Key Points in Kenya’s new e-Health Strategy

During the month of August 2011, one of the many developments in the national Health and ICT scene was the launch of Kenya's National e-Health Strategy 2011-2017. The vision of the strategy is “To develop efficient, accessible, equitable, secure and consumer friendly health care services enabled by ICT”. The strategy also outlines a mission to “promote and deliver efficient healthcare services to Kenyans and consumers beyond our borders, using ICT”.

Hon. Peter Anyang Ngong'o – Kenya's Minister for Medical Services officially launched the strategy on 11th August 2011.
Hon. Peter Anyang' Nyongo - Kenya's Minister for Medical Services

Calling for a paradigm shift

The newly launched strategy seeks to set in motion a process of compensating for the shortage of skilled health care professionals by harnessing ICT for improved healthcare delivery. It also aims to tap into the latent capacity of healthcare consumers to play an active role in the protection and management of their personal health. The strategy also leverages the imperative for the government to provide quality healthcare for all its citizens to build a nation with increased economic and social productivity.

These underlying themes constitute a requisite mindset to begin addressing the failures of the country's National Health Sector Strategic Plan - NHSSP I (1999 – 2004) and NHSSP II (2005 – 2010).

The Real Challenges

Challenges of the health care sector in Kenya are highlighted for attention in the strategy are
  • A shortage of healthcare professionals   
  • Emerging threats to public heath such as H1N1 ad H5N1 flu
  • Expectation of equality in service deliver among rural and urban populations
  • Silos of care resulting in duplication and difficulties for national health management     information systems
  • Inadequate health infrastructure and equipment
Strategic areas of intervention

To address the above challenges the strategy isolates five key areas of intervention forming a five pillar conceptual framework approach as follows:

  1. Telemedicine
  2. Health Information Systems
  3. Information for citizens
  4. mHealth
  5. eLearning
Although the document does not take time to elaborate specific roles and expectations for these pillars in the conceptual framework, the strategy acknowledges that the pillar will include technology service overlaps and that interventions might cut across pillars.

Implementation

Stakeholders involved in development of the strategy prioritised the Health Information Systems Pillar for implementation. Indeed this is a clever move because it targets to build on progress made by the Ministry of Health’s division of health information systems to access some low hanging fruits. Arguably it appears to be a politically clever move to focus the Division of eHealth and Continuous Professional Development (CPD) and the Division of Health Information systems on the same objectives.

The Health Information Systems pillar was further subdivided for implementation in the strategy into various functional domains as  follows :-
  • Patient Centric Information
  • Pharmacy and Medical Supply Chain Information System
  • Financial Information, including insurance and payments
  • Health Workforce Management and Training
  • Regulation

Curiously, this subdivision of functional domains seems to relegate health management information systems (HMIS) in which significant progress has been achieved with the ongoing national roll-out of DHIS2 (username and password available from HIS division).

One more notable inclusion in the strategy is a phase to design the Enterprise Architecture for e-Health Strategy implementation. Depending on how well this is done, persistent concerns among stakeholders such as effort replication, implementation silos and unproductive undercurrents on tools selection should be a thing of the past.

The strategy was developed by the Ministry of Medical services in conjunction with the Ministry of Public Health and Sanitation and with the support of the World Bank Country Office. There also seems to have been a fair attempt to make the strategy development participatory. This was championed by Dr. Esther Ogara, Head of the eHealth and CPD division. Listed contributors to the strategy included physicians, pharmacists, ICT experts, supply chain experts, economists and development workers.

Of Mobile Money Reliability and a Case for Multi-SIM phones



Mobile Money in Kenya, and East Africa in general has become part and parcel of everyday activities. Often times users of M-Pesa in Kenya are seen complaining about how their mobile money payments (or transfers) did not go through in good time to much their hurry. Sometimes users complain about a complete failure of their attempted transactions. One would think then, "if M-PESA is that unreliable, why not Use alternative mobile money transfer platforms?" The reality is that the alternatives - the likes of Airtel Money, Yucash, Orange Money and Mobikash may not always be better. For instance, the alternatives might imply one driving for a long while looking for an agent to deposit money for the transaction as their agent networks are largely under-developed.


Critical minutes of need

At a critical moment this evening, I run out of power in my house (still learning to match KPLC pre-payments and usage). So having got used to the convenience of recharging the pre-paid meter account using M-PESA, I reached out for my phone telling people around that I would get power back in just a few minutes. I went ahead and used M-PESA's pay bill option for some units of power (business number 888880). After twenty minutes in darkness and not  having received a recharge token, I began ranting about unreliable M-PESA and slow delivery of SMS messages by Safaricom.

Emergency funds on Airtel Money

In the moment of impatience and grit (in darkness of course), I remembered I had recently loaded my Airtel Money account with some emergency funds.  Emergency it was, so I checked my Airtel 
Sim card option and used Airtel Money’s relatively simpler pay-bill service to order some units of power for the same KPLC meter. After about 1 minute, interestingly, I got SMS notifications on both Airtel and Safaricom Sim cards of the requested recharge tokens.

Simplistic conclusion

I waited 21 minutes to receive prepaid KPLC power units from Safaricom’s M-Pesa and 1 minute to receive the same from Airtel Money. There is probably an easy conclusion on the relative speeds of these two mobile money platforms. Those with more scientific minds might however wish for more “sample readings” for the same experiment. Regardless of the ultimate conclusion for such a rigorous approach, it is obvious that the speed of transactions is not the only factor for the choice of a mobile money platform.

While M-PESA may have an impressive national spread of agents in Kenya, the service is often down for various reasons (including congestion).  Orange Money, Airtel Money and others may be feature rich and perform better on transaction speeds. They may even boast of better international agent networks. However their local agent networks often fail would-be customers miserably.

Indeed there are ideal situations for instance where one has easy access to Airtel’s customer care center for money top up and Pesanet ATMs for withdrawals. In that case one might not really feel the pinch of a poor agent network. That would be more so if all they do is use pay pill options for utility payments and other integrated remittances. In that case the receiving party as well is not directly affected by the agent network’s extensiveness.

Enjoy from all sides

With mobile number portability efforts having failed to fulfill much of their promise, people may wish to try a time tested approach - getting the best from all sides. By keeping multiple SIMs - active or inactive, one can subscribe to services from all mobile network operators and enjoy the benefits from all directions. They can then invoke the service from the most ideal mobile carrier in their immediate context. With my little KPLC pay bill experiment (or accident) above am thinking I shall continue keeping at least 2 mobile money services with some emergency money for such situations. When more people begin to get smart in this suggested way, then multi-SIM devices become a necessity. The argument can be extended with much ease for voice and data services where pricing and service quality can vary significant across mobile carriers, taking into account usage at different times and geographical spaces.

Of Samsung (Wyre’s) Duos and others

Incidentally Samsung seem to have discovered the promise of Dual SIM markets in emerging economies well before other manufacturers. Samsung dual sim phones are the only ones that have worked for me over time (4 years now). Of late I have been trying Samsung’s Duos (C3222?) and I think it is as convincing as its predecessors in handling dual SIM cards. Sadly no manufacturer yet has dual SIM smart phone yet (forget the Chinese counterfeits).

In summary, multi SIM mobile phones increasingly have a way of saving consumers from unhealthy emotional attachment to their mobile networks. Gladly I think I recently convinced a friend - @techweez  to take this trend seriously. It is perhaps by recognizing the need for such mobile phones that manufacturers might endear themselves better to the peculiar consumer market in East Africa.

Child Count for A growing mHealth scene in Kenya


As the pivot25 competition progresses,  I have been getting curious over the nature of applications coming up in the category for mHealth. I thought to myself that perhaps an analysis of locally existing albeit underutilised mHealth applications will help to manage my curiosity.

Useful perspective

For some reason a lot of my last 8 years was spent working on information systems to improve community based health services. It is a shame that I did not get myself interested enough in SMS based data collection platforms for health service delivery  until recently. Earlier in the year, while reading through @mberg's blog post I was even surprised by a prediction to see a lot less discussion about the differences in particular platforms (CommCare, ChildCount+, FrontlineSMS:Medic, Mwana, MoTeCH). I could be excused for my apparently slow uptake of these tools because the Kenyan Health IT scene to which I vainly contributed has over the years been mark-timing. The apparent stalling of Health IT in Kenya seems to be caused by a 7+ year old inconclusive debate of which tools are best for electronic medical records (EMR) systems.

First encounter

Great initiatives like ChildCount have a way of eventually popping up the stack despite being implemented with muted marketing effort. I first heard about ChildCount in one of the annual OpenMRS meetings. I was not only impressed that ChildCount seamlessly integrates with OpenMRS for its master database. The SMS based platform impressed me further with its easy application in Kenya’s remote areas empowering communities to improve child survival and maternal health.

How it works

ChildCount uses  uses SMS text messages to facilitate and coordinate the activities of community health care workers (CHWs). CHWs are community based health care providers. Any standard phone can be used by CHWs to register patients and report their health status to a central web dashboard for as long as there is a slight mobile carrier signal. The system supports messaging features for communication between members of the health service provision system alongside an automated alert system which all combine to reduce gaps in treatment for local communities. By providing a central web dashboard with information based on the processed SMS messages, ChildCount also provides a real-time view of health of in a community.

The new improved ChildCount+ works slightly differently from the initial deployment but the overall approach remains fundamentally the same.

A combination of noble efforts

The ChildCount platform is developed by the Earth Institute in collaboration with the UNICEF Innovation Team for the Millennium Villages Project. ChildCount is now free and open-source software available under the GPL License. It is build on yet another open source framework - RapidSMS. An important provision of phone handsets for CHWs to initially launch the service was facilitated by Sony Ericsson in early 2009. Airtel Kenya, then known as Zain also assisted in setting up a toll free number for the project . The project has also benefited from having in its team Matt Berg, as its Technology Director. Matt was in the 2010 list of Time’s top 100 influential people of the world

Deployments

Like many other open-source platforms, it is difficult to know how many installations of ChildCount exist across the globe. For sure though, after interacting with some good people at the millenium villages project like Maurice Baraza, I know that ChildCount is instrumental to their exemplary service delivery at their project in Sauri in Kenya’s Siaya County. At Sauri, the project covers over 65,000 people  with child and maternal health care services. They have also deployed the system at the Dertu millenium village project in Kenya’s Garissa County.

In the larger East Africa, ChildCount is deployed in at least one millennium village in Tanzania. In regional health informatics circles, word has it that the Rwanda government is considering a national deployment of ChildCount to support its community based health service delivery system. This does not come in as a surprise as the Rwanda government has recently been a regional leader in taking up ICT to improve its service delivery with more action than speak.

Less speak for more action

More information on ChildCount can be found on the project’s website. This pdf report might be useful for those wishing to dig deeper into the rationale behind the project and its initial success as a pilot. It should interest local mobile application developers and mHealth enthusiasts to consider building on ChildCount’s successes as they seek to further innovate mobile solutions in health services. RapidAndroid is definitely a natural platform to look at in keeping this innovation wheel spinning. We can only hope that pivot25, the Android Developer Challenge and other developer competitions will spur innovation in this direction. I shall leave readers with a video of the health care service delivery works going on at Sauri Millenium Village that I found useful

Nairobi's Tech Scene - Personal Highlights for Quarter 1 of 2011

My last article in this blog was posted in December 2010. That makes almost 5 months since I made a serious post.  It was by no means intentionally staying away from writing for this long. It was rather more of  'the spirit is willing but the flesh is weak'. To kick start blogging again I shall lazily try to recap the noteworthy developments I have observed in my small technology world during the first three months of 2011.


Mobile Monday with Pesapal - January 17
That was an inspiring moment especially listening to Agosta Liko of PesaPal. It was impressive to see a local technology startup begin to penetrate the corporate market place - with schools and banks. I still have not heard much from them regarding one of my wish list items though. They should think more through the possibilities for Kenyans paying monthly rent using PesaPal - their great payment information service. Liko's powerpoint presentation can be downloaded here.


OpenMRS meetup  - January 24
Despite the rainy morning, we had a great meetup with OpenMRS friends at the iHub that was ably organized by my friend @JWesonga. On the same day there was an opportunity to engage students at the university of Nairobi's School of Computing and Informatics which I had helped organise. It was lovely then to listen in to @ and @ as they sensitized the local computer science students who were mostly in second year on software development for good. 

Fireside Chat with Ken Oyolla - January 27th
I had this great opportunity to listen to Ken Oyola - Nokia's General Manager for East and Southern Africa during the iHub's monthly Fire Side chat. I had first met Oyolla when I was a form one in Mangu high school - he had 'cleared' from the great institution and was coming back as a mentor a year after. During the FireSide chat, it struck me how people do not change even after a decade or more of exposure to the world out there. Ken was still the same candidly inspiring strong personality. Am sure he will achieve another 'first one', beyond being the first African to hold such a high ranking position in Nokia.

Mid-Feb Transitional Period
Mid February was a transitional period for me as I left my fairly comfortable, no-real-pressure state corporation Job. It was time to take up a more challenging role with m:lab EAST AFRICA. The new role is really exciting and much worth the career shift as it fits magically into my ICT4D leadership aspirations. More so, it seems like the best opportunity to amplify my modest contribution to East Africa's knowledge economy.

Mobile Monday with Microsoft Guys - 21st February
In all honesty I do not have a history of being a fan of Microsoft's products. Having to say something about m:lab at the event, attending this Mobile Monday was mostly a duty call. I was impressed to see how Microsoft has been working hard to contribute towards positive social transformation across the world. They had a video of previous Imagine Cup winners from somewhere in Asia which was impressive. It was also my first event to hear about Craft Silicon's ELMA platform for rapid mobile application development of mobile banking solutions. The thought of having a mobile applications generator, for development without much coding sounded interesting - only I thought it will remove control and gratification from the local application developer.

It is a shame I missed February's Fire Side Chat with Larry Wall  (on 24th February). Larry Wall is the creator of the Pearl Programming Language for readers who would care to know.

iHub one year anniversary - 11th March
In the dying hours of the year 2010, I was reflecting and thinking to myself that inception of the iHub had been the greatest thing that had happened to Kenya's tech scene that year. I really wanted to blog my thoughts then but I realized I needed to avoid looking to oversell my hurriedly done late application for green membership. The thought passed by and in March I was happy to participate in iHub's first anniversary. Meeting the bigger iHub community was awesome although I had a rude culture shock of members murmuring away as ICT board's Paul Kukubo gave his speech. With me coming from a government background - it felt awkward. A parastatal CEO like Paul was meant to be revered and accorded maximum attention in public service circles - the murmurs felt radically different. Culture shock and assimilation aside, I look forward to a ground breaking year 2011 for the iHub community in terms of innovation and entrepreneurship.

Mobile Monday with Moses Kemibaro of Dealfish - 21st March
This event was a must attend for me - not because of any duty call but because @MosesKemibaro is one of the most respectable bloggers in Nairobi's tech scene for me. I needed to find out what he had been up to after rumor had it that he was no longer actively involved with his DotSavvy company.  Moses is Regional Manager for Dealfish. His presentation helped to demistify Dealfish - currently a constant fixture in Nairobis outdoor bill boards and online google ad-words for the Kenya context. With tweets like this :- "RT @ Dealfish are not sure how to monetize their service yet - they are not worried about this either ", the message was loud and clear that Moses' new venture had deep pockets behind it. Moses fell short of being forthright on the issue of when Dealfish would start making money. His update later that Dealfish would turn on its money making machine at its own chosen time was quite telling on how serious the South African firm was about the Kenyan online market place.

During this Mobile monday it was also enlightening to know of m-order, an upcoming service from Hilda Moraa and her troop who were students at the Strathmore university. Nairobi's chapter of Mobile Monday has some good pictures of the event in their website here

Fireside Chat with John Waibochi of Virtual City 24th March
The iHub did it again with its March fireside chat. Then it was John Waibochi, the CEO of Virtual City on the raised floor. Virtual City is the Kenyan company that won 2010's Nokia innovation challenge with $1 million prize money. Mr. Waibochi's story was intriguing and inspiring as well. With the entrepreneurial tips of 'riding the wave'  and exiting just before the wave's peak, Waibochi did well to motivate budding tech-entrepreneurs. His talk was much of a consolation also for me - to know that my corporate, MBAish background had a place in tech-entrepreneurship. It got me dusting down my  ERP, ISO 9000 and balanced scored card salesmanship cap with some rather unrealistic ambitions for my new career situation. Waibochi also offered tips on important global trends such as android and impact investment which he thought were more important than looking up to real life mentors.

Anticipation for Second Quarter of 2011
There were many developments and events I missed on in the first quarter of 2011. Indeed Nairobi has a thriving tech scene that no one person can keep track of all happenings. Watching the iHub's event calendar helps a bit though. In the months of April, May and June 2011, there are some important events I look forward to. One of them is iHub's Fireside chat for April which will have Mr. Joe Mucheru of Google Africa on the raised floor on 21st April. I also have much anticipation for this year's Pivot25 event that will see 25 mobile applications being showcased at Nairobi's Ole Sereni Hotel in June 2011.