AHP IS SETTING ABOUT SOLVING A UNIVERSAL HEALTHCARE PROBLEM
By Saul Kornik, CEO and Co-Founder, November 2017
It’s hard to say where AHP’s story starts.
In some form, it starts with the advent of modern medicine and the physician as its technical head. But doctors are more than just clinicians. They coordinate people, systems, resources and infrastructure to deliver care to patients. Almost all health systems have been set up around them in this way. So without doctors, there is terrible healthcare.
While this may be the soil for AHP’s growth, the seed was planted in 2005 by Prof Steve Reid at University of KwaZulu-Natal. Steve is one of a few doyens of rural health in South Africa. He was struggling to find well-staffed rural hospitals to which he could send his students. South Africans just didn’t seem to want to work there. The consequence of no doctors is terrible healthcare – a universal problem in rural South Africa and across the continent.
So Steve thought, “Well maybe some British doctors would be keen?”
The following map is that of the distribution of disease across the world. One can see a very swollen, red Africa in the centre of the map.
The map below shows the global distribution of the physicians. The question I always ask when I show this is, “Where is Africa?”
The reality is that with 24% of the global disease burden, Africa languishes with only 2% of the world’s physicians. This leads to what Tudor Hart coined as the “Inverse Care Law”, which basically means: doctors go to where they are needed the least.
AHP’s reason for existing is simple: provide the obvious thing that is missing. Fill Africa with doctors.
Surprisingly, there has been a lot of willingness. In our 12 years of existence, AHP has placed around 4,200 health workers – three-quarters sourced from abroad and a quarter sourced locally. These professionals have served in government and civil society posts for on average 2 years in each of the six countries in which we have worked. The vast majority of this work has been in South Africa. It must be added that this work has happened through close partnerships with the various governments and health professional bodies.
In total, professionals placed by AHP have treated around 34 million people in rural and underserved areas. People who might otherwise not have had the opportunity to see a doctor.
AHP’s doctors have done what doctors do best – treated people and made them better. Yet, something more has been happening. Not only have these doctors been treating patients but they have been coming up with solutions to make their hospitals and clinics work better too.
Here’s an example that, however amazing, is not rare.
AHP placed a young British doctor (“Dr R”) in a rural hospital in KZN, South Africa. When she arrived, Dr R observed that she and the other doctors in this hospital did not hear about the worsening conditions of kids in the paediatric ward until it was too late. The consequence was that children were dying before they could intervene. So Dr R implemented an observation system with the nurses so that doctors could catch deteriorating children earlier. In the 6 months preceding this intervention, 102 children had died in this hospital. After its implementation, child deaths dropped by more than 75%. Seventy-seven children’s lives were saved in this one hospital in the space of 6 months.
AHP has found that not only do doctors make facilities work better but they change the behaviours of their colleagues too. In other words, they change the hospital culture.
AHP has codified what behaviours must be lived for all people in a hospital and a clinic – patients and health workers alike – to “feel cared for”. We have been running programmes to get such culture changes embedded. The results have been astounding.
Here’s one story that beautifully captures what has happened. One of many.
At one clinic, a clerk (“Andile”) worked with an AHP-placed doctor and went through AHP’s patient-centric culture programme. Andile found his behaviour changing as a result. He came to a different place in how he relates to patients.
This was the situation.
There was an HIV positive patient who, for some time, had not returned to the clinic to collect her HIV medication. Andile called this patient up to find out what was happening. The patient explained that the last time she had come to the clinic a nurse had treated her incredibly disrespectfully. As a result, the patient had no interest in returning. By Andile’s own admission he would previously have written off the patient’s case as futile. However, having had exposure to a new way of treating patients, he tried something different. He listened to the patient. He expressed empathy. He coaxed the patient back to the clinic, personally guaranteeing a good experience should the patient do so. And the patient did just that, getting back onto her HIV treatment. Andile was astounded.
So AHP has realised: there seem to be problems in hospitals and clinics that are as common as sickness. And we realised: Our doctors have been trying their best to fix them but often do not have the tools or training to do so. With this in mind, we now provide AHP doctors with access to the tools and training they need to fix the problems we know they will encounter. Solutions like running hospital triage systems, improving hand sanitization, performing audits on trauma services and introducing various clinical guidelines. The problems are the same. These doctors do not need to reinvent the wheel.
AHP doctors now get the following support: clinical training relevant to AHP’s underserved contexts; access to tools to fix problems; and a networking and lifestyle programme that fosters a growth experience for these doctors.
The result of this should be improved clinical outcomes, better functioning hospitals and clinics, and a more resilient workforce. This, at the end of the day, means fewer deaths and healthier people.
What will it take to scale this?
AHP first needs to dial its model down. The move from a purely placement operation to providing support to doctors represents a sea change for the organisation. We need to get our work refined and proven.
Then we need to increase the number of doctors we place and support. Our experience shows that there is a massive demand for our services. In 2017, AHP turned away around 450 doctors because we did not have posts into which to place them. AHP currently has just over 1,000 specialists on its database who have shown interest in working in South Africa but who cannot get registered in the country to practice. These are doctors which AHP can place before even casting its net wider for more candidates. We would also like to open our support up to South Africa and Africa’s home-grown doctors.
To place more doctors, we will need more sites in which they can work – in Africa and, eventually, across the world.
Finally, we need the money to make this happen. This past year we have gone from being 100% philanthropically funded to being funded 50% through fees that doctors pay us for the placement and support we provide. AHP still needs a large amount of philanthropic support to build the organisation to a point where the fees collected by the volume of its doctor covers all organisational costs.
If we are able to get to this point, we really will fill Africa with doctors.