A DIGITAL ARTIFACT FOR mHEALTH - CHALLENGES AND

OPPORTUNITIES IN KENYA

Submitted by

PHILIP OMONDI

(KENYA)

For GSMA Capacity Building as a Digital Artifact in Partial Fulfillment of the

requirements for the certification of MSED (Mobile for Socio-Economic Development)

Course

Course Leader : Julia Burchell (GSMA)

Course Moderator: Andrea Guajardo(GSMA)

NOVEMBER- DECEMBER 2016

PROJECT TITLE

mHealth - Challenges and Opportunities in Kenya

1) Background Facts

2) mHealth Challenges

3) mHealth Opportunities

4) Case: An m-Health App (M-TIBA)

5) Reflections

6) References

1) Background Facts(GSMA MSED)

• The role of mobile in healthcare service delivery: Worldwide, healthcare providers being asked to deliver more for less.

• Different challenges for healthcare delivery: Mobile solutions to healthcare challenges in developing markets very different to those in developed markets.

Background Facts(GSMA MSED) • Shift towards decentralization : Healthcare shifting

from expensive, over-crowded and under-resourced hospital-based care to decentralized delivery model.

• The mHealth dilemma : Currently huge amount of fragmentation - 86% of services dependent on donor funding and unable to demonstrate measurable value to health decision makers.

1) Background Facts(Kenya Context)

• According to GSMA’s Digital Entrepreneurship in Kenya 2014 report, 99% of internet subscribers in Kenya access the internet through mobile devices. Kenya has been the leader in mobile money banking, with apps like M-PESA, Zoona and others.

• As part of the GSMA Mobile for Socio-Economic Development (MSED) online course, I explore the Challenges, opportunities and case study(App) example for mHealth in Kenya. According to research done by GSMA, the impact is still low. Action and partnerships are needed for this to improve.

2) m-Health Challenges(Kenya) (a) Many m-Health projects rely on the use of smartphones

Smartphones can be expensive and beyond the purchasing power of Kenyan government institutions and individuals. Most people continue to rely on low-end phones, which are cheap and widely available.

2.m-Health Challenges(Kenya) (b) Multiple m-Health interventions remaining at the pilot stage • Many m-Health interventions in Kenya not yet integrated into

larger health and information technology systems due to the absence of a clear scale-up strategy and a lack of consensus on common software and hardware requirements. Different projects use different handsets with different operating systems.

• Projects with regional and national management information systems (MIS) necessary, but m-Health projects often function autonomously. It’s important to integrate m-Health data streams with existing MIS platforms to prevent duplication and mixing of data.

3) m-Health Challenges(Kenya)

(c) Scarcity of a reliable power source

Electricity supply in Kenya is unreliable and regular electricity is mostly available only in semi-urban and urban areas. Since graphics-enabled smartphones are highly power-intensive, any m-Health project that relies on smartphones may face challenges if users struggle to keep their phones regularly charged.

3)m-Health Opportunities(Kenya) (a) Almost universal penetration of cell phones

Strong base for mHealth project implementation. Kenyans familiar with the use of mobile phones for functions other than just making and receiving calls. Mobile money app like M-PESA used by tens of millions. Many financial transactions e.g. paying for trainings and workshops, issuing stipends to Community Health Workers (CHWs) and transferring conditional cash transfers.This extensive use of M-PESA for the social sector is already (indirectly) helping improve mHealth outcomes.

3)m-Health Opportunities(Kenya) (b) Incentivizing end-users such as CHWs to buy the phones

A common mistake of many mHealth projects is to provide the cell phones for the project as “giveaways.”

This results in less accountability and lack of ownership among the phone users.

Asking CHWs to partially cover the cost of the phones or buy them is a good strategy to create ownership and accountability. This also has ramifications for scale-up and sustainability, as governments in low-resource countries may be unable to cover the entire cost of purchasing cell phones.

3)m-Health Opportunities(Kenya) (c) Work is underway to develop a plan to coordinate m-Health activities in Kenya

There are plans to align multiple platforms, hardware, and

software with a common national strategy and to ensure that data

collected from these activities are facilitated to feed into national

and regional MIS.

(d) Simple smartphone apps

Simpler smartphone apps demonstrated to assist frontline workers

such as CHWs in data collection and as job aids to assist in

household visits and group/individual counseling. In an

environment with challenges in literacy rates, financial and

network connectivity, we cannot simply develop and run any

iPhone or Android app. Sometimes, it would be important to

develop ways to access m-Health tools offline.

4) Case: An m-Health App (M-TIBA, a mobile health wallet)

13

• Unique and revolutionary concept that

improves access to and financing of healthcare

• Allows family members to pay into a virtual

wallet on people's mobile phones

• Contributions are exclusively earmarked for

healthcare expenditure

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CLINIC

SUPPLIER Condition: based on pay-per-use

Condition: only if medical data submitted

1: Preauthorization medical care 2: Treatment information 3: Equipment usage data 4: Reporting on allocated funds

1

2 3

4

Money

Data

The platform links payers, clinics and patients

Condition: only for specific purpose

PATIENT

Example: mobile health wallet for HIV/AIDS

15

Objective

Introduce an HIV/AIDS mobile wallet, in order

to change from supply-side to demand-side

financing for the HIV/AIDS “Sunshine” program

of Gertrude’s Children’s Hospital in Nairobi

1,715 Family wallets

2,637 Beneficiaries

(71% women, 839 children)

5,598 Visits

77% HIV-related visits

16

Example: Cash Advance Loans

Healthcare Provider M-TIBA/M-PESA

Account

Healthcare Provider

Patients/ Customers

• Loans to the smallest clinics and pharmacies in low income areas

• Connected to the mobile payment platform

• Credit appraisal based on historic mobile revenues

• Unsecured short term lending (USD 100 – 5,000)

• Automatic repayment via deduction from mobile revenues

(M-PESA and M-TIBA)

Allows MCF to efficiently reach smallest clinics with loans

Mobile revenue via M-PESA or M-TIBA

Automatic loan

disbursement via

mobile platform

unto bank or

M-PESA account Automatic deduction

of revenue, until loan

is repaid (max. 6 months)

Net revenue (after deduction)

available to provider

5) Reflections (GSMA MSED) • Current regulatory environment: Without a clearly defined,

enabling regulatory environment supported by strong proof points, health buyers (governments and third party providers) are unable to incorporate m-Health services into their budgets. Regulation needs to respond to regional challenges.

• Global initiatives and references: Healthcare policy reforms are a crucial enabler for the adoption of m-Health. Governments & industry already taking positive steps in this area and developing specific initiatives.

• Success requires value creation : Success of m-Health services, defined by long-term commercial sustainability, is dependent on creating shared value across mobile and health stakeholder ecosystems.

Though m-health impact is still low, it is hoped this digital artifact will spur action and partnerships needed to improve the current situation.

6) References

• http://www.gsmaentrepreneurshipkenya.com/

• https://www.gsmatraining.com/lessons/msed-session-8/

• http://www.cio.co.ke/

• http://allafrica.com/stories/201410140177.html

• https://www.techchange.org/online-courses/mhealth-mobile-phones-for-public-health/

• http://www.hsrc.ac.za/en

• https://www.techchange.org/2014/11/03/mhealth-challenges-opportunities-kenya-india/

• https://www.pharmaccess.org/update/m-tiba-is-truly-leapfrogging-healthcare-in-kenya/