Just a click away: Apps bring doctors to your home

For the past five days, Catherine Ndunge has been fighting an illness that has made it impossible for her to get out of bed.

She feels the need to see a doctor, but she is broke. Even if she had the money to go to hospital, she would not feel safe leaving her house. Being in a hospital during this Covid-19 period is a risk she cannot take. “What if I get infected?” a frail voice mumbles from her bedroom.

Her sister, Joy Mueni, suspects Catherine has malaria.

Seeing how much pain she is in, she tethers her laptop to her mobile internet and logs in to her account on Daktari Africa, where she attempts to connect to an online doctor.

In Kyambeke, Makueni County, where they live, the 3G network takes her around five minutes of buffering to eventually find a warm Dr Charles Kamotho, who breathes hope to her worries.

“Hello daktari, my sister is very sick. Please help,” an impatient Joy almost screams to the smiling doctor through the platform’s videoconferencing interface.

Dr Kamotho asks her to turn the laptop camera towards Catherine, so he can see her. “How are you feeling? How is the fever? When did the joint pains start?” he asks Catherine, who struggles to answer, but finally delivers the responses.

Joy is requested to prick the tip of her sister’s finger to get a blood sample, which she takes to the nearby Kyambeke dispensary lab for testing while the doctor talks to the sickly Catherine.

Positive results are confirmed and the doctor prescribes a one-week malaria dose. The prescription is sent via email.

The whole doctor consultation service costs her sister Sh950, which she pays via M-Pesa, compared to incurring heavy transport costs to Makueni Level Five Hospital 38km away where queueing for several hours to get the same service is the norm. Days later, a jovial Catherine is back on her feet.

“We have a team of 512 doctors, who serve more than 10,000 patients across the country. To achieve this, we work closely with health players in the rural areas,” Dr Kamotho, who is also the chief executive of Daktari Africa, tells HealthyNation. Daktari Africa pioneered telemedicine in the country in June 2015.

He says since Covid-19 broke out more patients with chronic diseases such as diabetes and cancer have been using their services instead of going to the hospital so as to reduce their risk of contracting the virus.

Having run a rural telemedicine programme at Nyakiaga in Murang’a County last December as part of research work on the impact of e-Health in achieving universal healthcare in Kenya, Dr Kamotho dreams of a future medicine ecosystem where every county will have a telemedicine centre.

“Promoting access to telemedicine in rural areas is tied to a huge drawback. Many people have smartphones, but they lack stable internet at home. A model for a community centre with strong internet access and uninterruptible power supply will be a big step towards creating the awareness,” he says adding that he serves at least six patients per day.

Kenya had a smartphone, laptop and tablet penetration of 97 per cent, 42 per cent and 22 per cent respectively as at 2018, according to Deloitte.

According to tech think tank Research ICT Africa, the average cost of internet in Kenya is Sh244 per every 1GB of data.

When this writer logged in as a patient, an interface that allows you to self-record your medical data is displayed. A patient indicates their location and a new page loads that allows them to choose a doctor from those available online. Once a patient picks a doctor, a video call is established and the two can talk. A patient shares their medical data on the screen, and this helps the doctor to make faster diagnosis and prescription, which is sent via email. A patient has the option of buying the prescribed medicine via e-commerce platform, MyDawa, and get it delivered to their homes.

For Joyce Wachira, a diabetic, the platforms have opened her eyes to the use of modern technologies that cut costs.

“Every time I sense a deviation in my blood sugar level, I videochat my doctor on Daktari Africa to help me restore the balance,” says the 66-year-old resident of Kiriaini village in Murang’a.

According to the Kenya Healthcare Federation, the telemedicine field consists of 41 registered e-Health providers who offer diagnostics, prescription, surgery pre-assessments, ultrasound, crowd funding, pharmaceutical e-commerce, health insurance, doctor-to-doctor consultation and medicine e-learning.

Medical experts argue that the failure by Kenyatta National Hospital (KNH) to implement a Sh10 million telemedicine plan launched in May 2015 inspired private investors to bridge the gap.

The programme was supposed to link KNH physicians to Machakos Level Five Hospital via videoconferencing. The level five hospital was to act as a video booth where patients from the county would be served from Nairobi. But, five years later, Machakos residents have to wait for several hours to physically consult a doctor. “That brilliant idea was not well thought out. But it opened a window of opportunity for innovators,” said a surgeon who sought anonymity.

Calls and emails to KNH about the matter went unanswered.

KNH launched a similar project in March to fight Covid-19. Nicholas Gumbo, the former KNH chairman, said the second attempt at telemedicine will “use Big Data, connectivity and artificial intelligence to aid real time interpretation of CT scan images for early diagnosis and management of all medical cases”.

But, the idea will only make sense if rural residents will begin to benefit from quality online medical services in the coming months at an affordable fee.

Whenever she falls ill, Muthoni Kabucho, 39, uses Sasa Doctor and she says the online video consultation saves her. “I have used it with my daughter for a whole year now. There are also chances of your child catching opportunistic infections at the hospital,” she says.

Although she has health insurance cover, Muthoni does not mind paying because the price is pocket friendly. “Compared to doctor consultations in hospitals that can cost Sh5,000, I have never paid above Sh1,000 for the online services,” she says, adding that some doctors in the brick-and-mortar model prescribe expensive medicine, which they send you to buy from particular chemists.

Apart from Daktari Africa other players seeking to participate in the next wave of healthcare revolution in the country include MyDawa, M-Tiba, Access Afya, Penda Health, Sasa Doctor, AskADoc, Nadia, Unumed, MyOwnDoctor, Daktari Online and Afya Pap.

M-Tiba, which began as a mobile service that allows users to save, send and spend funds specifically for treatment, commands a client base of 4.3 million users in Africa, who have transacted more than 800 million times since its launch in December 2015. The service, funded by Safaricom, CarePay and PharmAccess Foundation, works with about 2,900 health providers and has processed 587,000 treatment claims.

Emilias Sambu, a father of two, observes that e-Health apps come in handy not only for individuals, but for the whole family. The Kileleshwa resident uses the same services when he travels upcountry. “If I have any health concern for my family when I travel to Kakamega and Eldoret, I always login to the system for help. I love it because the doctors keep calling to follow up on your progress,” says the 38-year-old.

Sasa Doctor Chief Operating Officer Francis Osiemo says the primary goal of the telehealth solution is to increase the uptake of health insurance by reducing the cost of premiums for individuals and corporates.

“We aim to assist in universal health coverage where patients can use a medical app to decongest public health facilities. I believe 60 per cent of the patients we have can use telemedicine without moving an inch,” he says.

The platform’s Tabibu Sasa mobile wallet allows users in low income populations to save between Sh20 and Sh50 a day for their healthcare needs. “With that, they can use Sh100 for the entire family to access telemedicine services unlimited times every month. The remaining amount in their wallets will be used for in-patient services if need be, as we have partnered with Britam to bolster our health insurance,” adds the clinical officer.

However, there are hurdles to reaching out to insurance providers.

Efforts to bring the National Health Insurance Fund (NHIF), which insures more than 7 million Kenyans on board, he says, have hit a snag.

Kenya National e-Health Policy document 2016-2030 lists some of the challenges facing telemedicine as poor infrastructure, low literacy levels, inadequate technical expertise, unreliable power supply, limited funding and lack of government involvement in most e-Health projects.

“The government is still faced with legal challenges in regulating e-Health systems due to lack of legislations,” it states.

Most patients still do not trust apps with their data, they suspect platform owners may share their private medical information. However, Osiemo assures the data is safe. Patient data, he says, is not stored in the smartphone, but on a secure cloud service that has a firewall to lock out hackers. “Only the patient and his/her doctor can access the health data,” says Osiemo.

A hindrance is also experienced on the part of doctors who are hesitant to register on e-Health platforms because they own clinics that provide the same services.

Despite the challenges, medical experts still see a rosy future for its uptake.

Telemedicine projects have been tried in KNH, Coast General Hospital, Malindi Hospital and Moi Teaching and Referral Hospital and the Aga Khan University Hospital, but they have never been upscaled.

While developed nations began rolling out telemedicine solutions 10 years ago, such as Doctor In Demand in the US, it is only during the past four years that the innovation has gained mass adoption.

This is attributable to the global seismic shift towards online platforms. Kenya, being one of the leading countries in online activity in Africa, commands a huge potential in the sustainability of online solutions.

According to Dr Were Onyino, the medical director at Daktari Online, 5,000 accredited Kenyan doctors are registered on the platform, with each doctor serving 10-15 patients per day at a cost of as low as Sh500.

“We are cutting down the waiting time and consultation fees. But, internet downtime means video calls cannot go through to rural areas,” says Dr Onyino.

He observes that despite the Health Act recognising telemedicine as a mode of treatment, insurance companies are hesitant to pay doctors for services rendered via online portals.

“Also, the learning curve for doctors needs a change of mindset. They must be tech savvy to serve the upcoming millennial population that loves faster, ubiquitous services,” he remarks.

Tony Wood, the managing director at local pharmacy e-commerce solution My Dawa, which delivers medicine for free in the Nairobi Metropolitan area, says 100,000 users are registered on the platform.

My Dawa buys medicine directly from manufacturers and stocks them. Within Nairobi, they are delivered within four hours, but to remote areas it could take two days, with a plan to make deliveries in Mombasa, Kisumu and Nakuru free, in course.

However, overpricing that chases away potential buyers arises in the sale of medical supplies over e-commerce platforms.

“In the post Covid-19 period, the online healthcare field will be the most attractive area of investment. Let people use this time to learn about health as a service in the technology sphere because that will form a critical component of the digital economy,” says Dr Kamotho.