Community life center: Strengthening primary care in Africa (learnings from 1st pilot in Kenya)

: 2.039_MDG Community life center: Strengthening primary care in Africa (learnings from 1 pilot in Kenya) K. Subbaraman, C. Kyalo, A. Orwa, E.B. .Sarroukh; Philips Research Africa, Kenya Program/Project Purpose: The Community Life Centre (CLC) is a community-driven integrated primary care intervention. Most primary care interventions are limited by their ability to scale or sustain the growing demand for clinical services. The aim of Community Life Centre is to co-create a self-sustainable community health hub that improves primary health outcomes. Structure/Method/Design: The program has three goals: (1) improve primary care outcomes, (2) implement community-engagement strategies to enable financial sustainability, and (3) achieve economies of scale. A solar-powered Community Life Centre (CLC) has five components 1. Co-designing a primary care facility with the community 2. Community-led commercial services to supplement incomegeneration by the CLC 3. Strengthen skilled-human resource capabilities 4. Empowering Community Health 5. Operational monitoring and evaluation The first CLC pilot was implemented in Kenya in partnership with a local County Government. An existing Level-II facility was upgraded to a Level-III Health Centre. The stakeholder map for the CLC includes the community, the existing health ecosystem, the governance and administrative structures (formal and informal). Outcome and Evaluation: Our short-term outcomes are based on improvements in clinical service-utilization. In this regard, we have observed increase in service utilization (20 times increase in OPD footfall, 3 times increase in ANC footfall, and nearly 600 deliveries over a 15-month period). The current facility is equipped to provide services for 24-hours with minimal poweroutage. In the long-term, we expect improved effectiveness of service delivery and self-sustainability of the CLC based on communitydriven strategies including commercial services. Going Forward: There are three ongoing challenges: (1) devolution of primary care services has negatively impacted operational and supply-chain mechanisms; (2) disconnected key performance indicators that affect caredcoordination between community health and primary health systems, and (3) informal mechanisms that are not fully-integrated into the health ecosystem (church, TBA, etc.) Moving forward, one of the key goals is to translate improved outcomes to policy-level dialogues to improve primary care readiness. An additional goal is to demonstrate clinical and cost-effectiveness of the CLC program in extremely low-resource and marginalized settings in partnership with global organizations including UNFPA.

Program/Project Purpose: The Community Life Centre (CLC) is a community-driven integrated primary care intervention. Most primary care interventions are limited by their ability to scale or sustain the growing demand for clinical services. The aim of Community Life Centre is to co-create a self-sustainable community health hub that improves primary health outcomes.
Structure/Method/Design: The program has three goals: (1) improve primary care outcomes, (2) implement community-engagement strategies to enable financial sustainability, and (3) achieve economies of scale.
A solar-powered Community Life Centre (CLC) has five components 1. Co-designing a primary care facility with the community 2. Community-led commercial services to supplement incomegeneration by the CLC 3. Strengthen skilled-human resource capabilities 4. Empowering Community Health 5. Operational monitoring and evaluation The first CLC pilot was implemented in Kenya in partnership with a local County Government. An existing Level-II facility was upgraded to a Level-III Health Centre. The stakeholder map for the CLC includes the community, the existing health ecosystem, the governance and administrative structures (formal and informal).
Outcome and Evaluation: Our short-term outcomes are based on improvements in clinical service-utilization. In this regard, we have observed increase in service utilization (20 times increase in OPD footfall, 3 times increase in ANC footfall, and nearly 600 deliveries over a 15-month period). The current facility is equipped to provide services for 24-hours with minimal poweroutage.
In the long-term, we expect improved effectiveness of service delivery and self-sustainability of the CLC based on communitydriven strategies including commercial services.
Going Forward: There are three ongoing challenges: (1) devolution of primary care services has negatively impacted operational and supply-chain mechanisms; (2) disconnected key performance indicators that affect caredcoordination between community health and primary health systems, and (3) informal mechanisms that are not fully-integrated into the health ecosystem (church, TBA, etc.) Moving forward, one of the key goals is to translate improved outcomes to policy-level dialogues to improve primary care readiness. An additional goal is to demonstrate clinical and cost-effectiveness of the CLC program in extremely low-resource and marginalized settings in partnership with global organizations including UNFPA.

Abstract #: 2.040_MDG
The adequacy of antenatal care services among slum residents in Addis Ababa, Ethiopia Yibeltal Tebekaw 1 , Yohana J. Mashalla 2 , Gloria Thupayagale-Tshweneagae 2 ; 1 University of South Africa, Addis Ababa, 2 UNISA, Pretoria, South Africa Background: Maternal mortality has been shown to be lower in urban areas than in rural areas. However, disparities for the fastgrowing population of urban poor who struggle as much their rural counterparts to access quality healthcare are masked by the urban averages. This paper aims to report on the findings of antenatal adequacy among slum residents in Addis Ababa, Ethiopia.
Methods: A quantitative and cross-sectional community based study design was employed. A stratified two-stage cluster sampling technique was used to determine the sample and data was collected using structured questionnaire administered to 837 women aged 15-49 years. Binary logistic regression models were employed to identify predictors of adequacy of antenatal care. A single overall ANC adequacy indicator was constructed using three indicators i.e., timing of first visit, number of visits, and adequacy of service content.
Results: The majority of slum residents did not have adequate antenatal care services i.e., only 50.7%, 19.3% and 10.2% of the slum resident women initiated early antenatal care, received adequate antenatal care service contents and had overall adequate antenatal care services. Pregnancy intention, educational status and place of ANC visits were important determinant factors for adequacy of ANC in the study area. Women with secondary and above educational status were 2.9 times more likely to have overall adequate care compared to those with no formal education. Similarly, women whose last pregnancy was intended and clients of private healthcare facilities were 1.8 and 2.8 times more likely to have overall adequate antenatal care compared to those whose last pregnancy was unintended and clients of public healthcare facilities respectively. MDGs and SDGs M a y eJ u n e 2 0 1 6 : 5 1 1 -5 3 1