Mobile clinics: How to improve access to health in remote areas? WHO Informal Technical Consultation BRAVE Geneva 6-7 November 2012 Dr Charles Senessie President AEMRN Myer Glickman Consultant Statistician

Afro-European Medical & Research Network (AEMRN) International NGO based in Berne, Switzerland Active members and groups in 10+ countries Promotes accessible, effective, evidence-based care for under-served populations in sub- Saharan Africa Emphasis on hands-on volunteer activities to deliver healthcare Inclusive approach collaborating with many other international and local NGOs

Mobile clinics - approach Annual programme in July-August Selected areas in several countries Kenya – Sierra Leone – Zambia – Uganda Group of international volunteers and local partners Liaison with local and international NGOs, government and healthcare providers Free medical clinics typically treat around 500 patients per day, provide medicines and refer to hospital Primary health care to populations with no regular access/unable to afford treatment Low resource settings – clinic/church/school premises, limited range of medicines, little or no diagnostic facilities

Mobile clinics 2012

Data collection from clinic records One AEMRN mobile clinic (out of three) in Kitale district, Kenya in July 2011 Clinical records were kept by hand on A5 plain paper Key data items were abstracted manually on site for later analysis: –sex, age, place of residence, weight, blood pressure, symptoms and diagnoses, medications prescribed, referral to hospital Data were collected for 307 patients out of an estimated 504 attending (61%) Catchment population mainly local area but not clearly defined

Clinic attendance by age and sex

Key points on demographics 65% of patients were female 53% were children <15 years 20% were aged 1-4 years Very few adult males 78% of patients (estimated) came in a family group – most often a mother and children Very rough estimate 14 per 1000 local population (nearest village) attended

Most common medical conditions

Respiratory diagnoses: percent of patients by age group

Antibiotics prescribed for RTIs: percent of diagnosed patients

Key points on medical conditions 13% of all conditions diagnosed were upper respiratory tract infections 12% were dermatitis of trunk or limbs, allergic or other 18% of patients had a potentially serious or life- threatening condition (definition available) 20% of children <5, 15% of 5-14 had URTI or suggestive symptoms Most patients do not have regular access to healthcare and conditions were often multiple and chronic Approx 80% of patients with RTIs treated with antibiotics, but NB multiple conditions

Final points Mobile clinics provide a rare opportunity to assess disease prevalence as well as treat under-served populations But need improved clinical records and good population denominator data Effectiveness of treating RTIs could be increased with rapid test facilities and antivirals Opportunistic clinic-based surveys could provide extra data on risk factors, population health Expansion into wider community surveys could greatly increase information available Thanks to local colleagues who helped with translation and data collection