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Connecting For Health in Kenya. John Grant Director, Internet Business Solution Group johgrant@cisco.com. Kenyan Healthcare. Developing Countries: World Bank country brief for Kenya. Kenya's economic performance worsened markedly in the 1990s.
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Connecting For Health in Kenya John Grant Director, Internet Business Solution Group johgrant@cisco.com
Developing Countries: World Bank country brief for Kenya • Kenya's economic performance worsened markedly in the 1990s. • Average GDP growth, which was about 7 percent in the 1970s, dropped to just over 2 percent during the 1990s. • Per capita income of US$360 in 2003 was lower than its level in 1990. • Poverty rose from 49 percent of the population in 1990 to more than 56 percent in 2003. • Life expectancy fell from 57 years in 1986 to 47 years in 2000, and the infant mortality rate rose from 63 per 1,000 live births in 1990 to 78 in 2002. http://www.worldbank.org/afr/ke
USA, UK and Kenya – comparative expenditure on health Per capita total expenditure on health at international $ rate http://www.who.int/whr/2004/annex/country/en/
Distribution of health facilities in Kenya - 2005 • 300 hospitals • 652 health centres • 2252 dispensaries • 8-10km radius of a health facility covers most of Kenya’s population
Experts are not easily consulted - communication links are poor Health facilities have very limited resources • Books are not widely available in health facilities • There are few PCs
Health Management Information Systems are ‘basic’ • Better information is needed to support decision making at all levels, but the quality of data is poor. The statistics displayed on the wall in an office at Nairagie Enkare Health Centre show the large numbers of cases of Malaria, URTI, skin infections, UTI and diarrhoea that are being seen each month.
Eradicate extreme poverty and hunger. Achieve universal primary education. Promote gender equality and empower women. Reduce child mortality. Improve maternal health. Combat HIV/AIDS, malaria and other diseases. Ensure environmental sustainability. Develop a global partnership for development. eHealth Millennium Development Goals “Today, eHealth – understood to mean the use of information and communication technologies locally and at a distance – presents a unique opportunity for the development of public health.” World Health Organisation. eHealth Report December 2004. Target 18 “In cooperation with the private sector, make available the benefits of new technologies, especially information and communications.”
How do we help Kenya develop a Connected Health infrastructure to meet the Millennium Development Goals and support better public health monitoring ? Fundamental question
“Providing access to reliable health information for health workers in developing countries is potentially the single most cost effective and achievable strategy for sustainable improvement in health care. “Neil Pakenham-Walsh, Carol Priestley, Richard Smith, British Medical Journal 1997; 314: 90 Editorial. 1. Knowledge - the enemy of disease
Clinical knowledge support via the Map of Medicine • http://www.medic-to-medic.com/ • Patient ‘journeys’ • are standard best practice, • ie. following internationally • recognised guidelines and sources • Developed in UK, will be adapted, tailored to local needs and developed further to include • “tropical diseases”
Testing the Map of Medicine in Kenya • Olasiti Dispensary • Mukeu Dispensary (online) • Siapei Dispensary • Narok District Hospital • Maai Mahiu Health Centre • Nairege Enkare Health Centre • Kijabe Hospital (online)
Abdominal Pain Anaemia Bite Breathlessness Chronic Cough Confusion – Cognitive Impairment in the elderly Diarrhoea - a) Acute b) Chronic Dizziness Dysuria - a) Male b) Female Eczema Eye (Painful Red) Heartburn HIV AIDS (suspected) Hypertension (primary care) Incontinence – Male, and Female Urinary Incontinence Infertility Lymph Nodes a) Generalised lymphadenopathy b) Regional Malaria (Fever In Returned Traveller) Oedema Palpitations Pneumonia (Management of community acquired pneumonia) Proteinuria (Incidental Dipstick) Psoriasis Rectal Bleeding & Uncomplicated Rectal Bleeding Rheumatoid Arthritis (Suspected) Seizure (Epilepsy) Syncope Care Pathways in use
Some Limitations • Paper-based is cumbersome, and seldom used with the patient present. • Light on paediatric presentations. • More varied presentations of Malaria, TB, HIV/AIDS seen in Kenya. • Light on management and drug options that are suitable in Kenya.
Developing an entry level Connected Health infrastructure 2. Connectivity
Hospital Connectivity - Kijabe Hospital WiFi + PDAs • To support: • better Health Information • Management • better decision making at the point • of care • physician training • Introducing a Cisco WiFi network that enables more (and more easily updated) knowledge to be stored on a central server and accessed from a PDA, tablet or laptop.
Connectivity between Health Facilities - developing a wireless infrastructure • Potential partnership with Kenya Data Networks. • Currently testing two-way VSAT provision of internet to Kijabe campus. • Extend point-to-point link from the Kijabe Hospital to its new Marira Outpatient and HIV/AIDS Clinic facility. • From Marira (high on the Rift Valley escarpment) provide a meshed WiFi service. • Provide internet services (voice and data) to health facilities to 8-10k away.
