Fellows

Andres Rubiano Escobar and Nancy Ann Carney are fostering a new consciousness and system for integral trauma care though MEDITECH Foundation. MEDITECH is a research and educational organization dedicated to developing improved trauma care systems in Colombia and Latin America. Trauma and injuries are the leading cause of death in the economically active population (12 years to 45 years) in Colombia and other Latin American Countries. Injury prevention and appropriate trauma and acute emergency care are required in order to decrease death and disability in these patients. MEDITECH educates at all levels—right from community first responders to advanced medical providers—and conducts clinical research and develops protocols of care for centers with varying levels of resources. The goal is to identify and disseminate the most effective treatments for trauma in low resource settings. MEDITECH will move to a new era of promoting development of systems of care, introducing leadership training for health care providers and developing sustainable business models for emergency care volunteer groups in rural communities. MEDITECH is creating a new context, moving ahead with health-related (education, research, technology) public and private partners to introduce new cost effective interventions, and developing successful pilot models that demonstrate a pathway to influence health policy in order to change the system. 

Armida Fernandez and Vanessa D’Souza reorient and reorganize the limited resources of India’s public health system through the Society for Nutrition, Education and Health Action (SNEHA). SNEHA is a secular, Mumbai-based non-profit organization working to improve the health of women and children in marginalized urban slum communities. SNEHA develops evidence-based models in partnership with public health systems and communities to improve maternal and child health. SNEHA works on a life cycle approach covering four main areas of public health: Maternal & Newborn Health, Child Health & Nutrition, Adolescent Health & Sexuality, Prevention of Violence against Women & Children. SNEHA’s aim is to break the inter-generational cycle of poor health and to give mothers and children opportunities to lead a healthy life. SNEHA seeks to change the health seeking behavior of vulnerable communities, while also empowering them through information on health services and their rights/ entitlements. SNEHA accomplishes this by mobilizing volunteers, forming action groups and building their capacity to address their own health needs. SNEHA also attempt to improve quality and accessibility of existing, inadequate public health services. They facilitate engagement between public health systems and communities. SNEHA is creating evidence based models of urban health intervention (that are currently not available) to inform policy on urban health. SNEHA is also in the process of scaling impact through partnerships with other NGO’s and the Government. 

Carlos Atencio is responding to the failing healthcare system in Venezuela by introducing a new model of care based on family practice medicine and centered on community participation and responsibility. Upon realising that 85 percent of ailments within communities can be addressed at the primary health care level, Carlos and his team set up local health centers to improve access and affordability of care. The FMF model is replicable in both the public and private sector. FMF is changing the landscape of health in Venezuela by reviving the role of the community or family doctor, who can care holistically for her patients within a community. Carlos believes that the siloed, specialised approach to health care not only increases costs for vulnerable patients, but also cannot provide the continnum of care that is based on wellness, and not sickness and disease. FMF is also shifting responsibility from only the health care providers to community members, who are trained in primary health measures and are better equipped to take care of themselves and their peers. Through these two front pillars, FMF is able to cut down the cost of care to almost 20 percent of private care, and also provide insurance at a lower cost for businesses and corporates. At the heart of the FMF model lies the ability to string together different stakeholders—doctors, nurses, community members, companies, public health systems—and create a role for each of them in the process of care. 

FMF seeks to replicate the successful model by developing and launching at new centers in the main Venezuelan cities. Their new Maternity Wards project seeks to develop strategy to decrease the maternal mortality rates in Venezuela. Fundación Medicina Familiar enables greater accessibility to prevention services for Venezuelan communities, with the goal of becoming the main health system in the country.  

More than 70 percent of people in Indonesia consider memory loss as a normal part of ageing, rather than understand it as a dementia symptom. Dementia is a neuro-degenerative disease affecting the brain, emotion, executive decision, thinking, behaviour and the ability to perform everyday tasks. Dementia affects 50 million people globally costing the US$ 1 Trillion in 2018, 23 million people with Dementia live in the Asia Pacific region, with 1.2 Million of whom in Indonesia. The figure is projected to reach 4 million in Indonesia with an estimated cost of US$ 2.2. billion (Alzheimer's Disease International Report, 2016).  To prevent people from Dementia Alzheimer and enable people to live well, Alzheimer Indonesia (ALZI) that was founded in 2013 with the purpose to improve quality life of PwD and caregivers in Indonesia, initiated a "Do Not Underestimate Memory Loss" campaign to raise awareness about the 10 warning signs of Alzheimer. The campaign and movement have increased visibility of dementia awareness and influenced the public - across generations. It has also influenced community based support groups to remain active and participate in the society to reduce risk, remain active and pursue a healthy lifestyle. The movement has influenced The Government of Indonesia to launch a Dementia National Plan in 2016, local government of Jakarta declared the city as a dementia and ageing friendly city in 2015 through an integrated support system of "purple troops" that are committed to provide information and solutions for families with PwD in the city and ALZI has become the go-to-source on all things related to dementia, the caregiver support group started in Jakarta has now grown to 12 cities in Indonesia. After the Globalizer process, the strategy and approach Alzheimer's Indonesia will take on is the establishment of a platform that will connect users to information, solution and a network of Care-Navigators. This approach will empower families and improved system diagnosis, care and treatment for PwD through an integrated Care-Navigation based approach. The platform aims to support users (families of PwD and caregivers) with holistic solution centred around  a Care-Navigator to best take care of their daily needs to live a healthy and good quality life. A Care-Navigator will identify what services are required, at the right place and the right time, thereby working as health care system integrator and coordinator for the individual, the family and the health system. Additionally, the Care-Navigator's role will work as part of the broader service system, looking to what other support is needed and available to support PwD and families (i.e. respite care, etc). The milestone: 1 million families will have access to Care-Navigators (via the platform-app) in 34 provinces in Indonesia by 2025. 

In one of Joost Van Engen’s early jobs, Manager of Sales and Marketing at IDA Foundation, where he distributed low-cost medicines and medical supplies to international organizations and governments, he found that bureaucratic processes caused a frustratingly low percentage of people to actually receive these medicines, and those who did often had declining health as they waited.

In response, Joost founded Healthy Entrepreneurs (HE), an organization which addresses these problems as well as providing an opportunity for local community health workers to run their own health-related small business in basic medicines and essential health products within their community. Each entrepreneur makes a $500 investment including a loan they will pay back over 5 to 12 months, thus encouraging responsibility, buy-in, and ownership. The organization also equips each Healthy Entrepreneur with a tablet through which they can share videos with customers on health and sexual education.

In 2017 and 2018, since participating in the AHA! Globalizer program, Healthy Entrepreneurs has increased their impact from 1,500 entrepreneurs serving 3 million people to 4,000 entrepreneurs serving 6 million. They are currently active in Uganda, Tanzania, Kenya, and Ghana. This scaling has been partly enabled by the support from the AHA! Program. Joost has a Champion, Annette Jung, head of Southern Europe and Africa for Philips Capital, who acts as a strategic sounding board, and Joost has also received support from the Philips’ Mergers & Acquisitions team to raise the investment needed to scale.

In 2019, Joost was selected as one of five AHA! Collaborative Action fellows, and the Philips Foundation has agreed to a joint project to test expanding the basket of goods that Healthy Entrepreneurs offer, to include diagnostic tests and telehealth connection with a remote physician, thereby enabling last mile communities to access a higher level of health prevention and advisory.

Marcos Lacayo is shifting Nicaraguans’ approach to their health from reactive to proactive. As of March, 2019, his organization, Estación Vital, has provided over 282,000 health evaluations to more than 64,000 users, only 20 percent of whom have health insurance. 

Marcos has found that, due to a lack of accessible health insurance and cultural traditions and habits, many Nicaraguans place a fairly low priority on their health, waiting to visit a doctor until their illnesses have progressed so far as to make treatment difficult – and sometimes impossible.  “With a lot of symptoms, people say, ‘It’s just a headache’. They don’t really think it could be something else,” said Marcos. 
 
Estación Vital creates a positive, preventative approach to health through kiosks in shopping malls that measure vital signs and weight, an alliance with Telefónica through which subscribers get daily text messages from physicians, and a mobile app.  With one kiosk currently in the Metrocentro mall in Managua, five more coming in malls throughout Nicaragua in the next year, and 40 to 50 kiosks planned to appear across Central America in the next five years, Estación Vital provides health education and prevention opportunities for the general public in a positive, upbeat environment.  Marcos also plans to offer low-cost health and life insurance and to add a membership program which will give access to many more health services, including appointments and home-care. 
 
Marcos remembers one woman who, prompted by concerning results from his kiosk, finally visited a doctor, after 10 years without seeing one, and discovered she had cancer. Luckily, it was still in early stages and could be treated.  “We created an alarm that forced this person to go to a physician and get examined,” said Marcos. 

Through Stroke Action Nigeria, Rita Melifonwu and  Tim Okolonji provide practical advice and support that enable stroke survivors and their caregivers to cope with life after a stroke.  Stroke prevention and self-management services are also offered to stroke survivors and at risk individuals such as people living with hypertension and diabetes. Currently, 200,000 Nigerians suffer a stroke each year. There is a dearth of stroke units in Nigeria, and, most of the stroke survivors are adults in their economically active life span who are disabled, unemployed and live in poverty as a result of having a stroke. Through an Ashoka Globalizer strategy, Stroke Action Nigeria will equip and empower these stroke survivors as Stroke Entrepreneurs who are able to improve their own wellbeing, advocate for policy change, and are incentivized to improve their livelihood through operating a Social Franchise outlet as an accessible, affordable and equitable Stroke Support Service Shop. The Stroke Entrepreneur franchisees, in collaboration with other health workers, will offer services that enable other stroke survivors to be healthy, regain function, and become re-integrated into their communities. Stroke Action Nigeria will achieve this through CARES Nigeria Limited, a Hybrid for-profit trading arm that will operate the Social Franchise, and, offer Logistics operation to manage the supply and distribution chain. Philanthropic finance and Social Impact investment will be secured to help with the service development. 

Every year, millions of people around the world suffer and die from conditions and diseases we know how to prevent, manage, and cure. Knowledge of effective interventions is growing, yet the ability to apply it broadly has not kept pace. Globally, almost four billion people could benefit from more widely shared best practices to address health and social concerns. Sanjeev Arora (represented today by colleague Oliver Bogler) and Project ECHO are changing the way knowledge flows. They use a collaborative education model where all teach and all learn, using guided practice, powered by technology and designed for measurement, that empowers health care providers to give better care to more people at the right place at the right time, often right where they live. Project ECHO does not care directly for patients. Instead, they dramatically increase capacity and access to best practice treatment in rural and underserved areas. Today, ECHO is being used by 200 centers in 29 countries to address over 65 diseases and conditions. Dozens of peer-reviewed studies have demonstrated the model’s strong positive impact on patients, providers, and entire populations and health systems. The ECHO Institute serves at the center of the ECHO community providing training and technical assistance to partners, replicating the model. ECHO Institute has the goal of touching 1 billion lives by 2025 and a strategy with four elements: 1) Pursuing growth focused on significant health concerns that are a strong fit with ECHO; 2) Achieving global scale; 3) Developing the ECHO Digital Platform; and 4) Improving the efficiency and effectiveness of the ECHO Institute.