BACKGROUND
In November of 2022, Inteleos hosted the Maternal Health Summit in Nairobi, in partnership with the Kenya Healthcare Federation, to improve maternal outcomes through the proficient use of obstetric point of care ultrasound (OPOCUS). In the last two years, the Inteleos team has worked in collaboration with the Kenyan Ministry of Health and many other key stakeholders on the ground in response to the momentum around enabling nurses and midwives to proficiently be able to conduct basic obstetric scans. A policy has now been developed and launched by the Ministry of Health which includes Point of Care Ultrasound certification of primary maternal clinicians. The national Kenyan healthcare system now must operationalize that policy, which includes the training of trainers, training and certification of clinicians in basic obstetric scanning.
STANDARDS, CERTIFICATION AND POLICY: NAIROBI 2024
Inteleos, represented by Dr. Luciana Young, President of the Board of Directors, Dale Cyr, CEO and Pamela Ruiz, Chief Business Development Officer, traveled to Nairobi, Kenya in November 2024 to host a Certification Roundtable, OPOCUS Certification Summit, and have meetings with key stakeholders in-country to begin the operationalization of that policy. The Inteleos team also included in-country representatives Faith Muigai and Cindy Robinson. Finally, additional Inteleos team member Joseph Williamson, RDMS, joined from South Africa to conduct a week-long training with RFH Healthcare clinicians, with sponsorship from device manufacturers U-Image and Mindray.
TUESDAY, NOVEMBER 12, 2024 CERTIFICATION ROUNDTABLE
Prior to the Summit, Inteleos hosted a focused Certification Roundtable. Key stakeholders from various organizations discussed the implementation of OPOCUS (Obstetric Point-of-Care brought together representatives from the Kenya Healthcare Ultrasound) in Kenya. The meeting Federation, Metropolitan Hospital, the Kenya Accreditation Service (KENAS), Kenya Obstetrical Gynaecological Society (KOGS), Kenya Association of Radiologists (KAR), Kenya Medical Association, Amref International University, Kenya Bureau of Standards (KEBS), USAID and ANSI.
The discussion centered on several critical aspects of OPOCUS certification implementation. The participants emphasized that OPOCUS should serve as a referral tool and not replace standard screening procedures. A key focus was placed on the importance of comprehensive training, particularly for consultants and higher-level clinicians, to maintain intact referral pathways. The group addressed concerns about artificial intelligence integration, highlighting the need for healthcare providers to receive proper training before using AI systems, especially since current AI systems lack local data training.
KENAS expressed interest in developing a certification scheme, while ensuring that scans and reports from certified healthcare providers would be accepted within the referral system. The environment was deemed ready for OPOCUS implementation and broader digitization efforts. The discussion also touched on financial aspects, including the transition from out-of-pocket payments to insurance coverage, though challenges remain regarding telemedicine reimbursement.
Quality assurance emerged as a central theme, with participants discussing the importance of maintaining proficiency and establishing proper training protocols for trainers (TOTs). The meeting also addressed concerns about scope of practice boundaries and the necessity of training physicians, medical officers, and interns in OPOCUS. Participants noted that while some resistance exists at higher levels, the goal remains improving patient care quality. The discussion concluded with considerations about priority counties and the need to incentivize primary caregivers.
Inteleos hosted an informal networking reception immediately following the roundtable.
The OPOCUS Certification Summit in Nairobi, Kenya, organized by USAID, the American National Standards Institute (ANSI) and Inteleos, focused on advancing the use of Obstetric Point of Care Ultrasound (OPOCUS) to improve maternal health outcomes in Kenya. Key stakeholders gathered to discuss the integration, implementation, and sustainability of OPOCUS, including establishing standards and certification for healthcare professionals.
SUMMIT DAY 1 (NOVEMBER 13): THE NEED FOR QUALITY STANDARDS AND CERTIFICATION
The Summit commenced with welcome remarks from Dr. Luciana Young and Faith Muigai of Inteleos. Dr. Young reflected on the progress made since the 2022 summit, including the completion of guidelines and policy around the scope of practice for nurses and midwives around OPOCUS and the requirements of standards and certification for clinicians. Both Daniel Vasquez and Leslie McDermott, representing USAID and ANSI respectively, also provided opening remarks focused on quality assurance and standards.
In the healthcare sector, USAID’s commitment to maternal and child healthcare reflects core U.S. values of promoting global human rights and well-being. This focus has demonstrated tangible economic benefits by reducing health burdens and building more resilient populations.
The American National Standards Institute (ANSI) serves as a crucial partner, coordinating U.S. standards and accreditation activities including healthcare product and service certification. Through the Standards Alliance Project, ANSI extends technical assistance and capacity-building support to partner countries, strengthening their quality infrastructure.
The morning featured a keynote address by Dr. Gregory Ganda, Kisumu County Minister for Health, who emphasized the importance of universal health coverage and discussed how maternal health outcomes in Kenya have remained stagnant despite improvements in newborn health. Universal health coverage in Kenya aims to ensure all citizens can access quality healthcare without experiencing financial strain. Despite improvements in newborn health outcomes, maternal health indicators in Kenya have remained largely unchanged.
Dr. Ganda went on to say that the healthcare system faces several Photo courtesy of Cara Productions interconnected challenges. People often seek advice from their community before pursuing medical care. When patients do seek care, they frequently bypass local facilities in favor of larger referral hospitals. Negative experiences at healthcare facilities spread through word-of-mouth in communities, discouraging others from seeking medical care. Another challenge exists in the form of a cyclical problem: citizens are hesitant to invest in health insurance due to perceived poor facility quality, yet facilities struggle to improve without adequate insurance revenue.
In Kisumu, significant strides have been made with 90% of the community enrolled in the Primary Care Network. This system collects comprehensive clinical data across the county, enabling efficient referrals through technology and allowing healthcare providers to deliver personalized care throughout patients’ lives. The healthcare system requires both professionalization and digitization, along with ensuring proper compensation for healthcare providers. These improvements are essential for breaking the cycle of inadequate healthcare delivery and building trust in the system.
Dr. Edward Serem from the Ministry of Health delivered the official opening, highlighting the significance of public-private partnerships and announcing plans for social health insurance programs. He announced that a new policy with accompanying guidelines had been implemented over the past nine months. A key initiative involves the launch of social health insurance programs designed to strengthen government funding mechanisms. Dr. Serem also expressed his desire for a presidential declaration to support these healthcare initiatives.
In a pre-recorded video presentation, Professor Anne Kihara, President of the International Federation of Gynaecology and Obstetrics (FIGO), presented background data on maternal and neonatal health, including alarming statistics showing that two-thirds of the world lacks access to ultrasound technology. She included global disruption data including climate, AI, and evolving health management systems. Dr. Kihara closed her talk quoting Steven Jeffes: “Innovation is the unrelenting drive to break the status quo and develop anew where few have dared to go.”
The OPOCUS in Africa: Why Skill Expansion is Possible and Necessary session was led by Dr. Micah Matiang’i of Amref International University (AMIU) and Dr. Janet Muriuki of IntraHealth and was moderated by Priscillah Ngunju AMIU. The session emphasized the importance of skill expansion in ultrasound training and highlighted several key aspects of implementing this technology in Kenya’s healthcare system.
AMIU has been conducting POCUS training for seven years, emphasizing skill expansion rather than mere task shifting. The program advocates for including OPOCUS training in current medical education to ensure job readiness. A phased approach to training is recommended, with a strong emphasis on hands-on competency development. OPOCUS has proven instrumental in bringing care closer to women and bridging healthcare inequities. The technology enables healthcare providers to make timely and informed decisions, ultimately optimizing quality of care.
The speakers noted that the implementation strategy centers on several key elements to strengthen healthcare delivery in Kenya. The approach prioritizes primary clinicians, with a special emphasis on midwives, while establishing well-defined scopes of practice for healthcare providers. The strategy promotes collaborative teamwork rather than competitive practices, alongside implementing standardized measures to ensure quality care. Healthcare leaders aim to develop a workforce that is both well-prepared and marketable to serve Kenya’s population effectively. The plan calls for making training more accessible through decentralization efforts. Additionally, the vision includes ensuring all providers achieve OPOCUS capabilities within clearly defined practice parameters. The presentation concluded with the powerful statement from Dr. Matiang’i that this initiative is irreversible: “The train has left the station, we are not going back.”
The Overview of OPOCUS Policy in Kenya discussion session featured Dr. Gladys Mwango of the Kenyan Association of Radiologists (KAR), Jevas Kevanya of the Society of Radiographers of Kenya (SORK), and Faith Muigai of Inteleos, who outlined ongoing policy developments for OPOCUS implementation in Kenya. A comprehensive policy initiative began in 2022, marked by collaborative efforts in its development process. The policy framework emphasizes the critical role of expert supervision during training phases and features highly detailed, prescriptive guidelines.
Standards have been established as fundamental components of the framework, with the Ministry of Health taking the lead in implementing standardized training protocols. Regarding certification specifically, the policy states that master trainers conducting the program must possess both OPOCUS certification and valid practice licenses from recognized regulatory bodies. The oversight framework places obligations on regulatory bodies and certifying institutions. These entities must monitor training compliance, manage master trainer re-certification, and ensure adherence to the standardized national curriculum in all training programs. While the guidelines have already been introduced, the complete policy is scheduled for launch in early 2025.
The afternoon session included Dr. Mercy Mwangangi, Senior Health Systems Strengthening Director at Amref Health Africa, who addressed the economic impact of maternal and fetal care transformation. She emphasized the importance of considering ethics, funding, and referral costs in healthcare delivery. She noted that 70% of Kenyans access healthcare in rural areas, highlighting the need for broader access to point-of-care ultrasound services. Dr. Mwangangi advocates for removing barriers to POCUS implementation by dropping the “O” to enable broader point-of- care access.
Dr. Mwangangi spoke of the need to address how devices, training, and certification can be affordably integrated into healthcare systems while ensuring healthcare providers maintain proficiency in POCUS. To achieve meaningful impact, Dr. Mwangangi stressed that patient outcomes must be achieved at scale. This requires close collaboration with regulatory bodies and the integration of POCUS training into university curricula to equip all graduating clinicians with these capabilities. She also highlights the importance of establishing proper reimbursement mechanisms through Universal Health Coverage for these essential services.
The first day of the Summit concluded with discussions on certification and standard-setting in ultrasound practices, featuring contributions from Dale Cyr, Leslie McDermott and Dr. John Aswani Inteleos, ANSI, and Kenya Medical and Training College, respectively. An independent validation of proficiency is imperative to maintain a standard of practice, and that standard must be rooted in local scopes of practice. The emphasis was placed on ensuring quality care through standardized training and certification processes.
SUMMIT DAY 2 (NOVEMBER 14): INTEGRATION, IMPLEMENTATION AND SUSTAINABILITY
The second day of the Summit opened with a warm welcome from Faith Muigai and key takeaways from a few of the attendees. It was noted that there is true goodwill among stakeholders and that now is the time to operationalize policy.
During the opening keynote panel, Dr. Njeri Gitau, representing the Presidential Unit from the Government of Kenya and Angela Nguku, Founder and Executive Director of White Ribbon Alliance, Kenya, emphasized the importance of resilient health systems and advocacy for quality maternal health services.
The state of healthcare access presents significant challenges, Photo courtesy of Cara Productions with 47% of the population lacking access to essential diagnostic services. This underscores the critical need for certification and quality assurance measures to improve healthcare delivery.
The White Ribbon Alliance conducted an extensive survey reaching 1.3 million women, revealing crucial insights into maternal healthcare needs. Women consistently expressed their desire for respect and dignity in healthcare settings, alongside basic necessities such as water, sanitation, and hygiene facilities. They also emphasized the need for adequate medicine and supplies.
Shared was a particularly alarming statistic that most maternal deaths occur in referral hospitals, where only 70% possess the necessary equipment. This highlights a critical gap in healthcare infrastructure and resource allocation. The survey highlighted the urgent need for increased numbers of competent healthcare workers, particularly midwives and nurses. Proper remuneration for healthcare workers emerged as an important factor in maintaining quality care. The initiative emphasizes the importance of having fully functioning, clean health facilities that are easily accessible to communities.
The “Ask, Listen, Act” methodology has been implemented as an effective feedback loop to improve healthcare services. This approach emphasizes the importance of bridging the gap between policymakers and healthcare providers. Finally, there is a growing emphasis on embracing technological solutions in healthcare delivery, with stakeholders questioning whether current technology adoption is sufficient.
The Tactical Implementation and Integration of Policy: Perspectives of Healthcare Providers on Obstetric Point of Care Ultrasound in Lower-Level Health Facilities in Kenya panel session included Dr. Grace Githemo from Kenyatta University, Sheila Masheti from GUSI and Heather Harmon Donahoe from Butterfly. The panelists presented their findings from a Gates- funded study that deployed 500 Butterfly ultrasound devices each in Kenya and South Africa. The program followed ISUOG practice guidelines for curriculum development, consisting of a comprehensive training structure that included two days of didactic learning followed by 2.5 days of practical training.
Patient word-of-mouth communication emerged as a significant driver for increased demand for ultrasound services. The study also showed the role of male involvement in the success of the program. A notable challenge identified during the implementation was the consistent access to essential supplies, particularly ultrasound gel and other disposable materials, which posed a barrier to service delivery.
A comprehensive discussion on the Structural Integration of Education, Certification and Maintenance of Proficiency took place, focusing on operationalizing Ministry of Health policies in Kenya. The session was moderated by Pamela Ruiz from Inteleos and featured key speakers including Dr. Lister Onsongo from the Nursing Council of Kenya, Michal Talam from the Kenya Accreditation Service (KENAS), Dr. Kireki Omwanwa from the Kenya Obstetrical the Kenya Medical Research Institute (KEMRI), Dr. Miriam Wagoro from the University of Nairobi, with additional content provided by Dr. Monica Oguttu of the Kenya Medical Education Trust (KMET).
The discussion emphasized the need to integrate curriculum into pre-service training and ensure guidelines reach all stakeholders. Professional societies were identified as critical participants in this process, along with the necessity to update scope of practice accordingly.
A successful implementation model from the Lake region, covering 14 counties, demonstrated several effective strategies, including: county-led initiatives driven by the Ministry of Health, facility-wide training approach after equipment procurement, development of inter-county referral pathways and implementation of affordable service fees.
The experts highlighted the importance of establishing comprehensive frameworks, including Train the Trainer (TOT) programs, to ensure sustainable implementation and maintenance of professional standards.
Dr. Mohamed Sheikh, a specialist in maternal and child health and the Director General for the National Council for Population and Development, stopped by to provide brief comments about his work and to provide overall support for OPOCUS policy and certification. While not a planned speaker, the Summit was honored that Dr. Sheikh was interested enough in the program and the continued discussion from the 2019 Maternal Summit to drop by and share his thoughts. The Financing and Commercial Sustainability of Education, Certification and Maintenance of Proficiency session was moderated by Ken Okongo of the Medical Credit Fund. He was joined by panelists Antony Mamati from Mindray, Solomon Mathenge from the International Finance Corps (IFC), and Anne-Marie Hosang-Archer representing U-Image, Kenya.
The conversation centered around the sustainable availability of POCUS devices, coupled with training and certification. The panelists offered insights into lending and financing options, as well as the bundling of services for the clinician and healthcare systems.
EVENT SUMMARY
The OPOCUS Certification Summit outlined a comprehensive strategy to enhance maternal healthcare in Kenya through the integration of OPOCUS (Obstetric Point of Care Ultrasound) services. The initiative primarily focuses on improving maternal health outcomes by expanding access to quality ultrasound services in primary care settings. Developing independent validation of proficiency through certification for primary maternal clinicians will operationalize the OPOCUS policy created by the Kenyan Ministry of Health.
The initiative has established partnerships across multiple sectors to ensure comprehensive implementation. The Ministry of Health provides essential government oversight. Professional associations contribute their expertise and support. Sustainability remains a central concern in the implementation process. The policy framework supports task expansion in healthcare delivery, maintains quality assurance mechanisms, and ensures regulatory compliance.
Looking toward the future, the Summit outlined several key directions. Strong partnerships between local stakeholders and international organizations will form the foundation of success. Sustainable financial models will support long-term OPOCUS implementation. Quality control mechanisms, including standardized training and certification, will maintain high standards of care. Clear policies will guide OPOCUS integration throughout Kenya’s healthcare system.
The comprehensive ecosystem being developed through these initiatives aims to sustainably integrate OPOCUS technology into Kenya’s healthcare framework. This integration will ultimately lead to improved maternal and fetal health outcomes across the country, creating lasting positive changes in healthcare delivery.
The Summit closed with Dr. Luciana Young (Inteleos), Daniel Vazquez (USAID) and Meredith Shaddix (ANSI) providing a summary of key takeaways and next steps, emphasizing the importance of continued collaboration among healthcare providers, policymakers, and international stakeholders.
PREPARING FOR 2025: NEXT STEPS
- Establish Inteleos Kenya local office
- Inteleos to get local accreditation to become a national certifier of OPOCUS
- Launch OPOCUS Certification
- Work in partnership with local stakeholders to design and implement training of trainer programs
- Integrate OPOCUS training into university curricula
- Develop sustainable financing models for equipment and training using existing national infrastructure and legislation
