AHI Year 1 Strategy Document

V1.4    31 5 2019 

The Affordable Health Initiative (AHI) is a newly formed organisation, with no funds or employees.

Our objective:

For the public benefit, to preserve and protect the health and to advance the education of people throughout the world in such ways as the trustees see fit.

Our Vision:

A world in which every child has access to the necessary tools to fulfil their potential and flourish.

Our values:

  • Accountability;

  • Ambition;

  • Humbleness;

  • Inclusiveness;

  • Integrity and

  • Respect.

Our goals:

  • Provide support for emotional, social and physical development

  • Provide structured support to access good healthcare and quality education. 

  •  Leave a better planet for future generations.

Theoretical framework:

AHI Health Promoting School (HPS) model is a comprehensive whole-school approach, which incorporates the principles of the Ottawa Charter and delivers a simple, scalable and sustainable operational model for the World Health Organisation’s (WHO) Health Promoting School (HPS) initiative. Affordable health Initiative is aligned to two major United Nations and World Health Organisation policies: "Transforming our World: the 2030 Agenda for Sustainable Development" and “Making Every School a Health Promoting School.” We aim to make a significant contribution to leave a better planet for future generations.

The AHI HPS theoretical model is based on the premise that health, education and income are strongly interconnected throughout the life course: In early life, healthier children achieve better results at school. Children with chronic diseases experience more school absenteeism and difficulty concentrating in class, which prejudices their school achievement. Later in life, educated people are more likely to understand their health needs, follow health instructions, advocate for themselves and their families, and communicate effectively with health providers. Furthermore, poor health and a low level of education are associated with lack of job opportunities. More educated workers tend to have a higher income, which has a major positive effect on health as a higher income enables a healthy lifestyle. By contrast, a lower income prevents an individual from adopting a healthy lifestyle. This is because families with higher incomes can afford to purchase healthy foods, they have time to exercise regularly and pay for quality health services. Conversely, low wages and lack of assets can make individuals and families vulnerable, particularly during long periods of economic austerity. This can lead to periods of poor nutrition, poor housing conditions and unmet health needs.

Furthermore, low income and fewer resources force people to live in socially deprived neighbourhoods. These areas are often marginalised economically and are associated with risk factors for health such as lack of safe drinking water; lack of sanitation; fewer high-quality schools; less access to sources of healthy food; an oversupply of fast food restaurants and outlets that promote unhealthy foods; higher levels of toxins, such as air and water pollution, hazardous waste, pesticides and industrial chemicals; and higher crime rates. In addition, socially deprived communities lack access to healthcare. It is the well-known ‘inverse care law’ proposed thirty years ago by Julian Tudor Hart; those who most need medical care are least likely to receive it. Conversely, those with least need of health care tend to use health services more and more effectively. This understanding of the combined long-term effects of education and health outcomes over the life course provides the foundation for the AHI HPS model school to community intervention. 

Our Current Standing (including SWOT analysis)

In 2018-19, the AHI has developed a simple, scalable and sustainable school based intervention, which is an integrated education, health promotion and healthcare programme that can be adopted by schools. The AHI HPS model is a rolling programme that consolidates and continues previously introduced health and educational practices, adding new school cohorts annually. AHI uses incremental approach by age, to avoid the high cost of attempting to include the whole school child population at once. It enrols school children aged 6-7 years in the programme and engaging them in the programme in subsequent years while adding the next cohort in subsequent years until all school children are enrolled in the programme. AHI HPS model involves parents as well as children in a number of activities, aiming to reach out to the community. The AHI HPS model includes five major components:

  • Life coaching

o   Resilience/Coping mechanism

o   Social behaviour

o   Social capital

o   Violence/radicalisation

  • Health coaching

o   Healthy diet

o   Basic hygiene practices

o   Physical activities

o   Tobacco consumption prevention/cessation

o   Alcohol abuse prevention/cessation

o   Drug use prevention/cessation

  • Health promoting activities

o   Basic hygiene practices

o   Healthy diet/Food distribution

o   Active commuting (“School bus walking”)

o   Classroom-based physical activities (Play/Games)

o   Gardening

o   Health detective game

  • Health care

o   Dental care

o   Medical care

o   Mental care

  • Community involvement

o   Health detective game

o   Evening role model talk

o   General knowledge quiz game night

o   Sport tournaments

o   Healthy food distribution

The AHI has also designed a multi-centre study to independently assess aspects of the implementation and the impact of the AHI HPS model on health and education of school children. Study centres will continually be recruited to provide a data on a large sample of schools from a number of countries and cultures. In 2019, the AHI enrolled with three different prestigious Universities in Brazil, who are independently assess the implementation and impact of the AHI HPS model in a mid-income country. This study will include initially seven schools and approximately 2,000 school children. The AHI will continue recruiting research centres across the globe, and further developing and revising our HPS model in order to keep improving cost effectiveness of the programme, as well as assure scalability and sustainability of the programme.

SWOT analysis

The below swot provides a high-level analysis of our current position.

STRENGTHS

  • There is a high demand for a cost-effective school health promotion programme;

  • There are world health leading expertise within the Trustees;

  • We have developed a simple, scalable and easily replicable health promoting school intervention, that schools can take on;

  • Evidence-based health promotion activities were adopted;

  • Potentially minimal central resource and cost is required;

  • Each individual school is independent and self-sustaining.

WEAKNESSES

  • The health promotion programme requires local coordination, local funds and buy in from schools;

  • If the health promotion programme is not implemented according to the AHI protocol, then they might not be effective;

  • The cost-effectiveness of the health promotion programme has not been stablished yet;

  • We may be going to be working in regions with potential political, social and geographic instability.

OPPORTUNITIES

  • To implement a simple, scalable and sustainable cost-effective health promotion programme, which is universal and aligned to two major United Nations and World Health Organisation policies: "Transforming our World: the 2030 Agenda for Sustainable Development" and “Making Every School a Health Promoting School.”

  • To bring in and disseminate epidemiological and public health expertise;

  • To create an opportunity for schools across the globe to share experiences

  • To further develop and improve the cost-effectiveness of the health promoting school programmes;

  • Potential for real time, dynamic improvement

THREATS

  • The expertise for the health promoting school programme is currently reliant on the founder;

  • Generate funds to implement and run the school intervention;

  • Communication, training and auditing is essential

  • Remote communications in multiple languages and across cultures will require local knowledge and support

  • Website based assessments and so access to the internet will be required at schools in each locality, but not to run the school intervention;

  • Potentially “crowded market” - especially in terms of fundraising

  • Potentially vulnerable to political changes, if dependent on government Health and Welfare resources and approval;

  • Geography and terrain need to be factored in for the ability and training of local coordinators

The Future Landscape (including a PESTLE analysis)

Overall, we expect that there is going to be more investment (time and money) and need for innovative, scalable, cost effective health promotion strategies, so that populations can take responsibility for and can improve their own health as well as their family and community.

Education and Health promotion programmes are likely to need to be more cost-effective and deliver simple evidence-based health promotion activities aiming to improve the overall health of low-income communities. It is likely that the demand for affordable health care initiatives will only increase in the future. School is an ideal setting for combining health and education, and schools are likely to have an increasing role in health promotion and care as advised by the World Health Organisation. Based on all of this, we conclude that there will be a high demand for the Affordable Health Initiative health promoting school intervention in the future.

As a newly formed organisation, we consider the future landscape and how this might affect the work of the Affordable Health Initiative, using a PESTLE analysis.

Political

  • Global austerity economic policies likely to lead to greater economic distress and reduced spending on education and health, leaving to charities to address the challenges;

  • Increased political interest in improving population health and reducing health inequalities between and within countries

  • Increased need of cost-effective health promotion strategies, in particular to address health challenges in low-income countries/communities    

  • From our initial assessment we anticipate greater political awareness and interest in identifying and implement cost-effective, alternative solutions and methods of protecting the health of the population, in particular children’s health care in low-income countries/communities.

Environment

  • Climate change and food insecurity are likely to lead to greater health challenges in low-income countries/community

  • Low-income countries/community are often marginalised economically and are associated with risk factors for health; lack of safe drinking water, lack of sanitation, less access to sources of healthy food; an oversupply of fast food restaurants and outlets that promote unhealthy diet.

Social

  • Culture and language are going to be different between countries. We have developed protocols for cultural adaptation and translations and validation of research instruments and the intervention to make sure the programme is accessible and scalable globally

Technology

  • Internet access and connectivity is likely to be a challenge in certain localities, but the intervention can be implemented and run without access to internet at school through data show;

  • Schools serving low-income communities may not have data show facilities, and AHI would have to provide the necessary equipment;

  • AHI website and e-learning material is easily accessible across different platforms and on different devices.

Legal

  • Data protection (GDPR) is becoming increasingly important and we will manage data flow with third parties. In addition to other measures, we have developed a code system and names, addresses or any information that can identify a school or a child is omitted and do not appear in any file. The key for codes and names is kept in a locked cabinet and only the local project director have access to it;

  • Staff and trustees must have the correct eligibility;

  • Legal differences in different counties will have to be accounted for.

Economic

  • Economic Downturn leading to counties being more innovative regarding the delivery of a cost-effective health care.

  • Improved economy in some countries, might lead to greater investment in areas such as education and Health and wellbeing.

Strategic Aims and Objectives for 2019/20

Trustee board and governance is in place and fit for purpose

  • Make sure that AHI is registered as a UK charitable organisation;

  • Recruitment of new trustees to provide expertise in key areas - finance, fundraising, public health, digital, marketing and legal;

  • Trustee recruitment to increase diversity and in line with AHI philosophy;

  • Governance policies are agreed, implemented and recorded;

  • All policies are in place for the successful and safe running of AHI mission;

  • There is a specific focus and attention on safeguarding;

  • Local committees will be constituted; trained and empowered to deliver AHI health promoting school model following the full registration of the AHI CIO

We have a scalable model, which can be easily adapted to local needs.

  • AHI offers a first in class evidence-based health promoting school intervention simple, scalable and sustainable;

  • The AHI HPS model is fit for the purpose and can be easily implemented within different schools and culture. An independent assessment of the programme demonstrated very good acceptability, adoption and appropriateness (domains of implementation research) of the school intervention by stakeholders;

  • Protocols to assess stakeholders behaviour towards implementing the AHI HPS model are 100% complete and available in our web page.

  • Protocols to drive the implementation of the AHI HPS model are 100% complete and available in our web page;

  • Protocols to assess the impact and evaluation of implementation processes are 100% complete and available in our web page;

  • Data collected is able to monitor the implementation process and drive improvement in the effectiveness of the AHI HPS model.

  • Data policy is in place and confidentiality is assured;

  • All AHI HPS model material is open source and available for all, although the global concept remains the intellectual property of AHI.

We are sustainable – both centrally and for local implementation

  • Clear and evidenced costs for implementation and running the AHI HPS model will be established in the on-going independent assessment. Our conservative estimation suggested its cost is low;

  • Data from implantation research studies is able to drive improvement to the cost-effectiveness of the programme;

  • Fundraising strategy is in place and have two tiers – AHI local committees will fundraise for themselves to afford to run the programme, any money raised locally will be invested locally. AHI will also fundraise to provide the support services and core costs incurred by AHI centrally.

    Note: while currently the AHI does not spend centrally, local committees may accept donations to fit the school to run the AHI HPS model. This includes construction of low-cost sinks, refurbishment of toilets and consumables. They may also employ a person to run the AHI HPS model in each school;

  • Financial systems and processes will be put in place to fundraise, report and facilitate spending, including auditing process, following the recruitment of a fundraising Trustee;

  • Reserves and spending policies will be in place to avoid political dependency and assure sustainability;

  • School programmes centrally funded will only be initiated after studies have demonstrated the programme is cost-effective and the financial resources have been secured to deliver it in full. The schools enrolled in the implementation studies are running the AHI HPS model through a partnership between the Department of Education, Department of Health and a Public University is assessing the implementation and impact in each locality.

We have a staff team and resource that is fit and able to deliver AHI’s mission. 

  • Recruitment strategy is in place and compliant with national employment policies and legislation either in the UK or oversee;

  • Employee handbook will be in place, including terms and conditions of employment, following the recruitment of a fundraising Trustee.