Tackling healthcare challenges through digital innovations

It is business as usual at the Comprehensive Care Centre (CCC) at Kenyatta National Hospital in Nairobi. Patients move in and out of different rooms as medical specialists address various concerns.

Along the corridors one encounters Kenyans from all walks of life: mothers with children on their backs, women fumbling with their phones, men carrying backpacks and the elderly reading the day’s paper as they wait to be served.

From a distance this seems like a normal public hospital ward in Kenya. However, a keen eye reveals something extraordinary. Here — unlike most government health facilities — there are no long meandering queues, patients’ paper files and disillusioned faces.

Ms Mary Wambui, CCC’s Data Management Officer, attributes this change to the department’s transition from a manual approach to an electronic system of healthcare delivery. “We are now paperless in all our operations,” she says.

Consequently, CCC can now be termed as an e-clinic and patients who frequent the ward are already reaping the benefits.

Ms Mercy Atis was diagnosed with HIV in 2005 and has attended the clinic since then for treatment and other support services. She recalls the ‘‘dark years’’ when sometimes she would come early only to spend the whole day at the hospital since her file was nowhere to be found and had to be traced among millions of other files at KNH’s storage room.

As a casual labourer at a local salon, Ms Atis states that she would end up losing all the day’s earnings.

“But since 2012 things have change. Today I came in late, at around noon, but I am almost through. I just gave them my unique patient number and within no minute they had retrieved my medical record from the system,” says the 43-year-old.

Joys of e-health

The electronic system — dubbed IQ Care — is linked to all departments at CCC. Therefore, Ms Atis doesn’t need to carry documents as she moves from one section to another.

“By the time she goes to the laboratory or pharmacy, medical personnel there will already be aware of what her doctor recommended,” explains Linah Atieno, Deputy Strategic Information Advisor at Futures Group (the company which installed the CCC system).

Ms Atis is among the few patients in Kenya who have begun experiencing first-hand, the joys of e-health which the government now seeks to roll out in most public hospitals.

In the past, such platforms have existed mainly in private hospitals which are way out of the reach of most Kenyans. The World Health Organisation (WHO) defines e-health as the combined use of electronic communication and information technology, such as mobile phones and computers, in the health sector.

Mr Onesmus Kamau, the Head of E-Health and Systems Development Unit at the Ministry of Health, notes that Kenya’s e-health strategy comprises of five major pillars: Health Information Systems (HIS), Telemedicine, M-Health, E-learning and Information for Citizens.

Kenya attained a major e-health milestone in 2011 when it launched the District Health Information System (DHIS). This online platform, centrally managed by the Ministry of Health, allows hospitals across the country to log in and key in data regarding their operations such as the number of patients attended to, ailments addressed and drugs administered.

Mr Kamau says that the system has made reporting easier as hospitals no longer need to bring hard copies to the headquarters monthly as they previously did. Similarly, he notes, MOH is able to monitor health service delivery in different regions “by the touch of a button” and identify gaps that need to be addressed.

Away from the MOH, the government — through the support of the WHO — plans to develop a system that will facilitate the automation of operations in public hospitals.

The project is currently being piloted in selected hospitals in Machakos and Turkana counties and should be completed by the end of this year. “Afterwards, we would like to encourage counties to take up the system and make their hospital operations paperless,” notes Mr Kamau.

This initiative will give other Kenyans the opportunity to enjoy effective health care delivery services such as what Ms Atis gets at the CCC.

Another e-health technology that would greatly impact on healthcare is telemedicine. This concept refers to the remote diagnosis and treatment of patients by means of telecommunications technology. Through video conferencing facilities, lower cadre hospitals with insufficient medical personnel can get in touch with specialists from Kenya or abroad and talk to patients in real time, diagnose them and prescribe treatment.

This technology is also currently being piloted at KNH. According to Dr Felix Olale, the CEO of Excelsior Group which deals with health technologies, telemedicine will enable Kenyans to bridge its doctor-patient ratio gap which currently stands at one doctor for every 26,000 Kenyans based on government statistics.

Worse still, 80 per cent of the doctors are based in urban centres where they serve only 20 per cent of Kenya’s population. Rural communities will thus greatly benefit from these technologies which allow many elements of medical practise to be accomplished in spite of the patient and healthcare provider being far apart.

Patients like Atis will finally be able to enjoy quality healthcare whether in Nairobi or upcountry.

Telemedicine will be especially important for chronic ailments such as cancers which are increasingly rising yet the country has few oncologists that deal with the cases.

“It will allow us to attend to many patients without them having to come to the city,” states Dr Anselmy Opiyo, an oncologist at KNH.

Even though the availability of fast broadband internet in Kenya offers a great opportunity for such e-health platforms, Dr Olale notes that an IT infrastructure should be rolled out across the country to address the digital divide challenges.

Similarly, purchasing of telemedicine facilities will require a huge investment yet funds allocated to healthcare in Kenya still fall way below the sector’s requirements.

M-health, which refers to medical practice supported by mobile devices such as tablets and phones, is gaining popularity in Kenya. Statistics by the Communications Authority of Kenya (CAK) show that close to 80 per cent of Kenyans are now using mobile phones. This massive reach makes it a powerful health tool in many perspectives.

For instance, previous studies have shown that sending text message reminders to patients increases their chances of taking tuberculosis and HIV/Aids drugs.

Linda Jamii

Safaricom, Britam and Changamka also recently launched a medical insurance product called Linda Jamii (Kiswahili for “protect the family”) which allows their clients to make monthly subscription instalments for the cover through mobile phones.

Mobile phones have also enabled doctors to check on their patients and consult other medical experts when the need arises.

“Whenever I miss my appointment, someone from the clinic will call to check on me and see if I need anything. This makes me feel good as it shows they really care about my wellbeing,” says Atis.

She adds: “Doctors also encourage us to call them whenever we feel unwell.”

In terms of human resource development, an e-learning programme established by AMREF in 2005 has been training nurses and enabling them to transit from certificate to diploma level.

Since it is an online classroom, it allows nurses across the country to learn from whichever location they deem convenient. Consequently, the programme is greatly contributing to an increase in the number of skilled human resource workers in public health facilities.

Mr Kamau notes that an increase in the number of internet users — through phones or computers — has made health information readily available to the public. “People can now learn a lot from our websites or other similar sources worldwide,” he says.

The MOH established the Master Facility List (MFL) which enables interested parties to search online for all health facilities found in the country. Despite these ‘‘early day’’ benefits, the full potential of e-health technologies is yet to be fully harnessed in Kenya.

Some of the challenges facing the sector, notes Mr Kamau, include low awareness and appreciation of e-health technologies by the public.

In addition, lack of an enabling infrastructure such as electricity and internet services in all areas, notes Dr Olale, also stifles uptake and innovation of e-health technologies. Similarly, there is insufficient information on different e-health technologies existing in the country.

To address this challenge, the government is currently working on the final touches of an e-health policy (to be ready by the end of 2014) which will provide a regulatory framework and streamline activities of all stakeholders working on e-health innovations.

Among other things, the policy seeks to make DHIS, a one stop shop for all e-health innovations and health information in the country.

“This will make it easy for us to track all e-health innovations and use them to improve health care in the country,” Mr Kamau states.
[email protected]