Home' Technology Review : March April 2012 Contents Feature Story 59
them. On the same day Kyalo launched MedAfrica last November—
with doctors’ phone numbers as a major selling point—Safaricom
announced that it was launching its own doctor-calling service. In
a nation with few doctors and no free 911 service for medical emer-
gencies, residents can now at least speak to a doctor for about 25
cents per minute. The service already fields 500 calls per day, but
while it’s helping, it also painfully illustrates the challenges facing
its potential users. Nzioka Waita, Safaricom’s director of corporate
responsibility, described a call that came through in January from
a woman desperate for help because her husband wouldn’t wake
up. During the course of the call, her mobile-phone credits ran out,
though the doctor was able to call her back. Safaricom says it is in
discussions with a partner willing to subsidize future emergency
calls so they can’t be cut off.
Safaricom is also working with partner companies to do for
health care what it did for banking with M-Pesa. A system now
being designed—initially for pregnant women in several rural
districts—would let community health workers create an elec-
tronic medical record for each patient, update the records, and
send health information and reminders to the patients’ phones.
In many ways, the project would adapt technologies pioneered
by groups like AMPATH and allow them to be rapidly scaled up.
The $2.3 million project is expected to roll out this spring. The
idea is for community workers, armed with a phone and sheets of
ID cards bearing bar codes, to issue a card to a woman and scan
the code with the phone’s camera, registering the woman’s identity.
The woman, if she has a phone, would then receive text messages
offering health advice and reminders of upcoming appointments.
On each return visit, new information, tied to the bar-code iden-
tifier, would be uploaded by SMS to a central database. Crucially,
the system would build on existing mobile billing and banking
platforms. Each transaction uses phone minutes, which are mostly
prepaid in Kenya and could be subsidized by donors.
And in a nation where 75 percent of the population is not cov-
ered by any health insurance, Safaricom envisions enrolling peo-
ple in insurance programs and letting them make payments via
M-Pesa. About 50,000 laborers have recently started doing just
that. Handling the financial side of health care with mobile phones,
say Biondich and others, would make it possible to bring more
people into the system and thus improve the nation’s health. Mobile
payment also provides a potentially efficient way for donors to
fund health care.
Nairobi’s Kenyatta National Hospital, one of the largest hospi-
tals in sub-Saharan Africa, has a distinctly 1930s feel, with painted
wooden doors and hand-painted signs. One day Ambrose Kwale,
the hospital’s director of IT, showed me around. There was a new
25-bed isolation unit for multiple-drug-resistant tuberculosis, and
a grassy spot outdoors where several people who appeared to be in
their 50s or 60s were sprawled, some curled in the fetal position.
These were cancer patients. Many had traveled overnight, refer-
rals in hand, for appointments with some of the few oncologists in
East Africa. (One hospital IT initiative is to install a telemedicine
facility to help patients at regional medical centers avoid the trip
to Nairobi to see specialists.) A woman who appeared to be in her
30s, wearing a pink jacket and a flowered shawl, leaned against
a concrete pillar, short of breath. When Kwale approached, she
weakly handed him a piece of paper marked up in blue pen. She
had traveled 50 kilometers to see a specialist for her breast cancer,
and now she was alone, exhausted, and at the wrong place on the
campus. A pale blue cataract blighted her left eye, and a look of fear
and pain shadowed her face as she rested her head against the pillar.
Kwale could only call for an orderly to help the woman find her way.
Mobile technologies offer great potential to help patients like
her—to keep track of their care, provide reminders, and give them
broader access to expertise. And experience is showing that local
talent can create the technology.
The challenge lies in organizing this emerging talent so that it
can tackle large-scale projects. Last year USAID, a major funder of
health projects in Kenya and other developing countries, requested
proposals for help creating a unified, Web-based national health
information system that would be “host country owned.” The five-
year, $32 million contract went to Abt Associates, a consultancy
based in Cambridge, Massachusetts, which has done extensive
work in global development projects. But although it has exper-
tise, so does the new tech class back in the host country—which
also has a long-term stake in the solution and no U.S . overhead.
“If you talked about an RFP for $32 million at iHub, people would
go nuts! You’d fund 500 startups for that,” CHAI’s Jackson Hungu
says. “And this country’s public health delivery would be changed
forever. I have no doubt about that.”
Davi D Talb oT iS Technology Review ’S chieF cor reS ponDenT.
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