Public-private partnership to rapidly strengthen and scale COVID-19 response in Western Kenya
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Abstract
INTRODUCTION
In Africa almost half of healthcare services are delivered through private sector providers. These are often underused in national public health responses. In line with our previous HIV experience and to support and accelerate the public sector’s COVID-19 response, we initiated a public-private project (PPP) in Kisumu County, Kenya. In this manuscript we demonstrate this PPP’s performance, using COVID-19 testing as an aggregator and with semi-real time digital monitoring tools for rapid scaling of COVID-19 response.
METHODS
COVID-19 diagnostic testing formed the basis for a PPP between KEMRI, Department of Health Kisumu County, PharmAccess Foundation, and local faith-based and private healthcare facilities: COVID-Dx. COVID-Dx was implemented from June 01, 2020, to March 31, 2021 in Kisumu County, Kenya. Trained laboratory technologists in participating healthcare facilities collected nasopharyngeal and oropharyngeal samples from patients meeting the Kenyan MoH COVID-19 case definition. Samples were rapidly transported by motorbike and tested using RT-PCR at the central reference laboratory in KEMRI. Healthcare workers in participating facilities collected patient clinical data using a digitized MoH COVID-19 Case Identification Form. We shared aggregated results from these data via (semi-) live dashboards with all relevant stakeholders through their mobile phones. Statistical analyses were performed using Stata 16 to inform project processes.
RESULTS
Nine private facilities participated in the project. A detailed patient trajectory was developed from case identification to result reporting, all steps supported by a semi-real time digital dashboard. A total of 4,324 PCR tests for SARS-CoV-2 (16%) were added to the public response, identifying 425 positives. Geo-mapped and time-tagged information on incident cases was depicted on Google maps dashboards and fed back to policymakers for informed rapid decision making. Preferential COVID-19 testing was performed on health workers at risk, with 1,009 tested (43% of all County health workforce).
CONCLUSION
We demonstrate feasibility of rapidly increasing the public health sector response to a COVID-19 epidemic outbreak in an African setting. Our PPP intervention in Kisumu, Kenya was based on a joint testing strategy and demonstrated that semi-real time digitalization of patient trajectories in the healthcare system can gain significant efficiencies, linking public and private healthcare efforts, increasing transparency, support better quality health services and informing policy makers to target interventions. This PPP has since scaled to 33 facilities in Kisumu and subsequently to 84 sites in 14 western Kenyan Counties.
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SciScore for 10.1101/2021.08.31.21262891: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Field Sample Permit: Research License was obtained from the National Commission for Science, Technology, and Innovation (NACOSTI) on July 6, 2020 (NACOSTI/P/20/5616). Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations of the study: There were also some data limitations during this project. Developing the …
SciScore for 10.1101/2021.08.31.21262891: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Field Sample Permit: Research License was obtained from the National Commission for Science, Technology, and Innovation (NACOSTI) on July 6, 2020 (NACOSTI/P/20/5616). Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations of the study: There were also some data limitations during this project. Developing the CommCare app was a continuous process, with constant improvements to adapt to the needs of the healthcare facilities, needs in sample tracking and transportation, and reporting needs from the laboratories. These changes sometimes affected how we presented the data in the final database. After extensive data cleaning, which was done manually regularly, the database issues were resolved in time for the final data analyses. Moreover, we tested patients according to the MoH national testing guidelines, meaning we were only allowed to test certain risk groups and symptomatic patients. Selective testing per MoH national guidelines was necessary in the absence of sufficient PCR tests available. However, the disadvantage of this was that the prevalence data we collected are not representative of the epidemiological situation in Kisumu County but somewhat biased toward positivity. Scalability of our project: While first focusing on building a good model for a PPP and assist with COVID-19 testing, we explored other opportunities to scale up testing. Early in the project, we found that large scale PCR testing had several limitations, such as high costs, requirement of trained staff, sophisticated equipment, and good logistics, which is often challenging in resource-poor settings. One of the constraints during COVID-Dx was the reporting of COVID-19 test results. We experienced delays, some...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a protocol registration statement.
Results from scite Reference Check: We found no unreliable references.
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