Improving access to healthcare in rural Kenya through mobile technology

Project Background:

Our client was Novartis, a large pharmaceutical company that recently launched a social business program to provide health education to community groups in several rural regions of Kenya. Novartis had previously achieved a highly successful social business program in India and hired our team to see how to build on a similar program in Kenya and also how to introduce aspects of mHealth.  In addition to health trainings, the company organizes health camps where people who often struggle to access healthcare can receive free consultations and lab tests.  Our team was tasked with investigating ways to further improve access to healthcare for people at the base of the pyramid (BOP population usually living on <$2/day) through the use of mobile technology.

Kenya is one of the leading African countries in terms of mobile penetration, and both SMS and voice calling is very inexpensive, creating many terrific opportunities for mHealth interventions. mHealth (mobile health) is generally defined as any program that delivers health messages, information, or does health data collection through the use of mobile phones.

Our first week – Field Research

We arrived in Nairobi and were immediately caught up by the energy of the city, excited to meet our client and get to know a bit of Kenya’s culture and healthcare system.  We spent our first Sunday exploring our neighborhood and local cuisine.  It turns out there is fantastic Indian food in Nairobi! On Monday morning we had our first encounter with rush hour traffic in Nairobi, but made it to our client’s office and had an immensely productive day, getting all of the background information for our client’s program.  The rest of our first week would be spent conducting field research in two regions where the client is currently operating.

Over the course of three days, we shadowed pharmaceutical sales reps, watched Health Educators give trainings to community groups, and were exposed to a full spectrum of healthcare options in rural Kenya.  We observed sales reps interact with pharmacists, physicians, nurses, and other healthcare providers.  Our team members had the opportunity to conduct in-depth interviews with community members to understand how they make decisions about when to access healthcare and how they manage the associated costs.  Interviews provided insight into opportunities for mHealth interventions to improve people’s ability to access and pay for care.

Our research made it abundantly clear that many people at the BOP struggle to access quality care and are often unable to afford better options. Most people had zero savings and paid for healthcare out-of-pocket with cash or money borrowed from friends and neighbors.  Community members were engaged and eager to receive trainings about such topics such as hygiene, nutrition, and avoidance of self-medication.

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First weekend – Masaii Mara safari!

We spent our first full weekend giddily bumping along jutted dirt roads, vying to get the best views of animals in the vast expanse of the Masaii Mara.  Our first evening we watched with a combination of awe and disgust as a pack of female lions hunted and killed a buffalo.  We were lucky to see four of the “big five” animals, only missing rhinos.  One evening we also visited a Masaii village to learn more about the culture, traditional dances, and how the Masaii people fend off predators when they graze their cattle and goats inside national parks full of lions, leopards, and other threats. 

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Week two – Meetings in Nairobi and analysis

Our second week was full of meetings with organizations who are working in mHealth, telehealth, and healthcare financing in Kenya.  We particularly enjoyed meeting with Medic Mobile and getting to see the iHub, a co-working space in Nairobi that looks very similar to the Hub and other shared workspaces in the U.S.  We were excited by the innovation and knowledge sharing opportunities. 

We took time to leverage some of our learnings from the Haas PFPS course and used hundreds of Post-It Notes to do an in-depth brainstorming session on findings from our field research.  Coincidentally, we chose to do this activity one evening at our hotel and hotel management was hugely perplexed by our iterative process of scattering and rearranging Post-It Notes across several tables on the outside patio.  Week two also provided us some real “consulting time,” as we dove deep into PowerPoint, diligently working to present our findings and recommendations in a compelling fashion for our client. 

On Friday we gave our client in Kenya a sneak peak at our deck to get his initial reactions.  He seemed excited about our ideas and was pleasantly surprised about the depth of insight we were able to gather in the field, as well as our operational insights that could be applied beyond mHealth.  We went into the weekend feeling energized and excited for more exploration.

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Second weekend – Nightlife and more exploring in nature

Our second weekend we opted to stay in and around Nairobi and had a fantastic time.  On Friday night we checked out the local nightlife at a restaurant that has one of the only local breweries in the region.  Once the DJ arrived, we made Haas proud and proved our worth on the dance floor, even taking time to learn some new dance moves from local Kenyans. 

On Saturday we left bright and early to drive down to the Rift Valley to visit the famous Hell’s Gate and Lake Naivasha.  We rented bicycles at the Hell’s Gate National Park and biked 8km through natural beauty to the famous gorges.  After a short picnic (during which we spent most of our time fighting off monkeys rather than eating) we went for a hike and were able to see some natural hot springs and scenery.  Before heading back to Nairobi, we went to a viewpoint at Lake Naivasha and saw some flamingos. 

On Sunday morning Aaron and Javier visited Kibera, the largest urban slum in Africa.  Our work has been focused on improving access to healthcare to people at the base of the pyramid, and while most Kibera residents lack access to basic services, including electricity and running water and sanitation is a major issue contributing to health problems, our focus has been on the rural poor.  Someone who lives on less than $2 per day, but has a half acre of land to grow maize and a small vegetable garden has a vastly different experience than someone who lives on less than $2 a day in a 5 kilometer slum with 200,000 other residents.  We have been very interested by updates we receive from one of the other Haas IBD team that is working in Kibera for the Human Needs Project.

On Sunday afternoon we headed to the outskirts of the city for Blankets and Wine, a music festival featuring singers from across Africa.  We were especially excited to see Zahara from South Africa.  One of the other Haas teams joined us and we had a great time sitting in the sun, listening to great music, and doing a bit of dancing. 

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Week three: Recommendations and client visit

We kicked off our third week by focusing on finalizing our recommendations.  We have to admit we got even closer as a team this week.  There is something to be said about spending hours together in a small conference room, meticulously going through minute details in PowerPoint.  Our client arrived from Europe on Wednesday morning and after another amazing Arabian lunch, it was time to unveil the key findings and recommendations from our research.  We took time to report on our findings from our field research, not just as they relate to recommendations for mHealth interventions, but also how to improve the operations and efficiency of the field teams as the program grows. 

In the end, we made three key recommendations about opportunities to use mobile technology to improve access to healthcare in rural areas.  Our recommendations centered around finding ways to use mobile to improve access to information about health and prevention as well as access to finance and savings.  M-Pesa, a mobile savings and payment system that is widespread in Kenya, has done a ton to open Kenya to opportunities in mHealth. 

During our three weeks in Kenya, we had the opportunity to meet with a number of companies and organizations that are working to improve the livelihoods of Kenyans in the BOP, either through helping to set up savings and credit groups, health education, other mHealth interventions, etc.  One of the program managers we met at AMREF made a very important point that partnerships are key to ensure sustainable and scalable interventions: “One thing to realize about the world right now is that no one is going out to do anything alone.  Groups are forming partnerships and consortiums where they all have strengths.  To go alone is risky, but finding complementary partners can lead to great programs.”

We believe Novartis is well positioned to be a leader in social business and sustainable mHealth interventions.  We are incredibly grateful to have had the opportunity to work on this consulting engagement and hope to visit Kenya some day in the future.

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