AHN Workshop Maputo, Mozambique 21 – 23 November 2008

1. AHN Workshop Maputo, Mozambique 21 – 23 November 2008 African Twinning Project A strategy for heart health in Africa

2. A programme with only one project– A great idea with little participation The Kenyan – Danish Twinning Project “The Nairobi Eastland’s Children’s Heart Education Project”

3. Here we have the “twins”

4. Facts about Kenya • Population: 31,5 mio • Mortality 2002 Heart disease 13.661 • Mortality 2002 Stroke14.843 • Mortality Rheumatic Heart Disease 360 • Smoking prevalence m:66,3% f: 27,3 % • Research number of publications on cardiovascular disease: 3 from 1991 – 2001 • Number of cardiologists 12 WHO: “The Atlas of Heart Disease and Stroke”

5. 2002: • e-mail from Paddy Murphy WHF requesting Heart Foundations to facilitate establishment of heart foundations in Africa • “The African Twinning Project” • DHF joined the project • Why: As a rather wealthy, big and well structured organisation we felt we had an obligation to offer our help to some of the poorest people in the world • After consultation with the Ministry of Foreign Affairs we decided to approach Kenya • Through Paddy Murphy we got in contact with Elizabeth Gatumia

7. We invited her to Copenhagen on our expenses • Agreed about the twinning, though non of us really knew what it was • DHF expected it to be about exchanging knowledge and experience • KHNF felt that primary need was funding

8. 2003 • Kenyan Heart National Foundation was established a legal national organisation • DHF started to receive requests for money • DHF realised little by little that twinning was impossible without funding • The most urgent was a sponsor • We found funding opportunities in DANIDA’s funding department for “Minor Projects”

10. 2004 • We asked KHNF for a draft of a concrete project • Project on prevention of rheumatic heart disease was presented at the African Heart Network meeting

11. 2005 • Meeting and study trip to Nairobi with the aim to make an application to the Minor Project Fond • Project focus: Prevention of Rheumatic Heart Disease

13. The project has received two grants: 1. 53.300 Euro for first project from 1 August 2005 - 31 July 2006 from DANIDA 17.300 Euro from DHF 2. 133.300 Euro for second project 1 February 2007 – 1 February 2009 from DANIDA 40.000 Euro from DHF

14. Project purpose: • That the population of Nairobi Eastlands has knowledge of RHD and seeks preventive treatment when getting the first symptoms • That KHNF become a strong and independent foundation/association who can work without financial support from Denmark

17. What did we do? • Training teachers in schools • Training pupils in schools

21. What did we do? • Training of staff in Nairobi Eastlands clinics

24. What did we do? • Training of staff in churches

26. What did we do? Organisational capasity building: • Memberships • Local committees

30. What did we do? • Events

34. What did we do: • Advocasy

35. We had no data. After 2 years intensive advocacy the District Health Information Record Office has integrated rheumatic heart disease in their data collection in Nairobi.

36. Nairobi City Council, City Education Department has integrated training prevention of RHD in Nairobi’s schools curriculum

37. Minister of Sanitarian Health and Prevention has declared her support and training RHD prevention is now a possible part of school curriculum though out Kenya

38. Results Highlights: • Local commitees 9 • Patients clubs 1 • Kenyan-Heart Clubs in schools 65 • Teachers has receives training in schools 65 • Talking walls 12 • Clinics have received education 108 • Seminars for church representatives, participants 54 • World Heart Day 2007 6000 • World Heart Day 2008 4500

39. We will receive an external evaluation commissioned and financed by DHF very soon. It is conducted by Dr. Bongani S.A. and Dr. Fred Bukachi, Kenya.

40. This was about the successes but what about the difficulties?

41. We have been very alone • We have learned the hard way • We still have to improve the sustainability aspect of the project • Lack of collaboration with Kenyan Society of Cardiology (Probably now in place) • Lack of data and statistics • Difficulties in understanding each other, cultural differences • Fundraising in Kenya • Governance • Making professional applications/understanding Logical Framework Approach

42. Suggestions: First: WHF – Heart Foundations/Associations in Africa (Twinning) • Define a framework for Twinning • Investigate funding opportunities by scrutinising development aid programmes in a number of countries and private foundations • Encourage more developed countries heart foundations to take part • Establish a supporting programme • Help to make applications • Help to tackle problems during the project • Exchange of experiences

43. Second: Button up advocacy • Investigate a number of developed countries aid programmes to see to which extend they contains support to combat NCD’s in developing world, and if not • Create an advocacy programme where national heart foundations/associations and cardiac societies advocate for NCD in development programmes for health • We will need to make internal marketing in order to have support from other foundations/associations and cardiac societies • Liaise with other NGO’s

44. From Norwegian Heart and Lung Associations Annual Report

45. We can do it with CVD’s if we want to do it. Lets start now

46. Yesterday is gone. Tomorrow has not yet come. We have only today. Let us begin. Mother Theresa