Huge health benefits have been achieved through clinical trials in Kenya with the use of Mobile phones at a fraction of costs, according to recent article in MIT’s Technology Review on Kenya’s startup boom. According to the article, the main challenge lies in maintaining the low-cost benefits of these clinical trials, and transforming them into normal daily procedures for the long term.
Implementing and maintaining new mobile technology based projects in health care is a huge potential business opportunity. It will also sustain a healthier population in Kenya, which is currently experiencing a huge growth in the emerging middle class segment, along with other African countries.
World Bank Grant
Mobile phones are omnipresent in Kenya, and internet usage is for the most part done through mobile devices. Within the decade, internet access is predicted to be done primarily accessed through mobile phones, exceeding the use of laptops and computers. The World Bank recognizes that Kenya can become the internet hub of Africa, which is why it awarded a $55 million grant to enhance accountability through web-based applications which can transform the economy.
The money will finance Kenya developers to create simple solutions to daily health and education problems and seek new ways to enhance government accountability while raising the economy through online job creation.
A World Bank statement noted that after Ghana, Kenya has the second-fastest broadband on the continent. This led to a 90% reduction in overall internet capacity prices, and raised internet penetration was from three to 37 percent. Even today, mobile phones are widely used for health enhancement – and that does not yet include the use of the internet.
AIDS, HIV and mobile phones
Consider Zuhura Hussein, 38, cited in MIT’s Technology Review article. Hussein is a community health worker in Kibera, a 170,000 population slum area. It reeks of poor sanitation and is a breeding ground for HIV, tuberculosis and other infectious diseases. Ironically, Kibera lies just one block away from Nairobi’s most posh mega shopping center.
Hussein is a community health worker. She urges Kibera residents to get medical check-ups and vaccinations. Through her Nokia 6070 mobile phone, she can daily reach patients with HIV and tuberculosis to remind them that it is time for them to take their medication.
The idea of using mobile phones for better health service in Kenya started five years ago. Richard Lester, a Canadian infectious-disesase specialist, saw that mobile phones were plentiful in Kenya. He also saw that there was on average one doctor per 6,000 citizens.
Lester’s group collaborated with three health centers to link up with HIV positive patients. Every week, they texted patients to ask if they needed antiretroviral (ARV) drugs or medical assistance. The results of Lester’s trial (published in the MIT 2010 report) revealed a higher percentage of regular drug intake among those who received reminders versus those who did not. Also, 57% of those reminded experienced suppression of drug loads versus 48% in the control group.
Lester believes that if all 410,000 Kenyans on ARVs use this system, HIV can suppressed the viral load of some 36,000, incurring a $17.4 million savings in healthcare costs that would otherwise go to the need for more expensive drugs, because AIDS onset was not forestalled.
A second clinical trial, Academic Model for Providing Access to Healthcare (AMPATH) was a collaboration of Indiana University School of Medicine and Kenya’s Moi University. By using mobile phones AMPATH maintained the medical records of 130,000 HIV-positive patients. This allowed them to run automated reminders to patients through Android phones. Also, some 55 clinics now have quick and easy access to the patients’ records to determine the medicines and tests they need.
A third clinical trial, called OpenMRS. was operated by Paul Biondich, research scientist of Indiana’s Regenstrief Institute. Through text message reminders, the incidence of the passage of the HIV-positive infection from pregnant mothers to their babies fell below 3%, compared to 15% in other areas where the reminder system was not applied.
Beyond Aids A Long Way to Go
With appropriate apps, other trials showed successes in other areas. In a country with an average one doctor per 6,000 people, an app like MedAfrica made a huge difference. People now had links to doctors an dentists, and could access advice for first aid care. Currently some 43,000 phones have this app. If a doctor is inaccessible, they can always be linked to storefront clinics that can also dispense of medical advice by phone.
Even more distressing is the quick spread of infectious diseases not only of AIDS but tuberculosis and others. The government of Kenya needed to have a quick and efficient tracking system to be immediately informed of disease outbreaks so that they could respond immediately and in a way that responded to specific immediate needs.
A cost friendly and efficient solution was delivered by a 21-year-old senior IT student at Strathmore, Erick Njenga and three of his classmates. Upon the instructions of their professor, they developed a program by which thousands of health workers can report and track spreads of diseases in real time throubh mobile phones. The program developed by these students is pivotal to Kenya where the HIV rate is 10 times that of the US, and other leading killer diseases like malaria and tuberculosis can now be addressed and lives saved.
Even more amazing, Njenga and his classmates developed the program at a slice of what the government would have paid if it has pushed through with an initial plan to hire a multinational contractor from Netherlands, at a contract that totaled $1.9 million. The project did not proceed because it relied on only one type of phone. Under the far less expensive program developed by Njenga and his classmates, the same can be achieved with any type of mobile phone.
Just as well, because Njenga and his classmates achieved all of this in the spring of 2011 and only received internship pay of some $150 per month. Their app permits disease reports to come in from any mobile. It went into operation last summer, and is called the Integrated Disease Surveillance Response system. Currently, they are also working on an new app that will enable the health ministry to track pharmaceuticals distribution to government hospitals and clinics to prevent waste and shortages.
Room for Improvement
While the success of these clinical trials are impressive, there are downsides. First, the sheer size of the problems of Kenya and second, the lack of financial commitment to successful clinical trials which inhibit their continuance and propagation.
Sub-Saharan Africa has the highest incidence of HIV, and the greatest need. But programs such as those mentioned above end as soon as funding dries up. Only a fraction of those in need benefit from the trials. There is still so much more to do, in the short term and long term. Lester, who started the use of mobile phones for improved health service in Kenya, ran out of funds in 2009.
The challenge is continuance, and this has to be accomplished by people who are committed to this because they themselves are the beneficiaries of it. With the World Bank grant, it is hoped that the finances will be geared towards a long term maintenance direction.
The Startup Culture is strong in Kenya. A number of homegrown technology cultures have come up, such as iHub, which in December 2007 enabled Kenyans to give first hand reports of ethnic violence, including the presidential election violence that ensued that year. iHub is also used in other countries — South Africa, Russia, Haiti and the USA where it was used to map flood problems in the Missouri River.
Kenya’s first mass-market Android, Safari.com, went on sale in 2010 with up to 600,000 phones of various types on their network. They expect to corner 80 percent of the market within two years. Another example is Shimba Technologies, led by University of Nairobi graduates Steven Kyalo and Kezia Mumo. They created MedAfrica, the software that lists government doctors and dentists, and first-aid menus and diagnostic information.
Local entrepreneurship is strong in Kenya. The World Bank grant can focus on these, have multiple achievements in health and economy at a fraction of the cost in the long term, if carefully handled.