Kenya has emerged as a major global testing point for the use of mobile heath, or m-health, technology to advance public health and development goals—providing examples of both the ingenuity of locally-sourced solutions and the challenges that remain to providing wide access.
More than half of Kenya’s population owns mobile phones, with 18 million people already using applications such as M-Pesa for daily banking services. The country has faced a prolonged battle to tame its biggest killers—HIV/AIDS, tuberculosis and malaria. Combine this with a growing body of research that shows phones can be used to help individuals overcome logistical, cultural, awareness and economic barriers to access, and increase adherence to treatment—and also help medical professionals manage care—and Kenya found an opportunity to become a leader.
Washington-based group mHealth Alliance is tracking 45 active mobile health projects in Kenya—the largest number of any country. Most of these projects were created and funded by aid agencies or NGOs. The projects are varied with some, such as one that uses M-Pesa to deliver money for fistula repair surgeries, focused on direct patient services, and others focused on data collection, administrative and medical logistics.
Though some projects have made a substantial impact, “most are limited in scope and time frame,” and often, there is “no business model for sustaining them when the funding runs out, leaving the field suffering from a bad case of ‘pilotitis,’” says Patricia Mechael, Executive Director of mHealth Alliance. “The space is incredibly fragmented, unfortunately. You have a lot of bits and pieces coming from different angles and lots of pilots going on.”
Richard Lester, a Canadian infectious-disease specialist, studied potential ways in which health services could be greatly improved. Beginning in 2007, Lester noted “the ubiquity of mobile phones, and recognizing that the country has only one doctor for each 6,000 citizens, Lester and his team developed a communication link with HIV-positive patients at three health centers, asking them weekly by text message whether they needed any assistance with their antiretroviral drugs (ARVs).” During the clinical trial, there were 500 participants, and the “results, published in 2010, showed not only that a higher percentage of those receiving the reminders said they took their drugs regularly, but also that viral loads were suppressed in 57 percent of them, compared with only 48 percent of the control group.” Lester estimates that “today, expanding that system to all 410,000 Kenyans on ARVs would suppress HIV in 36,000 people, saving $17.4 million in health-care costs by averting the onset of AIDS or making more expensive drugs unnecessary.”
In 2009, when funding for Lester’s research ran out, $719,000 coming from U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), two of the three sites participating in the program were forced to stop providing the SMS messages. With a vast majority of the world’s 33 million people living with HIV located in sub-Saharan Africa, Lester’s groundbreaking work has reached only a small portion of those who could benefit from the service.
Lester, back at the University of British Columbia, seeks more grants to continue his research. “That is the unfortunate fate of the study,” he says. “It’s been very frustrating to go from research finding to programmatic funding. I think there is an ethical obligation, when you have a clinical trial with positive results, to do everything in our power to provide it as a service.”
With such a need for mobile healthcare, a pair of University of Nairobi graduates named Steve Mutinda Kyalo and Keziah Mumo launched Shima Technologies, and created the MedAfrica platform as a means to provide a technological solution to the country’s shortage of doctors and other medical personnel. The platform serves up “lists of doctors and dentists taken from government registries, plus menus for finding basic first-aid and diagnostic information.”
“What we want is for the common man to have the right information in his hand,” says Kyalo, the company’s CEO. “We can’t replace the doctors, can’t replace the hospitals, but we can improve access to relevant information.”
An important feature of MedAfrica is that the startup “illustrates the power of local entrepreneurship.” Even though MedAfrica has “few connections with the medical community or the health ministry, its health-care app has been downloaded on 43,000 phones, and the company is still only halfway through $100,000 in seed funding.” The service is accessible via app or through a mobile Web interface, and the company hopes to make MedAfrica “available through SMS—an essential feature, because 85 percent of Kenyan mobile-phone owners don’t yet have Web access.” The company’s CEO, Kyalo, “hopes to aggregate other medical apps on the platform and ultimately sell sponsored messages from pharmaceutical companies, health-care providers, and others.”
Recently, research project Academic Model for Providing Access to Healthcare (AMPATH) in western Kenya “began keeping track of 130,000 HIV-positive patients using electronic health records and automated reminders on Android phones.” Workers throughout the 55 clinics can now quickly assess what tests or drugs an individual patient may need.
Research shows that “the proportion of HIV-positive mothers passing the infection to their babies has dropped below 3 percent, compared with nearly 15 percent in other areas, probably because more of the pregnant women are receiving antiretroviral drugs consistently.”
“These reminder systems are an extremely important way to make sure all of the ts are crossed and better quality of care is provided,” says Paul Biondich, a research scientist at Indiana’s Regenstrief Institute, who helped develop OpenMRS, the open-source records system platform.
MedKenya, equivalent to WebMD, “puts a library of health information at the user’s fingertips and performs other helpful tasks like guiding the ill to hospitals.”
From banking to healthcare, disaster response to agriculture, the “smartphone is quickly morphing into an indispensable tool of the information age.”
Kenya’s Minister of Information and Communication, Dr. Bitange Ndemo, has expressed the Kenyan government’s views on cellular telephones as a development tool, saying, “In the beginning of the 21st century, the mobile telephone was the reserve of an elite few and the gadget’s sole purpose was to make phone calls and send text messages. Today, all this has changed and the mobile phone is no longer a luxury but a necessity. By morphing and adopting into various aspects of our lives, the mobile phone has gone beyond its original purpose of phone calls and text messages and it now serves as a bank, a computer, a radio, and a television set, among other things. In a nutshell, it has penetrated every aspect of our lives.”
After a successful two-day workshop on e-health in Nairobi April 2012, where approximately 200 people from over 15 countries participated, Kenya said it is “committed to implement the goals of vision 2030, which seek to improve the health outcomes and indicators of Kenyans by shifting focus from curative to preventive.”
“The mission is to promote and deliver efficient health services to Kenyans and consumers beyond our borders using ICT,” said Anyang’ Nyong’o, Kenya’s Medical Services minister. He added that “the main focus should be to strengthen and stimulate access to health care” and that “the country’s success depends on how ICT is applied.”
“The making of information communication through application of knowledge has developed into what is today referred to as Information Communication Technology,” Nyong’o said.
Kenya’s experiences with m-Health applications is an example of government, the private sector and a broad array of stakeholders united with common goals. While progress and results remain fragmented proponents in other countries can use them to jump start efforts in other parts of the world—taking what has worked and replicating it on a larger scale. The results could deeply impact healthcare well beyond the developing world.