1. health and fitness

SHIKURI PROJECT ANNUAL WORKPLAN 2015
Vision: The Shikuri Project envisions the establishment of sustained, Sickle-Cell diagnostic and treatment Centres serving communities with high
-prevalence and lack of access to national programmes in East Africa.
Mission: The Shikuri Project exists to introduce and implement sustainable, Chronic Health Care Management (CHCM) programmes to reduce
the number of deaths and painful crises suffered by young children with Sickle Cell Disease, in underserved communities in Kenya, and
eventually East Africa.
Overall Objective: Establish Pilot Programme, integrating and implementing 4 elements of WHO’s Strategy for Sickle Cell Disease in Africa
and Advocacy deliverable in underserved communities of Western Kenya and Coast Province regions
Responsible
Activities
Timeframe
Indicators
Shikuri
Project
employees
and
volunteers.
County
Community
Health Workers
and healthcare providers
in community
health centres
and hospitals
Means of
Verification
Resources
Objective 1: To advocate for routine early Identification and screening of newborns and improved care of cases of Sickle Cell
Disease/Sickle Cell Anaemia
Conduct an assessment of the
magnitude of CSD/SCA in
Nov 2014 –
March 2015
Nyanza and Western
Shikuri Team
CHMT
Study Team
Study report
available
Shikuri
$10,000
provinces This study is
intended to provide a rational
and evidence based
information for initial
population estimates to
inform recommendations on
the provision of care
continuum defined by level
from community to all referral
levels.
1.1.1 Identify study team
1.1.2 Finalise the study TOR
1.1.3 Conduct the study
1.1.4 Present study findings
and recommendations
1.2 Develop Project Budget
based on inception report
October 2014
October 2014
Nov. 2014 –
Feb 2015
End Feb 2015
X
X
X
X
X
Comment [GS1]: 1.1
Deliverables
1. A comprehensive literature review of SCD/SCA
in Kenya with focus on Western Kenya
2. Estimation of children with SCD in Western
Kenya extrapolating the numbers for Homabay and
Kakamega Counties
3. Recommend appropriate systems to enable early
recognition, diagnosis and treatment continuum of
sickle cell disease and as to close to communities as
possible with reference to findings on health
facilities at tiers 1?2-5 in Goal 2 above.
4. Outline current best care practices for SCD in
communities, schools and health facilities
5. Generate a data base on:
i.No of centres by comparative capacities and
capabilities in diagnosis and treatment of SCD
ii.Estimated no of patients with SCD
iii.Estimates of typical syndromic presentations
(crises) and comorbidities with:
a.Malaria and/or
b.Pneumonia and/or
c.Malnutrition and/or
Other
1.3 Prepare advocacy
materials/messages
1.4 Sensitise/orient County
Health Management
Teams and Leadership
March 2015
1.5 Conduct community
awareness in targeted
counties.
March – June
2015
Onsite
Project team
March 2015
MOU or joint
workplan
signed with
County /sub
county public
health
officials and
Shikuri
Project
1.6 Advocate for inclusion
of SCD interventions in in
County and Sub County
District workplans for 20162017 planning cycle
?
Project
Coordinator
/team
District
workplan
which
incorporates
SCD for 2016
Objective 2: Improve care of existing cases of SCD/SCA at County Level
2.1 In two counties of Homa March – June
Bay and Kakamega, train
2015
health providers and
update their knowledge and
skills on SCD/SCA (initial
X
focus on two sub-counties
in each county)
2.2 As part of 2.1, prepare
and distribute learning and
caregiver/parental
education materials to
health workers on SCD/SCA
2.3 Provide free and/or
affordable medicines and
essential supplies to
targeted health facilities
including: Penicillin
prophylactics; Folic Acid;
Pain medication; Hydration
(ORS/ORT); Hydroxy Urea
(to limit mortality and risk
of strokes from low HGB);
Antibiotics; Anti-Malarials;
Thermometers
Feb – June
2015
Xxx
X
JuneDecember
2015
X
2.4 Improve supportive
supervision to targeted subcounties and health
facilities
2.5 Monitor stock-outs of
supplies and commodities
in targeted sub-counties
and health facilities
March –
December
2015
X
March –
December
2015
X
2.6 Introduce/pilot
screening test for SCD and
point of care test for
June – Dec
2015
X
This may
include
collaboration
anaemia. This may include
with
collaboration with USA/NIH
USA/NIHObjective 3: Improve community level awareness, syndromic diagnosis or screening of SCD and care/referral of cases.
3.1 Prepare learning
materials for community
health workers on SCD/SCA.
3.2 Print and distribute
SCD/SCA CHW learning
materials.
3.3 Identify/develop
appropriate screening
package for use at level 1
(community), 2 and 3
3.4 Identify target
Communities (est 1,000
under 18 patients) for
piloting community level
sickle cell disease activities
in 4 sub counties ( 2 each in
Kakamega, 2 Homa Bay)
Identifying partner
clinics/hospitals
March – June
2015
X
June 2015
X
March 2015
June – Dec
2015
3.5 Develop and
March – Dec
disseminate communication 2015
messages for public
education and awareness
X
X
X
X
X
3.6 Training/orient CHWs in
X
the care (home care, early
referral) of SCD/SCA.
Objective 4: Support counties to undertake newborn screening as part of district health package at community (1), dispensary (2),
and Health Centre levels (3)
4.1 Share experiences from Feb – March
?
other countries
2015
4.2 Develop policy
June – Dec Shikuri Project
guidelines on newborn
2015
collaboratively with CHWs
screening within maternalnewborn care package
4.3 Adapt/develop newborn June Dec 2015 X
screening protocols
4.4. Develop operational
2016
Shikuri Project collaboratively
plan for screening newborn
with CHWs
screening in two sub
counties, with target of
1000 OR 500 (anyone with
family history, )
New Objective 6 : Infant diagnosis campaign conducted with Measles Vaccination Programme
2016
CHWs
4.6 Disbursement of family
X
stipends
Objective 5: Surveillance: (i) Establish Cohort to capture data on Reduced Mortality/ mortality rates to highlight efficacy of interventions;
capture the burden of disease due to Sickle Cell Anaemia (SCA). (ii) capture estimates on typical syndromic presentations (crises) and
comorbidities with: Malaria and/or Pneumonia and/or Malnutrition and/or Other critical health variables
5.1 Elaborate computerized
X
data collection system in all
facilities we operate in
5.2 Train data entry and
analysis staff
X
5.3
Objective 6: Improved coordination of partners involved in care of SCD/SCA patients
6.1. Map out all partners
involved SCD/SCA in Kenya
and other East African
countries
6.2 Establish/strengthen
coordination of partners –
forming a stakeholders’
forum orassociation
6.3 Produce SCD newsletter
6.4 Hold Annual SCD
meetings
Nov-February
2015
X
June 2015
X
June 2015
Annually
X
X
SAMPLE MULTI-PARTNER PROJECT FRAMEWORK (to be added to Workplan)
Reducing Infant Mortality from Sickle Cell Disease in Homa Bay, Western Kenya
Programme Deliverable
Lead Partner
1. Systems established to provide sustainable, routine Early
Identification and Screening Of newborns for SCD.
(i)
Syndromic Diagnosis and referrals at community level
to district level
Shikuri Project
(Per our workplan we are to
(ii)
Neonatal screening of Shikuri project cohort at
hospital level (IEF) at MOI Univ/Teaching Hospital;
Homa Bay District Hospital, Webuye County Hospital
and
1.
Develop operational plan for screening newborn
screening in two sub counties, with target of
1000 (anyone with family history
2.
Conduct Infant diagnosis campaign in tandem
with Measles Vaccination Programme
AMPATH
2. SSA Surveillance System Initiated.
MOI Univ/Teaching Hospital
Study on SCA and prophylatic treatment in Homa Bay
-
Comment [m3]: Why append to measles
campaigns and not just stick to above proposal for
simplicity and sustainability?
Shikuri Project
Other
(i)
Comment [m2]: Retain this for children
attending antenatal clinics and health facilities as a
screening process for high risk. Suspect cases have
blood taken for IEF electrophoresis at Moi
Teaching.. Neonatal screening subsequently
instituted longitudinally in families with identified
cases
Comment [m4]: Yes. Establish firm partnership
since Ampath done as a research project rather than
long term service that Shikuri wishes to undertake.
Ampath would be a great joint researching/health
worker training partner. The infrastructure would
then be ideal for trying out of new innovations.
Including larger cohort on hydroxyurea with
outcome documentation besides TCD work and long
term side-effects/safety in children.
(ii)
Surveillance: (i) an estimate of mortality rates to
highlight the burden of disease due to Sickle Cell
Anaemia (SCA). (ii) Findings and estimates on
Shikuri Project
Comment [m5]: Correct. We will need elaborate
computerized data collection system in all facilities
we operate in with trained data entry and analysis
staff. Ampath may be willing to train the staff on
entry and analysis. We will also need good social
worker follow-up system to help monitor treatment
compliance and referral support.
We could consider registering needy clients on
National Social health insurance fund which is pretty
inexpensive and allows free hospital treatment. We
could explore how cost-sharing and sustainability
for annual premiums would happen.
Process documentation on the processes evolving as
we grow would form excellent scientific publications
in Health Services Research journals to share
experiences with others.
Duke University/ AMPATH
Comment [m6]: There is a global program on
Access to Free drugs for developing countries needy
that we could research more on. All free is not good
hence need to devise way of getting them to pay
minimal to value the service..free is taken for
granted, not valued and could be abused!
. Paper attached suggests blood counts alone would
be justifiable in service for all but maybe study
sample for more detailed tests on side-effects to
inform service as part of applied research.
typical syndromic presentations (crises) and
comorbidities with: Malaria and/or Pneumonia
and/or Malnutrition and/or Other critical health
variables. (iii) additional research on the impact of
ongoing initiatives which have resulted in reductions in
infant mortality, including national malarial control
programmes, Haemophilus influenzae type b; free
access to insecticide-treated bed nets for children and
pregnant women (to which major declines in malaria
incidence have been attributed54) 10-valent conjugate
vaccine against Streptococcus pneumonia
3. Free and/or affordable or free medicines provided to
beneficiary group to prevent death, complications, reduce
morbidity and suffering.
(i)
Hydroxy Urea:
(ii)
Other meds/supplies:
See Shikuri Proj workplan
Govt of Kenya
4. Chronic SCD health care management provided and
integrated into local and community health- care system .
MOI Univ/Teaching Hospital
(i)
Health worker training:
Shikuri Project
See Shikuri Proj workplan
Comment [m7]: Role of paludrine, and folate in
malaria prophylaxis not well studied and we could
get important information. Papers on possible
benefit of relative iron deficiency also interesting
and could be studied.
Comment [m8]: delete
Comment [m9]: This section in my view should
be devoted to Health Worker Training.
Shikuri Project
(II)
Other elements: to build and/or enhance the See Shikuri Proj workplan
capacity of community practitioners, comprehensive
treatment (mobile?) centers accessible to the target
populations, and interventions adaptable to the local needs
of communities. The comprehensive treatment centers will
provide: comprehensive (including emergency care);
provision of medications, including anti-malarials,
hydration; administration of specific vaccines; continuous
medical follow-up; early detection and management of
complications including fevers; patient referral to highercare centres when necessary;
and - of paramount
importance - parent/ care giver and patient education and
counselling in the foregoing. This output will also create or
enhance the capacity of a cadre of community Health
practitioners with training in SCD control including
prevention, diagnosis and management of cases.
(ii)
5. Increased awareness and knowledge of SCD as well as
 Shikuri Project
visibility on the public health agenda by community and
 KSCF
national stakeholders (e.g., Community Health Committees in
 Others
target counties)
Comment [m10]: Work with Media and County
governments as primary partners – religious leaders
etc to educate and promote referals.