With a GDP of $55.2 billion, Kenya now has the 9th largest economy on the African continent, and continues to experience economic growth (projected to accelerate from 4.9% in 2013 to 5.7% in 2014. The country has great potential to be one of Africa’s success stories with a growing and youthful population, a dynamic private sector, a new constitution, and a pivotal role in East Africa. Perhaps most interestingly, Kenya is implementing an ambitious decentralization program which holds enormous promise to lift millions out of poverty. The program aims to increase equity in distribution of opportunities as well as improve service delivery by transferring resources and governance to the 47 counties across the country. As the World Bank Country Director for Kenya, Diarietou Gaye, states, “This is a special time in Kenya, especially as the government moves to decentralize more power and public services to local communities.”
While Kenya experiences economic growth, it continues to face a number of significant public health challenges: a high burden of communicable diseases, a woefully high maternal and infant mortality rate (360 women per 100,000 live births, and 48 children per 1,000 live births), and a critical shortage of physicians with just one doctor per 10,000 residents. Most physicians are clustered in Nairobi, a city of 3 million that represents only a tiny fraction of the country’s 44 million residents. According to 2012 estimates by the World Bank, approximately 62% of Kenya’s health care expenditures originate from the private sector, and of that spending, 76.9% are out of pocket payments, risking pushing the poor even further into poverty.
As a result, Kenya has become a vibrant testing ground for health innovations. Both the public and private sectors play an important role in health care delivery, and innovations in both sectors are proliferating to help address some of these challenges and work to expand access to quality care for more Kenyans.
By the Numbers
CHMI profiles 187 programs in Kenya – the second highest number of programs in any one country in the database and the most of any African nation. These programs are using a variety of approaches and business models to address a wide swath of health issues: improving quality and efficiency, lowering costs, and improving access to care for low income populations in Kenya. Of these programs, 150 rely on donor support, and 28 are funded by revenue, with 14 programs generating revenue through membership/subscription models and the other 14 through out of pocket payments. 157 of these programs target the poorest quintile of the Kenyan population.
According to the database, 126 programs use models that focus on enhancing processes to deliver higher quality care or deliver care more efficiently, and another 122 focus on educating and training consumers and providers to seek and deliver higher quality care.
In this week’s installment we will highlight the first of three emerging models from programs in Kenya:
Information Communication Technology (ICT) through mobile phones
Leveraging mobile phones is ahead of the curve in Kenya both because of an incredible high mobile penetration amongst Kenyans and because of a thriving technology sector. In 2010, NGOs such as Omidyar and Hivos launched iHub as Nairobi’s central tech hub. Today, the community hosts 14,805 members, 152 companies and employs 1128 people. Since then, technology giants such as Microsoft and IBM have set up shop in Kenya, and the MOH has even established an e-health department. The success of Mpesa, a mobile-phone based money transfer and micro-financing service, launched in 2007 by Vodafone for Safaricom and Vodacom, the largest mobile network operators in Kenya and Tanzania, has also provided an accessible platform that innovators can easily leverage to both offer value-added products as well as to streamline their own business operations. The popularity of Mpesa has served to educate consumers on mobile applications, ensuring uptake.
Given this backdrop, it is not surprising to see over a third of the CHMI-profiled programs in Kenya indicating that they using information communication technology (ICT) as a core part of their model, with mobile phones and computers cited as the most commonly used technologies. To dive a bit deeper, forty-eight are improving innovator’s ability to collect and analyze data, forty-one programs are leveraging ICT to improve communications between providers and patients outside of traditional doctor visits, and thirty-two programs are using ICT to improve a health provider's ability to diagnose and treat patients, either through improved training or real-time assistance with clinical decision making.
For example, the MedAfrica app acts as a doctor to the masses. MedAfrica was designed to fulfill a specific need- Kenya has a severe lack of qualified healthcare professionals, and a large number of fraudulent healthcare services, making it difficult for consumers to access and identity reputable, quality care. Capitalizing on the fact that 25 million Kenyans have phone subscriptions, this pocket clinic can help diagnose and monitor symptoms, advise on treatment, validate doctors, authenticate possible counterfeit drugs and, if all else fails, direct the patient to the nearest hospital.
Patients can use MedAfrica's step-by-step diagnostic tool to identify the potential cause of their illness and then, through the application, be linked to a specialist that matches their initial mobile diagnostic. MedAfrica is growing quickly, with an average of 1,000 downloads a day just months after its launch. The app has won the Pivot25 and Ericsson Awards, and was originally incubated in the mLab East Africa. Revenue sources include targeted ads and subscription services.
Mobile phones are central to many of the fifty-five programs addressing challenges in Maternal, Newborn and Child Health. Kenya Integrated Mobile MNCH Information Platform (KimMNCHip) is a national-scale mHealth initiative that strengthens Kenya’s community health system/referral services by linking households, community health workers, and health facilities in a real-time health information system. The program uses a push/pull targeted health messaging system to track pregnancies, births, and maternal deaths and provides reminders to mothers and household members for timely interventions.
KimMNCHip popularizes mSavings and eVouchers for pregnant women to redeem in collaborating clinics of their choice. The vouchers act as an incentive for clinics to enhance the quality of services and attract more pregnant women, through a results-based payment system. The voucher also includes a social protection cash transfer to support the women with the costs of delivery. Their goal is to have national scale up to reach 6-10 million mothers and 200,000 community health workers in 200 districts.
Changamka, leverages mobile phone networks and smart card technology to encourage clients to save for maternal and child care services. This integrated health financing program includes a health savings account, e-vouchers, and a micro-insurance scheme. The smart card technology allows users to deposit as little as USD 0.56 at a time to go toward medical bills, including hospital delivery, and there is no expiration date for the money added. An estimated 8,000 families are using the Smart Card, and since its introduction, hospitals reported a 30% increase in utilization of antenatal clinics and hospital delivery.
ICT and mobile phones are an essential component to many of the 152 programs reaching rural communities. These technologies can help facilitate remote diagnosis of rural patients, make health records at peripheral clinics available to central health providers, and allow providers and patients to access health education and awareness information.
Be sure to follow next week’s Database at a Glance: Kenya Part 2, as CHMI’s Komal Bazaz Smith explores Micro and Community based insurance schemes and public sector insurance innovations in Kenya.
Image: An advertisement for Changamka's M-kadi ya Family Health mobile savings card. © 2014 Changamka Micro-Insurance Limited