Telemedicine a key cog in Kenya’s healthcare wheel

Kenya has adopted universal health coverage (UHC) as part of its Big Four policy agenda. It entails the ambitious goal of ensuring that every Kenyan has access to safe, effective, quality essential health care services, including affordable essential medicines and vaccines for all, without going into poverty.

The case for UHC is incontrovertible, with the right to health being a fundamental human right guaranteed in the Constitution, and critical to Vision 2030.

To achieve this ambitious goal, the government has spearheaded multiple important policy and administrative reforms and programmes aimed at improving access to healthcare.

These include the Linda Mama Programme that provides financial cover for maternal health services to pregnant women, and Edu Afya, a comprehensive health cover scheme under the National Hospital Insurance Fund (NHIF) aimed at making healthcare accessible to students.

The private sector has not been left behind, with the mushrooming of healthcare service providers, innovators, suppliers, and designers.

While the need for UHC is crystal clear, the pathway to achieving it is less certain. Despite considerable investment and planning at both national and county levels, health infrastructure and resources lag the health needs of the population.

In November 2021, the Kenya Master Health Facility List identified 13,517 public and private health facilities in Kenya, an insufficient number to serve the population of 50 million and growing.

As of 2019, Statista reports Kenya had only 12,090 registered medical doctors (a ratio of 25 doctors per 100,000 population), leaving us a long way to go from the World Health Organization’s recommended ratio of one doctor to 1,000 population.

Distribution of doctors

The distribution of these doctors is also inequitable — the Kenya National eHealth Strategy 2011 —2017 suggests 80 percent of clinicians serve only 20 percent of the population. The inequity in health care infrastructure and access between urban and rural Kenya is striking.

This is where the government’s prioritisation of and investment in the ICT sector may reap significant rewards for health. Kenya is a regional leader in terms of broadband connectivity, ICT infrastructure, value-added services, and mobile money or banking.

Quarterly data from the Communications Authority of Kenya shows active mobile SIM card subscriptions standing at 64.4 million as of June 2021, representing 132.2 percent market penetration. Internet subscriptions reached 46.7 million, 99 percent of which were mobile data subscriptions.

Millions of Kenyans use their phones multiple times daily to communicate, access financial services, work from home, shop online, study and socialise. Healthcare is one of the final frontiers that has been less accessible through the use of mobile phones and digital technologies to date, and that too has seen a shift since the onset of the Covid-19 pandemic in 2020.

The Kenya Medical Practitioners and Dentists Council (KMPDC) moved swiftly to respond to the restrictions imposed by the pandemic and ensure that patients still got quality service from their healthcare providers despite the prevailing circumstances by commencing the issuing of approvals for various registered and licensed health institutions to offer virtual medical services.

By February 2021, about 20 health facilities had received approvals from KMPDC to offer telemedicine services in the country, and this number has subsequently grown.

In the past few years in Kenya, we have seen guidance and direction on telemedicine and virtual medical services, including the National eHealth Policy 2016–2030, which requires that providers must offer eHealth solutions that are of good quality and guarantee confidentiality, privacy, security and integrity of health data; the Kenya Standards and Guidelines for mHealth Systems 2017, which guides the design, development and implementation of interoperable, scalable, sustainable mHealth solutions for improved health outcomes; the Data Protection Act, 2019 which also safeguards and ensures privacy of personal data; and the County eHealth Bill 2021 which, once passed, will provide mechanisms that promote and regulate interactions between eHealth service providers and clients.

The adoption of telemedicine will complement the other universal healthcare investments by enabling Kenyans from all locations to access quality, affordable and secure healthcare services.

This reflects a global trend. In July 2021, Mckinsey & Company reported that global telehealth utilisation has stabilised at levels 38 times higher than before the pandemic, with 40-60 percent of consumers expressing an interest in accessing a broader range of health solutions virtually.

Interestingly, the utilisation data analysed by McKinsey reflects “more than two-thirds of what we anticipated as visits that could be virtualised”, freeing up human resources, expertise, time, and finances for those who really need it.

It is important to note that telemedicine or virtual medical services alone will not solve the challenges faced by the Kenyan health system today. They are not, and should never be viewed as, a magic bullet. Rather, they are one critical piece of a strong and functional health system.

The Kenyan health system will always require physical clinics and hospitals. In many situations, patients will require or prefer face-to-face consultations and examinations. Most specialised and surgical services necessitate the patient and doctor to be physically proximate (although globally there are major technological advances in these spaces too).

Telemedicine — particularly for primary health care — sits in the gaps between these necessary in-person interactions, allowing patients to access high quality preventive, promotive, curative care, and mental and physical well-being support as and when they want it, wherever they are, and at a price they can afford that does not push them into debt, or below the poverty line.

Health system

Therefore, all health system players should appreciate the role telemedicine has in making healthcare more accessible, affordable, and patient-centred.

Let us build on the promise of telemedicine, not by simply digitising the same flawed and overcrowded systems that have held back our achievement of UHC, but by prioritising data integration, improving our interface with patients, and proactively engaging patients and other healthcare services such as pharmaceutical, laboratory, and radiology.

The promise of UHC in Kenya is within our reach. To achieve it, we must reimagine a seamlessly blended model of healthcare that places the rights, needs, and wants of the patient consistently at the centre of what we do.

Dr Karnad is the Chief Medical Officer, HealthX Africa