Should Kenya invest in Digital Health?
In the last couple of decades, Kenya has contemplated various healthcare programmes and has struggled to find an efficient programme, suitable for its growing population, and high degree of urbanisation. According to data from the WHO (2014), Kenya has a total population of 43178 thousand in 2012, but only 0.181 physicians per 1000 people, and 0.792 nurses and midwives per 1000. There is limited national statistical data available to the public and depending on sources, differing statistics can be found on the life expectancy and mortality rates, but there seems to be a consensus in the belief that the life expectancy remains relatively low, and although there is some improvement in the infant and under-5 mortality, it remains higher than the desired level. There is also great concern regarding the maternal and neonatal mortality, which has not improved significantly over the years (Muga et. al., 2005, WHO, 2014). Communicable disease also remain a significant problem for the Kenyan healthcare, with Malaria claiming the most lives outside of the hospitals, and is closely followed by HIV/AIDS (Muga et. al., 2005; WHO, 2014). Other infections such as those of the respiratory system, the skin and gastrointestinal organs still people of all ages, (Muga et. al., 2005; WHO, 2014), as well as the re-emergence of the certain conditions such as polio become an increasingly pertinent problem, which may be the result of an observed decrease in Immunization rates compared to the several decades ago (Muga et. al., 2005).
This depicts a worrisome healthcare situation in Kenya, one which is the Kenyan government has tried to tackle by implementing a number of policies over the years, in order to attain certain goals and to improve the situation. The current government’s Kenya Health Policy (2014-2030) aims to be able to reach a level and distribution of healthcare which is comparable with that provided in middle income countries (WHO, 2014), by improving the life expectancy by 16% and reducing the total annual mortality by 50%, amongst others.
The positive value of information and communication technology in different sectors, including the healthcare has become evident throughout the world. Some scholars even argue that in order to excel, an even survive, organisations and institutions must invest heavily in information and communication technology (Chau & Hu, 2002). Therefore, in this essay it will be argued that the answer the question “should Kenya invest in Digital Health?” is yes, and that a significant investment in the information and communication technology in order to attain the goals of the Kenya Health Policy. Several advantages of a well-developed information and communication technology system will be put forward, followed by more practical matters regarding the implementation in the Kenyan context.
Why invest in information and communication technology?
In order to provide adequate healthcare, practitioners must be able to collect and store complete and detailed data, and they should have systems in place which allows for easy retrieval of the data. In more economically developed countries the majority of the patient information, lab values, test results and pharmacy data is stored in an electronic format (Tierney et. al., 2008). The concept of collecting and storing patient data is by no means a new one, yet this is often done by writing the information by hand in notebooks and it is limited to the follow-up of certain diseases only, mainly HIV/AIDS (Drury, 2005). This disparity in ICT development between less and more economically developed countries no doubt contribute to the differences in healthcare outcomes in these two regions. This shows the importance of the reliance on ICT and the development of Digital Health. Digital Health is defined by Chau & Hu (2002) as “the use of IT to support healthcare services and activities via electronic transmission of information or expertise among geographically dispersed patients, including physicians and patients, in order to improve service effectiveness and resource allocation and/or utilization efficiency” (p.2). Considering the Kenyan healthcare context which is characterised by a fairly low amount of physicians per 1000 people, the use of Digital Health could facilitate the transfer of information and knowledge to those physicians working outside of the cities where physicians and healthcare practitioners in general, are present. The WHO has acknowledged the importance of the development of ICT in economically developing countries, and encourage the development of Digital Health, but refer to the broader concept of eHealth based on the models already developed in more economically developed countries such as the UK and Canada (Drury, 2005). The term e-Health refers all practices of medicine one using the computer or the Internet, and more specifically to the attitude and commitment to improving healthcare using information and communication technology (Eysenbach, 2001).
Besides data collection and storage for correct diagnosis and follow-up, there is also the need to obtain data to monitor the spread of highly infectious diseases such as AIDS (Drury, 2005), on not only an individual level but on a national level. In order to observe, monitor and contain an epidemic, there is a need for national data on all patients, stored digitally in order to be able to establish effective strategic information management and to analyse the data.
Information and communication technology can be used in various forms and different purposes within the healthcare system. One of the purposes is monitory technology, which refers to gadgets which facilitate the monitoring of certain patient characteristics and blood values. These can be used for the monitory of chronically ill patients by, for example, measuring the blood pressure of those who suffer of high blood pressure or the measuring of blood glucose levels in those who have diabetes. Such devises do not only provide more information for the doctors; they also ensure that a significant part of the healthcare services are moved outside of the hospital, and that the patients integrate it in their own lives, taking more responsibility for their treatment (Ballegaard et. al., 2008). This not only reduces the hospital costs made, in terms of occupation of bed and doctor time, but it also means that those who live far from hospitals can still benefit from adequate follow-up from their physicians who have enough data to be able to help the patients well. A correct follow up of, for example blood glucose, can limit the disease and the consequences of the disease.
A second purpose is for educational purposes. In order to ensure that the healthcare practitioners can provide good quality health, it is imperative that the health care practitioners receive continuous education and training (Geissbuhler et. al., 2008). Digital Health can be used efficiently to increase the possibilities, as it would allow for the sharing of medical information in the form of online and/or digitized libraries or knowledge bases, easy communication between experts in order to help solve a difficult or unique case or simply to share information, and courses can be offered online. The Réseau en Afrique Francophone pour la Télémédicine (RAFT) network is a successful example of the use of Digital Health for medical education and tele-consultations, which was initiated in 2000 by Geneva University hospitals. They webcast interactive courses in a total of 10 French-speaking countries, with an emphasis on the possibilities to share knowledge and expertise across the different countries and specialisations (Geissbuhler et. al., 2007). The focus was on creating a collaborative sphere, although it was long distance, which allowed for the healthcare practitioners from all the countries to gain new knowledge, but also for the creation, maintenance, and publication of quality medical content (Geissbuhler et. al., 2007).
Who to target with Digital Health?
The use of Digital Health can be beneficial for all patients and the healthcare system in general. Yet there are some segments of the population which have significantly less access to healthcare. There are great disparities the access to healthcare in Kenya, especially in Nairobi, which is a result of the differences in income (Muga et. al., 2005; Huber, 1993; Fotso et. al., 2008). Nairobi has experienced extreme urbanisation, which has resulted the formation of slums. These slums are characterised by the fact that they are overcrowded, there is a lack of basic infrastructure, substandard sanitation and public services and there are the security conditions are less than desirable (Taffa & Chepngeno, 2005). It is noteworthy that in 2008 60% of the Nairobi residents lived slums (Fotso et. al., 2008). Studies have shown that these residents also exhibit the poorest health, poorer than urban residents who do not live in slums and even poorer than those who live in rural areas (Fotso et. al, 2008). This is not attributed to far from than sanitary and health conditions which they live in but also because of lack of money, which causes not to seek health care when needed (Taffa & Chepngeno, 2005). Consequently, when patients have symptoms, they wait far too long before seeking help and often end up going to the doctor only when they have more than one complaint or when the disease has already advanced significant (Drury, 2005). This shows that this group is vulnerable to disease because of limited access to healthcare. There are multiple ways which Digital Health can be used to reach this group. For example, there is the possibility of tele-consultations which can be done from central points in the slums which are equipped with computers and webcams, and are connected with various doctors in the city. This already will diminish the costs which the patients have to make to go see the doctor, as the transportation costs will be absent or less expensive. The closeness of such a point to the residents of slums may also be encouraging for patients to go consult a doctor more quickly. Furthermore, the use of monitoring devices for those who need it and the ability to digitally transfer the data to physicians will mean less trips will be needed to see the physicians on location. These are only some suggestions out of many, and ideas which can be applied for other residents of the country which are trapped in poverty and/or are geographically distant from hospitals.
How to implement Digital Health?
The implementation of Digital Health requires financial investment, as well as necessary knowledge and skill, human resources and a certain attitude. To begin with, in order to be able to deliver electronic healthcare, adequate infrastructure must be in place, ranging from continuous power supply and internet connections, to sufficient amount of computers and other technological gadgets (Drury, 2005). There must also be safe and secure systems set in place, which allow for patient data and records to be stored (Drury, 2005). These investments are expensive if they must be done all in one go, yet they are necessary. Furthermore, thought needs to be put into issues of confidentiality, security and identity management (Drury, 2005), which all will require more financial investment.
There will also have be in an investment in the training of medical professionals to ensure they can use the system, as well as an investment in the training of ICT professional and management in order to conceptualize, design and install information systems (Tierney et. al., 2008). All this will also require significant financial investment, however the ministries must not see this as a reason to not implement such systems. They must consider the advantages ICT can provide for healthcare, and they must remember that health is closely related to other social issues such as employment, income and family life. Governments must consider the delivery of good healthcare, using ICT when necessary, as part of national approach to reduce poverty and reach some of the development goals (Drury, 2005).
Lastly, there needs to be a high degree of technology acceptance amongst the healthcare practitioners and the patients. Technology acceptance is defined by Chau and Hu (2002) as “an individual’s psychological state with regards to his or her voluntary or intended use of a particular technology” (p.2). Chau and Hu (2002) state that no matter which system physicians find themselves in, they make the decision on whether the effectively and efficiently use technology, based on whether they have accepted the technology. Studies have shown that, whether or not the technology is accepted depends on whether they consider the technology (or information system) used to be useful for their own practice. The ease of use of the technology itself is not the most important factor (Chau & Hu, 2002). This means that the practitioners have to be fully involved in the development of Digital Health programmes to ensure it will be developed in a manner which will be accepted by most, if not all, practitioners.
The patients must also accept the new relationship dynamics between them and the healthcare practitioner which is established as technology is used for communication and consultation. They must also feel that the technology which they must deal with is easy to use and can be easily integrated into their everyday life (Ballegaard et. al., 2008). If this is not the case, a system may be built and technology may be available, but patient-use will be low.
In conclusion, Kenya can profit tremendously from the implementation of infrastructure and systems which would allow for the healthcare practitioners to practice Digital Health. It will facilitate the collection and storage of patient data, it will ease the monitoring of chronically patients and it will ensure the collaboration between different doctors with different expertise and from different countries and will allow for continuous training. The improvements which the use of Digital Health and e-Health will show will be visible in all layers of the society, but there is one segment of the population, namely those living in slums, who will like profit the most. Although the investments needed in order to have well-functioning systems is significant, the government of Kenya should see it as a component of their general strategy to improve quality of life and reduce poverty. All in all, yes, Kenya should heavily invest in Digital Health.
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