FELLOWSHIP IN CLINICAL NEPHROLOGY

Chronic Kidney Diseases are emerging as a major global health problem with heavy morbidity and mortality with its associated social and economic burden. They are the 12th cause of death and the 17th cause of disability, respectively with approximately 850,000 deaths every year (WHO report 2008)

The Eastern and Central Africa region is experiencing great need for the scientific base for knowledge and skills for the practice of urology and nephrology. The East and Africa states through the Africa Development Bank agreed to set up the East Africa Kidney Institute (EAKI) as a regional centre of excellence to address the need. The University of Nairobi/Kenyatta National Hospital will serve as the lead institutions and is mandated to build capacity in research, training, clinical and preventive services in urology and nephrology for both faculty and service providers. 

In Kenya, it is currently estimated that 10,000 people develop end stage renal disease out of which only 1,000 (10%) access medical care. Of these, only 250 undergo dialysis at Kenyatta National Hospital with approximately 50 receiving transplantation annually, thus approximately 200 people go to for transplantation outside the country. In line with the Constitution of Kenya, 2010 Article 43 (1) (a) there is therefore, an urgent need for an increase in capacity building at county level for service provision. This falls within the mandate of East Africa Kidney Institute.

In line with this mandate, EAKI has developed Fellowship courses to address skills gap for the healthcare providers (HCPs) at the county and Nation wide level.

Philosophy

Chronic kidney disease (CKD) is recognized as a world-wide public health problem with an increasing prevalence estimated to be about 10 - 12% in tropical African countries.  These statistics suggest that 4 million Kenyans have some form of kidney damage.  CKD is associated with premature mortality, decreased quality of life and increased health care expenditure. If kidney disease is detected early and managed appropriately, the deterioration in kidney function can be slowed or even stopped. There is evidence that early management of CKD patients by a nephrologist is associated with better clinical outcomes, with less morbidity and mortality.  It is thus vital, that training for nephrologists should be enhanced, to provide for the necessary and optimal care of individuals with CKD in this region.

Rationale

Facilities and human resource required for specialized care of CKD patients are still limited in the East African region. There are about 40 trained nephrologists inthe region, serving a population of about 145 million people. 31 of these nephrologists live in Kenya and are concentrated in major towns and cities.  The nephrologiststo population ratio is far below the WHO desirable of 1 per 200,000 population.

The Kenya Government has plans to provide specialized renal care services at all the 47 administrative counties in the country.  However it is becomingincreasingly difficult to get opportunities for ‘hands-on’ training in clinical nephrology, in developed countries for students from developing countries. 

Providing local opportunity for training, will address the urgent need for an increase in capacity building at county and regional level for renal service provision.  This is in line with  the Constitution of Kenya, 2010 Article 43 (1) (a), and in tandem with the Social Pillar (Pillar 2) of the Kenya Vision 2030 with the objective of improving the overall livelihood of Kenyans by providing an efficient and high quality healthcare system with the best of standards. This goal is also envisaged in Goal 3 of the United Nations Sustainable Development Goals (SDG).

The need to locally train renal care providers for Kenya and the East African region has been recognized. The University of Nairobi has established the East African Kidney Institute (EAKI) which is a centre of excellence funded by the Africa Development Bank (ADB). This is in conjunction with the Ministry of Health and is based at the College of Health Sciences University of Nairobi and the Kenyatta National Hospital. This centre will have capacity and facilities to train nephrologists and urologists for this region.

Goal

The Fellowship in Nephrology programme is intended to provide opportunity for eligible individuals to attain fundamental knowledge, procedural skills, practical skills, and professional and ethical behavior, essential for the practice of nephrology to the standard recognized internationally.

Objectives

The objectives of the program are to equip a student with:

1. Knowledge, clinical and practical skills and attitudes relevant to the practice of specialized clinical nephrology.
2. Knowledge and skills to support self-learning, training, performance of research, and scientific dissemination of findings.
3. Leadership and management skills.

 Expected learning outcomes

     By the end of the training programme, the student should be able to:

1. Provide specialized Clinical care in Nephrology.
2. Carry out independent research.
3. Carry out training and mentorship
4. Lead and manage renal care programmes.