Afya Bora: An Approach to
Global Health Leadership
Aliza Monroe-Wise, MD, MSc
Carey Farquhar, MD, MPH
Overview
Afya Bora: The Concept, Participants,
Timeline, and Activities
Structure
3 week modules
Attachment sites
Mentorship
My experiences
Attachment site
Activities
GO Health
Project
Afya Bora: The Concept
4 US Academic Institutions partnered with
4 African Institutions
UW - University of Nairobi (Kenya)
UCSF - Makerere University (Uganda)
UPenn - University of Botswana
Johns Hopkins - Muhimbili University
(Tanzania)
Participants chosen from 85 applicants in
medicine, nursing, and public health
Afya Bora: The Participants
23 Fellows selected
7 Kenya, 4 Tanzania, 4 Uganda, 4
Botswana, 4 US
Multidisciplinary group
10 Medical post-graduates and postresidency physicians
13 Graduate nurses
9 with public health degrees (2 PhD; 6
MPH)
7 men and 16 women
Afya Bora: Timeline and
Activities
Attachment I
(~3 months)


2-day Orientation and
Responsible Conduct
of Research Training

Independent Projects at Attachment
Sites

1-day workshop for Mentoring Teams
within first 2 weeks

Weekly meetings with primary mentor

Semi-monthly meetings with Country
Lead and Fellows in-country

Monthly meetings with Mentoring Team

Project report due last day of rotation
Core Curriculum
3 one-week modules
January 7-28
January 31-April 28
Overview
Afya Bora: The Concept, Participants,
Timeline, and Activities
Structure
3 week modules
Attachment sites
Mentorship
My experiences
Attachment site
Activities
GO Health
Project
Module 1: Leadership Skills
 Leadership attributes
 Definitions of leadership
 Leaders vs. Managers
 Strategic thinking
 Thinking vs. Planning
 SWOT analysis
 Consensus building
 Modalities, steps
 Mentorship
 Mentoring vs. training vs. coaching
 The learning contract model
 Roles, benefits
Module 2: Implementation
Science & Health Systems
 Stakeholder and policy analysis
 Polio eradication case
 Measuring impact and effectiveness (surveillance,
metrics)
 Operations research
 Qualitative Health Systems Research
 Sex worker case
 Cost effectiveness and economic analysis
 Motor vehicle injury prevention case
 Social marketing
 Group Case Discussion
Module 3: Project Management
& Research Coordination
Federal and international ethics
regulations
Examples and cases from US, Kenya, etc
Budget and financial management
Case: how to develop a budget
Personnel management
Case: the SHARE project
Subject recruitment and retention
Data Management
Creating questionnaires and databases
Afya Bora: Timeline and
Activities
Attachment I
(~3 months)


2-day Orientation and
Responsible Conduct
of Research Training

Independent Projects at Attachment
Sites

1-day workshop for Mentoring Teams
within first 2 weeks

Weekly meetings with primary mentor

Semi-monthly meetings with Country
Lead and Fellows in-country

Monthly meetings with Mentoring Team

Project report due last day of rotation
Core Curriculum
3 one-week modules
January 7-28
January 31-April 28
Attachment Sites
Kenya: MoH, AMREF, Kenyatta
Hospital, Kenya Medical Research
Institute
Uganda: Joint Clinical Research
Center, MoH
Botswana: University of Botswana, iTECH, Botswana-USA CDC
Tanzania: Ben Williams HIV/AIDS
Found, AMREF,
Mentoring
1-day workshop for Mentoring Teams
within first 2 weeks, includes fellows
As needed meetings with Attachment Site
Mentor
Weekly meetings with Primary Mentor
Semi-monthly meetings with Country Lead
and Fellows in-country
Monthly meetings with Mentoring Team
Project report and evaluation due last day
of rotation
Overview
Afya Bora: The Concept, Participants,
Timeline, and Activities
Structure
3 week modules
Attachment sites
Mentorship
My experiences
Attachment site
Activities
GO Health
Project
Attachment Site: AMREF
Founded in 1950s by British Doctors
Emphasis on flights to remote areas
International organization with operations
in 29 African countries, as well as offices
in UK and USA
Vision: Better health for Africa
Strategic foci:
Community partnering for better health
Health systems and policy research
Capacity Building
AMREF: Kenya
HIV/AIDS integrative approach
Sanitation and basic services
Maternal and child health
Nursing clinical skills courses
Community health worker training
Work in remote rural areas, and
urban slums
Kibera
 Urban slum with ~2.5 million residents; 60% of
Nairobi population (gov’t estimate 170,000)
 ?Largest slum in Africa
 2 water pipes, 20% electricity, no sewage
AMREF: Kibera
Full care clinic in Kibera
Maternal health care
Pediatric clinic
Adult clinic
HIV testing/care
TB clinic
Laboratory
Social work
Pharmacy
AMREF: Kibera
HIV counseling and testing program
Over 3,800 HIV-positive patients have
enrolled to date
Almost 2000 on ARVs
823 defaulters identified (no return to
clinic in >90 days)
Tracking in progress
Activities
Evaluation of clinical practice by Clinical
Officers in the adult medicine clinic
HIV testing, counseling, group information
session, enrollment, follow-up
Evaluation of procedures in laboratory
HIV rapid tests, CD4 count, malaria blood
smears, stool O&P, UA
Evaluation of tracking activities performed
by the clinic Social Worker
HIV “social assessment,” tracking defaulters
Activities
Review of HIV/ART database
Large longitudinal database from all
HIV positive patients in the clinic
Preliminary literature review
Several studies published regarding HIV
positive cohort in Kibera slum
Attendance at meetings of ART
program staff and clinical providers
Project: Goals & Hopes
Afya Bora Fellowship
Learn GH leadership skills
Gain valuable GH experience with international
organization
AMREF Management
Data analysis of existing data
Journal publication
AMREF Kibera Employees
Improve working conditions in clinic
Serve as advocate & liaison with management
Personal Goals
Project Overview
Quantitative Data analysis
Evaluation of overall project retention
Timing between visits
Factors affecting time between visits
Value Stream Mapping
Steps taken in clinic visits
Value in individual steps analyzed
Time in Motion Analysis
Timing of steps taken in clinic
Preliminary Data Analysis
Overview of HIV Program Initiation
3848
4000
3500
3108
3000
3031
2361
2500
Individual
2000
Patients
1500
2025
1940
1117
1000
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Major Bottlenecks
Eligible
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Program
3848
HIV+
#Extra
If
Eliminated
3108
81%
CD4
Testing
3031
98%
270
2361
78%
320
Retention
>90 days
2025
86%
1940
96%
1117
58%
823
Time and Motion Analysis
One observer watches all patients
coming to the clinic
Records of wait times at each step
taken in clinic
Overall bottleneck steps can be
evaluated
Can be used in conjunction with
value stream mapping