Leveraging technology to reduce health inequities in Kenya
IDRC’s Regional Office for Sub-Saharan Africa (ROSSA) hosted representatives from the Kenyan government, the private sector, and research institutions on November 9 for a presentation of research findings by the Kenya Medical Research Institute (KEMRI)-Wellcome Trust. The three-year study, titled Addressing health inequities in Kenya: Potential and feasibility of e-health approaches to promote health equity in the Kenyan health system, was implemented under IDRC’s Strengthening equity through applied research capacity building in e-health (SEARCH) program.
Findings were presented by Dr Doris Kirigia, a researcher with KEMRI-Wellcome Trust and the principal investigator for the SEARCH study in Kenya. The research sought to understand the extent to which digital technologies such as e-health (electronic health) and m-health (mobile health) interventions reach vulnerable populations across Kenya and influence progress towards greater health equity. The study also explored the potential to engage communities to participate in decision-making that could improve accountability and governance of the health system.
The study mapped 70 e-health projects — the majority m-health interventions — that focused on various goals, from extending geographic access to health services, improving data management, providing education to health workers, improving diagnosis, and promoting healthy behaviour change. Targeting behaviour change featured strongly, particularly around primary care, HIV/AIDS, and maternal, newborn, and child health.
Results from the project indicate that e-health initiatives are rarely evaluated (59% of the projects did not report any evaluation). This lack of evaluation is noteworthy because it can deter the scale-up of interventions. One finding showed that few projects have been implemented in marginalized areas or in the least urbanized counties.
Issues of confidentiality and ownership of data were also flagged as important considerations when using e-health. The study team found that data collected from e-health interventions is often stored on servers outside of Kenya. This raises concerns about confidentiality for patients, providers, and planners. In response, the Ministry of Health (MoH) is developing a common server with the University of Nairobi to store data in-country.
The research revealed that many e-health implementers are reluctant to share information about their applications, including details about the hardware and software being used. Consequently, very little of the work is known and collaboration is limited — in many cases resulting in the duplication of efforts. This limits the MoH’s ability to leverage achievements and lessons emerging from these efforts.
Influence on policy and practice
At the start of the SEARCH project in Kenya in 2013, there was no regulatory framework for e-health in the country. Standards, guidelines, and supporting policy documents were lacking. This limited the government’s stewardship and buy-in, important factors to ensure the sustainability of e-health projects. The research team worked closely with the MoH e-health unit throughout the project, and the ministry is now developing a framework to certify all e-health innovations at all levels of the health system. This will help to reduce the duplication of initiatives and encourage the use of common platforms.
The project demonstrated the importance of engaging government officials, the research community, and the private sector towards a common goal. For example, MoH was involved from project formulation and throughout its implementation. The director of e-health regularly convened stakeholders (including the private sector) throughout the process. The study findings were used to develop policy documents to guide e-health and m-health implementation in Kenya. These include the e-health policy and strategy 2015–2020. Complementary guides about enterprise architecture definition, interoperability, standards, and guidelines for m-health systems will be launched in early December 2016.