Amref Health Africa
This interview with Dr. Meshack Ndirangu, acting
Country Director at Amref Health Africa in Kenya,
was conducted on November 6, 2014. Dr. Ndirangu
speaks about the Community Health Strategy in
Kenya, the importance of collaboration, and the
scaling up of local initiatives to the country level.
Q – In 2007, a Community Health Strategy was
implemented in Kenya aiming to help in the achievement of
the Millennium Development Goals 4 and 5. A key feature
of this is the use of Community Health Workers (CHWs).
Could you please briefly explain the basis of this strategy?
Q – You were one of the authors of a study performed in
Busia County, Kenya. For the period 2008–2010, you reported
that the deployment of CHWs had resulted in significant
improvements in many aspects of maternal and newborn
healthcare.1 Have these improvements been sustained?
A – It was noticed in Kenya that key indicators like maternal
mortality were stagnating. It was an effort to come up with
strategies to empower communities to advance their own
health. While it has many elements, CHWs are an essential
pillar of that strategy. The CHW is supported by a Community
Health Unit made up of local leaders who work very closely
with the nearest health facility called the Link Health Facility
for the process of referral, call assistance, and training. CHWs
have the capacity to provide information to households,
women, expectant mothers, new mothers, and other
household members to educate them on key life-saving
behaviors and also to initiate referral if necessary.
A – The structures and the systems that we established in
Busia with the Ministry of Health have been sustained to this
day. We have not done a follow-up evaluation to assess the
key indicators, but I fully expect that the changes have been
sustained because the structure that we put in place has
continued to perform as it did when the project was ongoing.
We worked very closely with the District Health Management
Team (DHMT), and we had a very clear exit plan whereby the
DHMT would cover all the relevant responsibilities at the end
of the project.
Q – How does the referral interface work between CHWs
and the regular healthcare infrastructure?
A – From each community unit of CHWs, information is
collected on a regular basis, the community discusses
it during a dialog day, and they agree on actions. They
take actions with the support of their local health facility
leadership. There is very clear leadership, very clear linkage
to the healthcare facility in terms of referral and information
flow.
Q – The study in Busia County demonstrated that the
Community Health Strategy has been very successful. Is the
model from Busia County transferrable to other counties?
A – Yes, when we were doing this work in 2006, there were
very few community units in Kenya, just 100 or so. Today we
have 2–3,000 community units working with thousands of
CHWs. So the community health strategy has already been
scaled up to all 47 counties.
Q – The sustainability and improvement of such a healthcare
strategy involves education/retraining initiatives to
encourage upskilling of CHWs and enable task shifting from
traditional healthcare workers. Was this an aspect of the
Busia initiative?
6
Philips_Africa_repor_V5.indd 6
18/11/2014 14:54
A – Upskilling was a feature because, when we introduced
the project, we were developing the training curriculum
for CHWs. For the first time we were equipping CHWs with
various technical skills, for example counseling women and
households. It was not so much about task shifting. But in
several other Amref Health Africa projects, there has been
significant task shifting. A very good example is where we have
trained CHWs to make the diagnosis of malaria and provide
treatment at the community level.
very close to achieving universal health coverage. Above all,
I expect that, in Kenya, we will show reductions in especially
maternal and newborn mortality, which have been resistant
to many of the interventions we have had in place. Finally,
there will be greater social accountability. Communities will
have a deeper understanding of what they can expect from
their county governments in terms of health. They will more
effectively demand the quality of services and hold the
county governments to account on issues of health.
Q – A study performed in South Africa found that the use
of CHWs was very effective. However, a major barrier to
Q – Does Amref Health Africa have any ongoing or future
initiatives that you would like to mention?
sustainability was under-resourcing. For example many
CHWs needed to use their own personal resources (money
and food) to help their clients. Are there safeguards in place
in Kenya to ensure sufficient support for CHWs?
A – This is an issue that the government and development
agencies have been addressing. There has been a new
arrangement whereby the number of CHWs has been
reduced to a lower ratio compared to community members
but supported by Community Health Extension Workers
(CHEWs) who are on the payroll of the Kenyan government.
That reduces the cost of running the community health
strategy. Whereas before we needed to have 15 CHWs in one
community unit, now we have 10, and the plan is for every 2
CHWs to be supported by a CHEW. The government is also
looking into mechanisms of providing various tools to the
CHWs. For example, some county governments have worked
with [the telecom provider] Safaricom to provide mobile
phones to CHWs. Also the county governments now have the
leeway to allocate more resources to the community units. In
my opinion, although we are not there yet, there is a very clear
direction towards sustainability.
Q – Kenya has announced an ambitious plan to transform
the infrastructure, economy, and healthcare system called
Vision 2030. What changes in healthcare in rural Kenya do
you envisage during the next 10–15 years?
A – Although Kenya is one country, it is very diverse in terms of
social systems. I expect to see more contextually appropriate
health interventions happening in the different counties.
And this will lead to significant gains in, especially, maternal
and child health. I expect that in 10 to 15 years the country
will have addressed the whole issue of healthcare financing.
We should have most people in the rural areas, even those
who are not working, having insurance cover. We should be
We have initiatives where we are using technology, mobile
phones, to advance health, especially maternal and newborn
health. This is called mHealth.2 CHWs are now being trained
and updated using mobile phones. This was piloted and
now is being scaled up. We have seen this working to greatly
improve the skills of health workers over a short period, as
well as improve adherence to care for people attending health
facilities supported by Amref Health Africa.
We are working on the issue of collection and consolidation
of data where CHWs have mobile phone applications for
household data entry, which is consolidated in a central
server. This way community health data is easily analysed,
interpreted, and used by the communities and local health
management teams to make rational programming decisions.
We are also working with grassroot organizations, women’s
groups, and self-help groups, to improve maternal health. We
are working to finance them and build their capacity so they
are able to confront the social barriers to maternal health. We
are seeing this working to a significant extent in two of our
projects where we are testing the model. It has been used
a lot with HIV, TB, and malaria, but now we want to see how
these organizations can help with maternal health.
Amref Health Africa is now strongly considering programming
for non-communicable diseases: cardiovascular programs,
hypertension, and so forth. In Kenya for example, we have a
project focusing on hypertensive care. We are working with
CHWs to create awareness of community-level screening
of hypertension, and even to start the process of lifestyle
modification. We are very excited that our experience working
with CHWs may help with our emerging programs for noncommunicable diseases.
7
Philips_Africa_repor_V5.indd 7
18/11/2014 14:54
The Mama Ni Uhai Women’s
Healthcare Screening Program
The Mama Ni Uhai (Mother is Life) Women’s Healthcare
Screening program is currently underway at the Mathare
North Health Center in Nairobi, and is poised to begin in
other facilities throughout Kenya. The program focuses
on providing Kenyan women with improved access to
quality healthcare, including ultrasound scans and fetal
monitoring.5 Many hope that the program will help prevent
some of the complications associated with pregnancy
and childbirth occurring frequently in sub-Saharan Africa.
“Worldwide, complications of pregnancy and childbirth
contribute to 358,000 maternal deaths annually,
99 percent of which occur in developing countries
especially in sub-Saharan Africa. Most of the maternal
deaths are preventable with accurate and timely diagnosis
to guide intervention,” says Dr. Moses Owino, Medical
Officer of Health for Kasarani District, Nairobi.6
More than 1,000 mothers have been screened since the
inception of the program in April 2013.
8
Philips_Africa_repor_V5.indd 8
18/11/2014 14:54
The Community Life Center
in Kiambu County, Kenya
A mother’s perspective
There is a growing need for improved maternal and newborn
healthcare in sub-Saharan Africa, which is currently struggling to
meet guidelines set forth by the Millennium Development Goals
to reduce infant mortality by 66% and maternal mortality by 75%.3
However, these numbers cannot improve if primary healthcare
facilities are not able to offer quality care to local communities.
With the development of health centers like the Community Life
Center in Kiambu County, Kenya, quality healthcare is within
reach for many more women. For Ms. Josephine Bosibori, a
Kenya resident with four children, the new center offered a
nearby alternative for the birth of her fourth child.
Ms. Josephine Bosibori was born in 1978 and grew up in Kisii
Town, the bustling capital of Kisii County, in the southwestern
part of Kenya. As the oldest in a family with eight siblings, she
was often responsible for taking care of her six sisters and
two brothers. After moving to Kiambu County, Josephine had
three daughters, the first of whom, now 17, was born on the
way to Pumwani Maternity hospital in Nairobi County. Her
other two daughters were born in private facilities, but with the
introduction of the Community Life Center (CLC) at the Githurai
Lang’ata Health Center in Kiambu County, Ms. Bosibori found
she had a new alternative for the antenatal care for her fourth
child, an alternative that was much closer to home.
health outcomes for both mother and child. In Kiambu
County, the infant mortality rate is 40 per 1000 live births, and
the maternal mortality rate is 230 per 100,000 deliveries.4
This is lower than the national average, but many feel that
improvements could still be made. “The facility brings health
services closer to home and so it is expected to do better,” as
stated by Kiambu County governor William Kabogo.4 However,
much work still needs to be done. The CLC currently delivers
an average of two babies per day, and this number is expected
to grow exponentially in the coming months. Steps need to be
taken now in order to ensure that programs like these become
widespread in sub-Saharan Africa, not only meeting but
surpassing the Millennium goals set for this region.
When Ms. Bosibori heard about the new CLC, she was glad
to have a facility so nearby. “I was so excited,” she says, “I
was hoping for the best!” During her antenatal visits, she was
treated cordially by the staff, and appreciated the cleanliness
of the environment. Although she was offered antenatal
scans, Ms. Bosibori declined to have them, as she wanted
the gender of her baby to be a surprise. Her fourth child was
born with no complications at the CLC, and is a happy and
thriving 4-month-old baby boy, named Dreckvillah Onchiri.
The introduction of healthcare centers like the CLC is vital
for improving the health of mothers and their infants, as they
offer antenatal care to more women, resulting in improved
9
Philips_Africa_repor_V5.indd 9
18/11/2014 14:54
Esther Madudu:
Still standing up
for African mothers
Towards the end of 2013, Fabric of Africa featured an interview
with Esther Madudu, a midwife from Uganda, who had been
invited to Europe by Amref Health Africa as part of their Stand
up for African Mothers (SU4AM) campaign.7 At the time there
was a growing initiative to nominate Esther for the 2015 Nobel
Peace Prize. In this short follow-up interview, Esther speaks
about developments in the intervening year.
SU4AM was initiated as part of the drive in sub-Saharan
Africa to attain Millennium Development Goals 4 and 5, which
include the reduction of maternal and infant mortality and
morbidity.8 One aim was to recruit and train 15,000 midwives,
2,000 of whom were urgently needed in Uganda where the
maternal mortality ratio in 2011 was 438 per 100,000 live
births.8,9 This was partly the result of a chronic deficiency of
midwives who, at the time, totaled just 1 per 5,000 mothers.10
Although, as Esther tells me, the Ugandan Ministry for Health
has not yet published updated figures on maternal mortality,
she is typically positive about developments. “I have seen a
very good improvement in Uganda,” she says. “It’s really very
Some Uganda statistics
• According to Index Mundi:13
The maternal mortality rate (MMR) is currently the
36th highest of 183 countries at 310 per 100,000
live births.
• According to the WHO: MMR reduced from 435 per 100,000 live births in
2006 to 320 per 100,000 live births in 2010.
14
• According to UNICEF:15
During the period 2000–2012, 88.6% of births
in urban areas had a skilled attendant present,
compared with 52.3% in rural areas.
effective. And I hope we shall get more than 2,000 midwives
because we are receiving attention on television and in the
newspapers.”
Esther has become the public face of SU4AM which has now
trained almost 6,000 midwives in total. Speaking at high
schools has become an important aspect of the initiative
to raise awareness of the importance of midwifery among
young girls in Uganda who may never have considered it as a
career option. “When you are growing up, you have to have
a vision,” she tells me. “So when we talk to young girls in the
high schools they will pick their interest in midwifery in future
because they see what I do and how I am. It’s just a matter
of explaining very well what midwifery is so that girls can get
motivated to come and do midwifery courses.”
Esther is also a realist. From her day-to-day activities working
at a rural health center at Atiriri, in Katine sub-county, eastern
Uganda, she knows that there is no magic wand: change is
a gradual process that needs to be carefully planned and
managed.
Besides recruiting additional midwives in Uganda, Amref
Health Africa has initiated a scheme to upgrade the skills
of existing midwives, training them so that they can handle
more difficult deliveries and manage the complications that
arise during pregnancy and childbirth. Esther sounds amused
when I ask if this involves midwives attending formal classes.
“You learn as you work.” she says. “It’s an e-learning program.
Because the midwives are still very few in the country, the
program is giving them the chance to study as they work. You
can’t remove the midwife from her workstation completely
because then there will be nobody to do her job!”
10
Philips_Africa_repor_V5.indd 10
18/11/2014 14:54
Looking ahead to Uganda 2030:
the scale of the challenges for midwives
• The Ugandan population is projected to increase to 63.4
million by 2030.
• By 2030 midwives will need to respond to about 3.4 million
pregnancies per year, 82% in rural settings.
• Between 2012 and 2030 there will be:
• 221.9 million antenatal visits.
• 37.2 million births.
• 148.8 million post-partum/postnatal visits.
Source: UNFPA.16
In 2013, Esther mentioned that, due to the lack of some basic
comment, her own clinic could not be officially upgraded to the
status of a district hospital, which would allow them to have
a doctor present. “There is no change as yet,” she says. “The
only change that I got is more staff, more midwives to work with
me.” Besides the lack of some basic clinical equipment and
hospital beds, a major stumbling block has been the absence
of a blood bank. The solar power that had been installed in
2013 could provide lighting for nighttime deliveries, but was
insufficient to power the cooling units needed to store blood.
Esther tells me of a recent initiative by the Ugandan
government to attach all healthcare facilities to the electricity
grid. The main power cables have now been laid at Atiriri, it’s
just a matter of making the final connection. She is now very
optimistic saying, “After the installation of the electricity, I
know the government will help with the installation of the
blood bank and then we shall be upgraded.”
Besides SU4AM, many other initiatives are making an impact
in Uganda, Esther tells me, and she reels off a list including
various Outreach activities,11 a campaign for the prevention of
mother-to-child HIV transmission, the widespread provision
of hand-washing facilities, the immunization of babies, and
the establishment of integrated antenatal care.
When Esther last spoke with Fabric of Africa, the campaign
to have her nominated for the Nobel Peace Prize had only
recently been initiated but was gathering momentum. An online petition was accruing signatures.12 A total of 15,000 would
be needed for the nomination. When I ask how this is going,
Esther sounds uncharacteristically evasive, telling me she hasn’t
looked at the website for a while and that the petition is really to
nominate her “as a representative of African midwives”. When
I check the petition website myself, I realize that her vagueness
had been motivated by modesty. At the start of November 2014,
the number of signatures was 29,290, and rising.12
11
Philips_Africa_repor_V5.indd 11
18/11/2014 14:54
Improving care through mHealth
Patients and healthcare professionals alike can benefit
from interventions using mobile health technologies
(mHealth). Here we report on projects in Africa that show
how mHealth is helping to widen and improve access to
patient information and high-quality surgical training.
The potential for mHealth to transform and strengthen
healthcare systems was highlighted in a recent paper,
in which the authors observed that pilot projects “have
demonstrated conceptually how mHealth can alleviate
specific health system constraints that hinder effective
coverage of health interventions.”
The authors outlined 12 common mHealth applications
– including behavior change communication, decision
support, and training and education – that make use of
technologies such as text messaging, mobile web access,
and photo/video distribution (see box for the full range of
applications).17
Africa represents a major opportunity for using mHealth
applications to help improve care, particularly as health
systems in many countries in sub-Saharan Africa face the
challenge of reaching populations in remote rural areas.
The social enterprise TTC has been running a Swahililanguage mHealth initiative in Tanzania for several years,
providing pregnant women and new mothers with advice
and information via personalized text messages. The
national “Healthy Pregnancy, Healthy Baby” text messaging
project was developed with the Tanzania Ministry of Health
and Social Welfare, as a way of addressing the high level of
preventable morbidity and mortality faced by women during
and after pregnancy.
To date, about 460,000 people have signed up to the free
text messaging service, intended for pregnant women, and
mothers with newborn children up to 16 weeks old (plus
supporters such as partners, friends and relatives). Those
who sign up are asked to provide some basic personal
information, including age, location, week of pregnancy,
and whether or not this is their first pregnancy. In return
they receive personalized messages covering issues such as
healthy behavior, nutrition, medication use, and reminders
about visits.
Hajo van Beijma, director and co-founder of TTC, says
about 80% of people in Africa now have access to a mobile
phone (if they do not own one themselves they have access
to a friend’s or partner’s), and this proportion is increasing
rapidly. mHealth applications therefore have a real potential
to impact on care. According to van Beijma: “If we tell
pregnant women that in a certain week they should visit their
clinic, they are more likely to attend. So health outcomes
are being changed, although it is still too early to establish
effects on morbidity and mortality.”
He says the project is meeting a real need: “We saw a big gap
in the provision of health information to people in countries
such as Tanzania, particularly people living in remote areas.
The information existed but it was difficult for people to get
access to it. Providing easy access to that information – and
personalizing it – was crucial for improving care.”
TTC has adopted a slightly different approach in Kenya,
offering access to a family planning book via text messages.
In 3 years, about 50,000 people have signed up to the free
service, and are able to navigate through an interactive
menu-driven system to view bite-sized (160-character)
12
Philips_Africa_repor_V5.indd 12
18/11/2014 14:54
sections of the book – such as advice on condom use,
or clinic locations, for example.
Meanwhile, a company called INCISION is using
mHealth to help meet the high demand for skilled and
specialized surgeons in countries including Ghana
and Kenya. Its “Sharing Surgical Skills” project makes
use of an interactive e-learning environment, with 3D
videos, to provide training and information on surgical
procedures, including state-of-the-art techniques.
Co-founder Jaap Maljers says the key is finding more
efficient ways to train surgeons: “There are not enough
local trainers, so our internet-based tool is about
helping them to be more effective and deliver better,
more consistent quality. The training capacity must
be increased to help meet the demand for surgeons
– there are more than 50 times as many surgeons per
capita in the Netherlands compared with Kenya – and
internet tools accessible via mobile technologies offer
a practical solution.”
Common mHealth applications
• Client education and behavior change
communication.
• Sensors and point-of-care diagnostics.
• Registries and vital events tracking.
• Data collection and reporting.
• Electronic health records.
• Electronic decision support (information,
protocols, algorithms, checklists).
• Provider-to-provider communication (user
groups, consultation).
• Provider work planning and scheduling.
• Provider training and education.
• Human resource management.
• Supply chain management.
• Financial transactions and incentives.
Source: Labrique et al. Glob Health Sci Pract 2013;1:160-71.
13
Philips_Africa_repor_V5.indd 13
18/11/2014 14:54
Viewpoints:
a final word
Philips and Amref Health Africa are developing
sustainable, innovative, and community-based
programs that can help bridge the gap between
communities and formal health systems.
Moreover, both Philips and Amref Health
Africa acknowledge the need for continuous
education to advance and maintain the clinical
competencies of healthcare professionals on
the ground.
By presenting viewpoints from key stakeholders,
representing NGOs, patients, and healthcare
workers, we hope that this Fabric of Africa
ViewPoint has highlighted the impact that
strategic partnerships can have in strengthening
of healthcare systems in resource-limited
settings.
14
Philips_Africa_repor_V5.indd 14
18/11/2014 14:54
References
1. Wangalwa G, et al. Effectiveness of Kenya’s Community
Health Strategy in delivering community-based
maternal and newborn health care in Busia County,
Kenya: non-randomized pre-test post test study. Pan
Afr Med J. 2012;13 Suppl 1:12.
2. AMREF Kenya receives matching grant for mHealth
Project. http://amref.org/news/news/kcoamrefkenya-receives-matching-grant-for-mhealth-project/
3. The World Health Organization. Millennium
Development Goals 4 and 5. http://www.who.int/
pmnch/about/about_mdgs/en/
4. Capital News. Philips innovative clinic opens in Kiambu
County. http://www.capitalfm.co.ke/news/2014/10/
philips-innovative-clinic-opens-in-kiambu-county/
5. Fabric of Africa. Comprehensive maternal
health screening program to be rolled out across
Kenya. http://www.healthcare.philips.com/main/
clinicalspecialities/womenshealthcare/foa/matharenorth.html
6. Africa Healthcare IT News. Philips Developing
Sustainable Healthcare Revitalization Projects in
Kenya: http://africahealthitnews.com/blogs/2013/05/
philips-developing-sustainable-healthcarerevitalization-projects-in-kenya/
7. Fabric of Africa. Interview with Esther Madudu. http://
www.healthcare.philips.com/main/clinicalspecialities/
womenshealthcare/foa/esther_madudu.html
8. Stand up for African Mothers. Roadmap. http://amref.
org/standup/the-situation/stand-up-for-africanmothers-road-map/
9. Uganda Demographic and Health Survey 2011. http://
www.ubos.org/onlinefiles/uploads/ubos/UDHS/
UDHS2011.pdf
10.Stand up for African Mothers. Training in Uganda.
http://amref.org/standup/en/midwifery-training/
training-in-uganda/
11. Outreach Uganda. http://outreachuganda.org/
12. Petition to nominate African midwife Esther Madudu
for the 2015 Nobel Peace Prize. http://amref.org/
standup/the-situation/the-appeal/#sthash.
W68J3EMk.dpuf
13. Index Mundi. Maternal mortality rate. http://www.
indexmundi.com/g/r.aspx?c=ug&v=2223
14. World Health Organization. Country cooperation
strategy at a glance. Uganda. http://www.who.int/
countryfocus/cooperation_strategy/ccsbrief_uga_
en.pdf
15. UNICEF. Uganda statistics. http://www.unicef.org/
infobycountry/uganda_statistics.html
16. UNFPA. A Universal Pathway. A Woman’s Right to
Health. http://unfpa.org/webdav/site/global/shared/
documents/publications/2014/SoWMy-ReportEnglish-rev2.pdf
17. Labrique AB, Vasudevan L, Kochi E, et al. mHealth
innovations as health system strengthening tools: 12
common applications and a visual framework. Glob
Health Sci Pract 2013;1:160-71. http://www.ncbi.nlm.nih.
gov/pubmed/25276529
15
Philips_Africa_repor_V5.indd 15
18/11/2014 14:54
© 2014 Koninklijke Philips N.V.
All rights reserved.
No component of this publication, neither the whole publication may be reproduced, disclosed or stored in a retrieval system by means of print, photocopy,
microfilm or any technique other than the written permission of the publisher.
The publisher accepts no liability for damage and/or injury to persons and/or property on account of product, incorrect, incomplete or misleading information,
whether caused by the use or application of methods, products, instructions or ideas contained or referred to in this publication, or for deficiencies on other grounds.
The views expressed in this publication belong to the ideas of the authors and do not necessarily reflect the opinion of the publisher, the sponsor or the editors.
www.philips.com
Philips_Africa_repor_V5.indd 16
18/11/2014 14:54