Transcript GHCC-Team-4-Slide-Deck-FINALx

2012 Triangle Global Health Case Competition
Prevention of Cardiovascular Disease
(CVD) Risk Factors in Kenya
ENGAGE. EDUCATE. EMPOWER.
UNC Team 4
Adam Jutha
Gladys Manzur
Joel Lugones
Leena Patel
Hans Peng
1
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Executive Summary
Objective: Prevent and manage cardiovascular disease (CVD) risk
factors in Kenya
Recommendation: Develop public health prevention programs and
strategies to target Kenyans under age 45 in urban areas
ENGAGE
OPPORTUNITY
• Under 45 years
• Urban Areas
• Risk factor: obesity
EDUCATE
SMS MED
HEALTH
AMBASSADORS
• Widespread
mobile use
• Effective health
education channel
• Personal community
approach to care
• Culturally sensitive
• Low-cost training
EMPOWER
HEARTY GARDENS
• Sustainable, fresh
and healthy
alternatives
• Local job creation
Impact: $12.3MM grant from Gates Foundation will initiate
sustainable programs for the prevention of CVD risk factors in Kenya
2
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Agenda
Opportunity
Engage
• SMS Med
• Financial Cost: $4.5MM
Educate
• Health Ambassadors
• Financial Cost: $1.3MM
Empower
• Hearty Gardens
• Financial Cost: $6.5MM
Impact
3
• Urban areas and <45 yrs
• Leading factor: obesity
Opportunity
• Total Financial Cost: $12.3MM
SMS Med
Health Ambassadors
Hearty Gardens
Impact
As Kenya’s population grows, CVDs are expected to increase
unless public health programs are expanded
Kenya’s population (M)
46.4
2.6%
35.6
 Kenya’s population has
steadily increased
27.4
3.5%
19.7
 The growth rate will likely
slow down in the coming
years
9.5
1965
13.5
1975
1985
1995
2005
2015
Kenya’s population growth rate, average
3.64%
3.78%
3.09%
2.62%
2.68%
1966-1975
1976-1985
1986-1995
1996-2005
2006-2015
4
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Annual deaths from CVD are projected to increase 86%,
reaching 80,000 deaths by 2030
Projected deaths from cardiovascular disease in Kenya (’000s)
79.9
22.8
Forecasts suggest
significant
increases in CVDs
58.7
4.1
16.8
Other
42.9
Hypertensive
heart disease
12.1
2.3
Ischemic heart
disease
3.1
Ischemic heart disease
25.2
18.5
13.7
Cerebrovascular
disease
14.8
2002
5
Opportunity
84%
20.3
2015
SMS Med
27.8
Cerebrovascular disease
88%
2030
Health Ambassadors
Hearty Gardens
Impact
Obesity is one of the leading factors for CVD and affects a
large portion of Kenya’s growing urban population
Relative Risk of CVD
Correlation between obesity and CVD
4
Overweight/obese populations
Overweight (25<BMI<30)
3
Obese (>30 BMI)
39.8%
2
1
15.8%
0
5.1%
Not Affected Overweight
BMI
15.5%
Rural
Obese
Urban
Increasing urbanization
6
2005
2015
7.5M people (21%)
11.1M people (24%)
Opportunity
Health Ambassadors
SMS Med
Hearty Gardens
Impact
Effective public health and CVD programs should target
Kenya’s largest demographics
Population by age
Population Forecasts (M)
> 65 yrs
45-64 yrs
26.8
3%
9%
2010
2015
21.9
18.5
14.2
53%
35%
< 20 yrs
20-44 yrs
3.8
< 20 yrs
88% of Kenya’s
population is under
age 45
7
Opportunity
Under age 45 is also
fastest growing
demographic
SMS Med
Health Ambassadors
20-44 yrs
5.2
45-64 yrs
1.1 1.6
> 65 yrs
Public health
programs should focus
on prevention of CVD
Hearty Gardens
Impact
Successful CVD prevention programs should target three key
demographics
Location:
urban areas
CVD
prevention:
target
market
Leading
factor:
obesity
8
Opportunity
Population:
< 45 yrs
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Agenda
Opportunity
Engage
• SMS Med
• Financial Cost: $4.5MM
Educate
• Health Ambassadors
• Financial Cost: $1.3MM
Empower
• Hearty Gardens
• Financial Cost: $6.5MM
Impact
9
• Urban areas and <45 yrs
• Leading factor: obesity
Opportunity
• Total Financial Cost: $12.3MM
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Widespread use of texting presents an opportunity to
communicate with majority (75%) of Kenyans
Cell phone penetration
Cell phone usage
83%
Phone Calls
50%
31%
2%
2001
5%
Text Messages
Efficient
Communication
14%
2005
2007
2009
75%
Take Pictures
Internet Usage
2003
98%
50%
23%
Year (2012)
2011
Text message costs in Kenya (USD)
Sending:
$0.06/TXT
Receiving:
FREE
10
Opportunity
SMS Med
Cost-Effective
Health Ambassadors
Hearty Gardens
Impact
Texting has been proven to be an effective channel of health
education
Maryland
California
Illinois
Content
Purpose
Read TXTs:
Prenatal and
postnatal care
education
 3 TXT/week
 Reminders, tips,
advice
11
Sex education
Sports injury
prevention
100%
Found it educational:
95%
 1 TXT/week
 FAQ, clinic
location, ask Q
Opportunity
SMS Med
 1 TXT/week
 FAQ, clinic
location, ask Q
Health Ambassadors
Complied with msg:
66%
Hearty Gardens
Impact
SMS Med engages Kenyans to learn more about CVD
prevention through texting
Author
•
Subscribers
Ambassadors for
their respective
community
Features
12
Community
members
Frequency
•
Weekly
educational email
•
Event info
•
Find ambassador
Opportunity
•
SMS Med
•
78 texts per year
•
Average 1.5 texts
per week
Health Ambassadors
Hearty Gardens
Impact
SMS Med can expect to reach over 200,000 people in its first
4 years of programming
Community reach forecasts for SMS Med
$1,000
200,000
# Med TXT Subscribers
$900
Cost of Sending TXT ($)
$800
$700
150,000
$600
$500
100,000
$400
$300
50,000
$200
-
Total Cost of Sending TXTs ('000s)
Number of Med TXT Subscribers
250,000
$100
Year 1
13
Opportunity
Year2
SMS Med
Year 3
Health Ambassadors
Year 4
Hearty Gardens
Impact
Agenda
Opportunity
Engage
• SMS Med
• Financial Cost: $4.5MM
Educate
• Health Ambassadors
• Financial Cost: $1.3MM
Empower
• Hearty Gardens
• Financial Cost: $6.5MM
Impact
14
• Urban areas and <45 yrs
• Leading factor: obesity
Opportunity
• Total Financial Cost: $12.3MM
SMS Med
Health
Ambassadors
Hearty Gardens
Impact
Despite rising obesity and CVD, Kenya lacks a cohesive
prevention plan and personnel resources
Growing CVD Factors
Average BMI
22.5
BMI
131
Systolic Blood Pressure
130
22
129
21.5
128
21
127
20.5
126
20
125
19.5
124
19
123
1980 1984 1988 1992 1996 2000 2004 2008
Systolic Blood Pressure (mm Hg)
23
Has an operational integrated program for:
Cardiovascular Disease
No
Lack of
Unhealthy diet/Overweight/Obesity
prevention
programs
Physical Activity
No
No
Tobacco
No
Physician: Patient Ratio
Significant lack
of trained
Kenya (Year 2011) personnel
WHO Recommended
Rise of early indicators of
obesity and CVD
15
Opportunity
SMS Med
Health
Ambassadors
1:1000
1:10,000
Hearty Gardens
Impact
Lay Health Advisors (LHA) model shows proven results in
curbing health issues factors in culture driven communities
4 year program
2 year program
2.5 month pilot program
1.5 year program
100 Advisors
200 advisors
500 advisors
50 years
Treating Malaria
Hypertension
Heart disease & stroke
Infant mortality
•
•
•
•
•
•
•
•
Check blood pressure
Monitor symptoms of stroke
& heart attack
promote healthy living
•
Reduction in
hospitalization for
stroke, heart attack:
Initiate primary
Immunization
Family health planning
Medication access
Referrals to physicians
Diagnosed: 85%
Treated: 91%
Mortality: -49%
16
Monitor blood pressure
Modify diet, physical
activities
•
Decreased average
systolic BP from
140 - 108mm Hg
Opportunity
SMS Med
9%
Health
Ambassadors
Mental health
counselors for
black mothers
98%
Mortality: -23%
care:
Hearty Gardens
Impact
Training represents the highest cost in this relatively
inexpensive program
Costs for Health
Ambassador’s Program in
USD (’000s)
$1,293
Workshop and Training Costs
$1,021
Health
Workshops
7%
Training
Costs for 400
Ambassadors
93%
$91
Year 1
17
Years 2
through 4
Opportunity
Total
SMS Med
Health
Ambassadors
Hearty Gardens
Impact
Agenda
Opportunity
Engage
• SMS Med
• Financial Cost: $4.5MM
Educate
• Health Ambassadors
• Financial Cost: $1.3MM
Empower
• Hearty Gardens
• Financial Cost: $6.5MM
Impact
18
• Urban areas and <45 yrs
• Leading factor: obesity
Opportunity
• Total Financial Cost: $12.3MM
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Accessibility to healthy alternatives should complement
educational programs to allow for lifestyle modifications
Educational programs through SMS Med
and Health Ambassadors provide
awareness for people to try new
alternatives
Healthy
Alternatives
Education
19
Opportunity
SMS Med
Accessibility to healthy food alternatives
enable people to practice new habits
Health Ambassadors
Hearty Gardens
Impact
Urban food gardens (including “Hearty Gardens”) provide
access to fresh and affordable produce
Improved access
to food
alternatives
Targets at risk
urban population
MicroGardens use
Woolly Pocket
system
Fresh, organic
produce
Decreased risk of
CVD
Community Empowerment
20
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
“Hearty Gardens” can use Woolly Pockets, innovative and
cost-effective technology, to enhance urban gardening
The Woolly Pocket System
A Modular Gardening System

Space efficiency ideal for urban areas
 33% less space required to grow crops
 Requires 50% less water.
 Made from 100% recycled plastic bottles
 Easy set-up and user-friendly
21
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Woolly Pocket Gardens can be established in Nairobi as a
self-sustaining business to target at-risk populations
Actions
Details and Justifications
•
•
Largest urban center in Kenya
Targets population of 40%
overweight, 15% obese
•
Potatoes, soy beans,
tomatoes, salad greens,
beats, onions, cabbage,
beans, etc.
•
Self-sustaining after
initial capital investment
Implement in capital city
(Nairobi)
Supplement produce
needs for up to 30,000
people in Nairobi
Offer cheaper produce
while maintaining
profitability
Source: WHO, Woolly Pockets Website, Horticulture Development Centre
22
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Four-year plan of 640 “Hearty Gardens” would require
$9.1MM investment (result in $3.3MM net cost after revenues)
Year 1
50 Gardens
Year 2
120 Gardens
Year 3
360 Gardens
Year 4
640 Gardens
Cost-Revenue Structure for 4-year Implementation Plan
Capital Costs
Variable
Costs
Net Cost
After 4 years, “Hearty Gardens” projected to turn $0.40MM annual profit
Source: Team Analysis
23
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
As revenues grow, investments totaling $6.5 MM are required
to offset capital investments
Projected Revenue Growth (’000s)
$3,207
Revenue Realized
$2,486
$2,728
Req Investment
$1,813
$715
$534
$604
$0
$252
1
2
3
Implementation Year
4
5
Total Investment Required: ($534K + $714K + $2486K + $2728 K+$0) = $6.5MM
Source: Team analysis
24
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Agenda
Opportunity
Engage
• SMS Med
• Financial Cost: $4.5MM
Educate
• Health Ambassadors
• Financial Cost: $1.3MM
Empower
• Hearty Gardens
• Financial Cost: $6.5MM
Impact
25
• Urban areas and <45 yrs
• Leading factor: obesity
Opportunity
• Total Financial Cost: $12.3MM
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Recommendations will provide education, outreach and opportunities for
reduction of CVD risk factors in Kenya’s urban population
Costs
Impact
SMS Med
$4.5MM
Cost-effective widespread outreach
Health
Ambassadors
$1.3MM
Culture-sensitive community engagement
Hearty Gardens
$6.5MM
Empowering with healthy and sustainable
nutrition alternatives
Total:
$12.3MM
26
Sustainable programs for the prevention of CVD risk factors
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Executive Summary
Objective: Prevent and manage cardiovascular disease (CVD) risk
factors in Kenya
Recommendation: Develop public health prevention programs and
strategies to target Kenyans under age 45 in urban areas
ENGAGE
OPPORTUNITY
• Under 45 years
• Urban Areas
• Risk factor: obesity
EDUCATE
SMS MED
HEALTH
AMBASSADORS
• Widespread
mobile use
• Effective health
education channel
• Personal community
approach to care
• Culturally sensitive
• Low-cost training
EMPOWER
HEARTY GARDENS
• Sustainable, fresh
and healthy
alternatives
• Local job creation
Impact: $12.3MM grant from Gates Foundation will initiate
sustainable programs for the prevention of CVD risk factors in Kenya
27
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Appendix Index
Opportunity
SMS Med
• Literacy rate
• Secondary
school
enrollment
• Financial
calculations
28
Opportunity
Health
Ambassadors
• Benefits &
case studies
• Financial
calculations
• Sensitivity
analysis
SMS Med
Hearty
Gardens
• Financial
calculations
• Specifications
and design
Health Ambassadors
Impact
• Risk Analysis
• Challenges
Hearty Gardens
Impact
Three-quarters of Kenya’s population is literate and nearly half
of the population is enrolled in secondary school education
Literacy rate, as per 2005
Secondary school enrollment
Illiterate
26%
Enrolled
49%
Not
enrolled
51%
Literate
74%
29
Opportunity
Literacy rates and
school enrollment
will increase due to
introduction of free
primary and
secondary schooling
in last 6 years
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Financial and Impact Calculations for SMS Med
Population of Nairobi
Percent with mobile
Population of Nairobi with phones
Year
Year 1
Year2
Year 3
Year 4
3,130,000
83%
2,597,900
Market Share Obtained
Cost per text
Number of Subscribers
25,979
64,948
129,895
220,822
$
$
$
$
Texts per week Total Texts Total People Hit
Cost ( S 000's)
101
253
507
861
Total Annual Costs
Year 1
1.0%
0.05
1.5
78
25979 $
101,318
Year 2
2.5%
0.05
1.5
78
64947.5 $
253,295
Year 3
5.0%
0.05
1.5
78
129895 $
506,591
Year 4
8.5%
0.05
1.5
78
220821.5 $
861,204
Total Cost
30
Opportunity
SMS Med
Health Ambassadors
$
Hearty Gardens
1,722,408
Impact
Texting programs for Sex Education
The HOOKUP
Sex, Etc.
Sex-Ed Loop
Healthy TXT
•Weekly sex info and life advice
•Find the nearest clinic by zip
code
•Privacy and casual
•Has twitter, facebook, blog, and
youtibe pages
•Twitter:
•Tweets: 1504
•Following: 1142
•Followers: 1409
•Facebook:
•Likes: 1,814
•Funded by Federal Office of
Population Affairs and California
Wellness Foundation and
California Endowment and
American Civil Liberties Union
•Has a mobile site that has FAQs,
terms, and rights information
•Part of a larger organization
answer sex ed, honestly
•Part of a larger organization
answer sex ed, honestly
•Weekly sex ed tips
•Find nearest clinics via text
•Mary Beth Szydlowski, the H.I.V.
education prevention specialist
for Chicago schools, said that
Sex-Ed Loop not only reinforces
what students learn in class but
can reach all teenagers,
including dropouts.
•Teenagers write the texts and
blogs
•Founded in Chicago in 2011,
Healthy TXT™ is a physiciandesigned service that delivers
healthy text messages to
inspire, engage, and empower
people to take action for health
•Educational concussion
messages – along with football
injury prevention, performance
tips, and motivational messages
from leading sports medicine
physicians, trainers, and
professional athletes – will be
delivered once or twice a week.
•All subscribers will go through a
mini concussion-training course,
with a text message and an
educational link delivered
weekly. Upon completion,
participants can take a
concussion quiz, and be entered
for a chance to win an iPad2.
Winners will be announced on
Super Bowl Sunday.
31
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Where else is texting being used?
•
A pilot study at Nationwide Children's Hospital in Columbus, OH, found that
adolescent patients with diabetes who received text messages related to their
medication plan were more likely to comply with it than those who didn't.
– http://www.healthy-txt.com/#info
•
The Pediatric Heart Transplant Program at NewYork-Presbyterian / Morgan Stanley
Children's Hospital is launching a one-year program that will use a text messaging
platform to increase medication adherence in its teenage heart transplant
patients.
•
According to BabyCenter, a social networking site for over 10 million Moms, the
mobile phone is a Mom's companion that makes juggling easier. It is also changing
behavior as seen in several pilot studies from Harvard and Johns Hopkins
Children's Center. Healthy behaviors can be inspired and sustained by using mobile
platforms where people live, work, and play.
32
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Texting Case Studies
•
•
•
•
•
•
•
•
•
•
•
•
“For better or worse, this technology is here, and sending a text to a patient’s cell phone about an upcoming appointment or a test or simply to
remind them to take their meds is a great example of how we can harness new communication technology for a greater good.”
Research has shown that up to half of patients may fail to take their daily medication properly, with forgetting being a top reason for nonadherence, so at least in some cases, a text reminder may be all that a patient needs, adds Robotham, who has encouraged the use of appropriate
texting among pediatricians at Hopkins Children’s.
one study involving children with diabetes showed improved blood glucose testing rates. These children were also more likely to share their blood
glucose test readings with their doctor’s office.
patients on immunosuppressive drugs after a liver transplant had improved medication adherence. The liver study detected measurable clinical
benefits from text-messaging: Acute liver rejection episodes dropped dramatically as a result of better medication adherence.
Chronic conditions that require daily medication, like HIV, asthma and TB, or daily testing, like diabetes, are great candidates for “SMS
therapy,” Robotham says.
“Texting is an even more popular mode of communication outside the United States, and especially so in developing countries, where most of the TB
cases are, so I could see this being a great new way to reach those hard-to-reach patients,” Jain says.
“Why wouldn’t it?” she says. “A patient can read a text instantly and respond unobtrusively, it doesn’t require Internet access or picking up the phone
in the middle of class or an important meeting. Sometimes, I call patients and I get no response, but when I text, I get a response immediately.”
“It won’t be a silver bullet but it could certainly be a nice little tool in an arsenal of many other tools,” Robotham says.
By asking questions about glucose testing, meal boluses and frequency of high and low glucoses, Dyer said she saw an increase in teens taking their
medications.
After three months of sending text reminders she reported that they were three times less likely to miss a dose.
"This form of communication allows for real-time health management which is extremely valuable for patients that suffer from a chronic illness like
diabetes," said Dyer.
The study, which was conducted by Mt. Sinai Medical Center's Pediatric Gastroenterology Department in 2008, found that as a result of receiving
regular text alerts liver transplant patients were more likely to have higher adherence rates. The number of rejections dramatically decreased from
12 episodes the previous year to only two during the study
33
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Football Injury Prevention Texting Program
“Texting is an effective way to reach teens and adults where they are today, on their mobile
phones,” says Dr. Vishal Mehta, a Chicago area sports medicine orthopedic surgeon, as well as the
medical advisor and co-founder of Healthy TXT, the organization behind the public service venture.
“Harvard University and John Hopkins Children's Center studies show that healthy behaviors can be
inspired and sustained using cell phone technology.”
34
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Does texting work?
•
Quantifying services is difficult. But Ms. Levine, who hosts Sex::Tech, a conference about sexual
health programs for youth, said that requests to make presentations about online or mobile
services had soared. Typically, she receives between 40 and 50 applications. This year, she
received about 120.
•
Most online services receive grants from philanthropies, like the Ford Foundation, and health
and education agencies on the state and federal level.
•
Real Talk held a classroom contest to see which student could send the most texts containing this
prevention message: “ROFL!!!” (Translation: rolling on the floor laughing). “STDs and HIV can
spread as fast as this message. Still laughing? Pass on the message not HIV/STDs. 518-HIVTEST.” Within an hour, the message had been sent to nearly 450 phones.
35
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Technology to make this work exists
Supporting Education through SMS in Kyrgyzstan
• The teachers and students we’re working with are attached to their cell phones, and therefore our
team decided to experiment with text messaging as a method of communication. FrontlineSMS
software enabled us to use mass text messaging, which streamlined our communication and
allowed us to use time more efficiently. It only takes about a minute to send out text messages to
all of our teachers through FrontlineSMS, whereas in the past staff were making individual calls
which took a lot longer.
• Few people have internet in their homes, yet everyone has mobile phones and so using SMS makes
regular communication accessible to more of those we work with. When we ask teachers how they
like working with SMS, they say that they find it very convenient, useful and flexible.
• We plan to collect SMS feedback reports from our program participants on how often they attend
IREX trainings and where trainings are being held. We will then map these reports using online
mapping tool Ushahidi, and this will allow us to visualize our impact. addition, the GCE program is
also planning to use FrontlineSMS to conduct polling and short surveys among students and
teachers, which will help us to further understand the value of our program and the needs that
program participants have.
CareSpeak Communications Inc., a privately held mobile health company in New Jersey
• The study was so successful that half of the patients that participated in the study in 2008 are still
in the program today, says Miloh.
• “Before this program, we had only the power of people trying to educate the children and their
families about the deadly nature of noncompliance,” adds Addonizio. “Now we have the ability to
give these adolescents a safety net to help them become responsible.
36
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
What is the purpose of answer, sex ed ?
•
They are only focusing on the risk-reduction model - Valerie Huber, executive director of the
National Abstinence Education Association
•
Those who run digital programs say they simply want teens to have accurate information, to
help them make good decisions. Even though popular culture is saturated with sex, facts and
advice can be hard to find.
37
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Sensitivity Analysis for LHA Costs
Conservative
Events per Year
Locations
Total Events per Year
Attendees per Event
Tables Needed per Event
Estimated
4
10
40
4
10
40
4
10
40
400
20
400
20
400
20
Per Tables + 6 Chairs Rental Cost
$
20.00
$
Table+Chair Cost per Event
$
400.00
$
Highschool Gym Rental
Total Cost per Event
Total Cost of Events per year
Total Number of Health Ambassadors
Training Cost per Ambassador
Medical Supplies
Total Training Costs
4-year Total Cost
38
Opportunity
SMS Med
Liberal
13.50 $
270.00
$
Source:
10.00 www.costhelper.com
200.00
$5,000
$2,000
$1,200
$5,400.00
$216,000.00
$2,270.00
$90,800.00
$1,400.00
$56,000.00
200
$8,000
200
$4,500
200
$2,000
$450
$1,690,000
$150
$930,000
$2,554,000.00
$1,293,200.00
Health Ambassadors
Source:
http://www.mysteth
$30 oscope.com/
$406,000
$630,000.00
Hearty Gardens
Impact
Education via lay health advisers (LHA)-led workshops will
surmount to sustainable and long-term benefits
Similar programs have a track record of
success
Improves access, the role of the health worker,
and outcomes among at-risk population
Program will train
health workers in
educating the at-risk
populace adopt
preventive care and
adherence to
suggested treatment=
39
Opportunity
Addresses a more
effective and
communal approach
that educates
preventable care
SMS Med
Health Ambassadors
Hearty Gardens
Impact
CVD risk factors are increasing
40
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
A partnership with the Canadian Public Health Association (CPHA)
can aid the success of preventative education for at-risk populations
•
•
•
•
Precedent
Prevention
Promotion
Protection
Policy
• Previously helped fund
$110,000 to 100 LHAs
throughout Kenya
• Extensive Training; Low
Drop-out Rate
Shared
Principles
• Use budget to organize
health workshops in the
community; visit
households.
• Act as health facilitators
and advocates
Partnership
CPHA will fund the training of LHAs
while also providing them a budget for
health promotion events (i.e.
workshops)
41
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Focus should be on recruiting community leaders in Kenya’s
urban areas
WHO
WHERE
Hypertension and
obesity is more
prevalent in urban
areas
More respect and
resources
Has more
knowledge of
their community
health status &
needs
Able to develop
better
relationships
Recruit
local
community
leaders
LHA model is more
needed in urban areas
Note: Education level of LHAs does not matter:
study shows it makes no significant impact
42
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Health Ambassador Program will train LHAs to budget and
program health workshops
Provides and
teaches
basic health
services
Introduce
innovate
technologies
Acts as a
facilitators
Organize
health
workshops
43
Opportunity
SMS Med
Encourage
healthy
action plans
Health Ambassadors
Hearty Gardens
Impact
Health Ambassador Survey – Metrics
Measure awareness, comparing pre and post-event
awareness from likert scale
Measure effectiveness of event and how likely you’re going
to incorporate newly learned info into their daily regimen
Measure attendance of events, from those that were
marketed (at-risk population). This measures response rate
Assessment of health ambassador and their confidence and
respect for them. Perceived effectiveness?
How entertaining was the event; receptiveness
44
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Information on Training and Recruiting
The CHWs in the Krieger et al., Jafar et al. and Gary et al. interventions were
trained to counsel patients to adopt preventive care and adhere to the
treatment of hypertension
They were taught the risk factors for cardiovascular diseases and trained to
conduct blood pressure measurement
The CHWs recruited in these interventions were mostly locals from the
community
Having a personal experience of managing own illness or someone else in the
family resulted in producing highly significant results
45
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Information on Canadian Public Health Association and
Testimonial/Quotes
Community Health Workers in Kenya Stir Broad Changes
This article appeared in the January-March 1996 issue of One Country.
Active in more than 200 communities, a project to promote vaccinations has also helped to
build a new level of intersectoral and interfaith collaboration - collaboration that has paid
off by stimulating the construction of latrines and helping create better access to clean water
“The project is funded in part by the Canadian Public Health Association, which has provided
about $110,000 to the project over the last three years.”
Testimonial: "When I attended the first community health worker training, I did not know that I
would find my answer there," she said. "But since the training program, I've been able to help
my family, my neighbors, all the village and the surrounding villages to understand what is
primary health care and how easy they can improve their health. And I feel there is an
answer to my question, that we all can do something to improve our
health.
Dr Santau Migiro, Division of Child Health, Ministry of Public Health and Sanitation, disclosed
that currently, the doctor to patient ration is 1: 10,000. The WHO recommends 1:1000.
46
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Health Ambassador Program is not expensive
Adviser incentives
were reported to be
more on knowledge,
empowerment, and
public recognition
Not
expensive
Proven that when
communities take a
grassroots effort--public health
campaigns are more
effective
Focuses on how the info diffuses and who the sender is
47
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
More support on Health Ambassador Program
CVDs impose severe costs on
the health-care system but
there is not enough present
emphasis to combat this
Essential to move to programs in
that focus on risk factor
prevention and initiatives for
health promotion at every level
(individual, family, community
and national).
11
Opportunity
SMS Med
A Health Ambassador
Program does this:
Primary control and
prevention of CVD risk factors
helps strengthen, rather than
compete, with health-care
interventions for other
diseases
Health Ambassadors
Hearty Gardens
Impact
Capital costs (land, site development, Woolly Pockets) total
$4.0MM to build 640 “Hearty Gardens” over 4 years
Capital Cost Analysis for the 4-year “Hearty Garden” Construction Plan
Cost per Woolly Pocket Unit (USD)
$ 30.00 Source: woollypocket.com
Meters-sq per MicroGarden (sq-m)
30
Source:
http://www.a4architect.com/2011
/02/10/best-land-prices-aroundnairobi-kenya-price-kes-6000000.007 to-kes-700000-per-acre/
Acres per MicroGarden (acres)
Cost per Acre (USD)
$
Source:
http://grahamgjfencing.co.uk/GJF
300,000.00 ENCINGServices.aspx
Fencing Cost per Meter (labor included)
67.18
Perimeter per Garden (m)
22
Total Fencing Cost (USD)
$ 941,460.52
Total Land Cost (USD)
$ 1,337,700.00
Total Woolly Pocket Purchase Cost (USD)
$ 1,718,220.00
Total Capital Cost (USD)
49
Opportunity
$3,997,380.52
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Labor and material costs to build 640 “Hearty Gardens”
total $2.8MM over 4 years
Variable Cost Analysis for the 4-year “Hearty Garden” Construction Plan
Total Produce Servings demanded
Annual Produce Servings per Woolly unit
Units Required (demand/servings per unit)
Units per Hearty Garden
Total # of Hearty Garden Required
90
637
Kenya Minimum Wage per month (USD)
Average Workers per garden
Labor Cost per Month (USD)
Labor Cost per Year (USD)
Soil+Water Annual Cost per unit (USD)
Seed Annual Cost per unit (USD)
Material Cost per Year
Total Annual Variable Cost
50
Opportunity
5727388
100
57274
$100.89 Source: Bloomberg
2
$128,533.86
$1,542,406.32
$ 15.00
$ 7.00
$ 1,260,028.00
$ 2,802,434.32
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Capturing just 1% of Nairobi’s produce market at a reduced
price would yield an annual revenue of $3.2MM
Market Demand Analysis for “Hearty Gardens”
Nairobi population
Average Servings per person per
day
Days per year
3,138,295 Source: World Bank
0.5
365
Source: http://www.numbeo.com/cost-of-
Price per serving (USD)
$ 0.56 living/city_result.jsp?country=Kenya&city=Nairobi
Market Size (USD)
Market Share
$ 320,733,749.00
1%
Annual Revenue (USD)
51
Opportunity
$ 3,207,337.49
SMS Med
Health Ambassadors
Hearty Gardens
Impact
Four-year plan to build 640 “Hearty Gardens” would
require an investment of $6.5MM
Year-by-year Cost-Revenue Summary
Year 1
Year 2
Year 3
Year 4
Total
Number of Total Gardens
50
120
360
637
Number of New Gardens
50
70
240
277
637
Revenue
$ 251,753.34 $
604,208.00 $
1,812,624.01 $
3,207,337.49
$ 5,875,922.84
Variable Cost
$ 219,971.30 $
527,931.11 $
1,583,793.34 $
2,802,434.32
$ 5,134,130.07
Capital Cost
$ 313,766.13 $
439,272.58 $
1,506,077.43 $
1,738,264.37
$ 3,997,380.52
Investment Required
$ 533,737.43 $
715,450.36 $
2,485,662.76 $
2,728,074.68
$ 6,462,925.23
This model assumes that revenue is realized for the following year
52
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact
After four-year development period of 640 “Hearty Gardens,” program will
be sustained on annual profit of $0.40MM
Summary Analysis of Annual Profit
After 4-year Capital Investment:
Annual Revenue (USD)
$
3,207,337.49
Annual Variable Costs (USD)
$
2,802,434.32
Profit per Year (USD)
$
53
Opportunity
SMS Med
404,903.17
Health Ambassadors
Hearty Gardens
Impact
“Hearty Garden” Design and Specifications
“Hearty Garden” Specifications
5m
6m
Lanes
6
Rows
3
Units per row
Units per Hearty
Garden
5
90
Example of choice of fencing
54
Opportunity
SMS Med
Health Ambassadors
Hearty Gardens
Impact