I've got 99 problems but a phone ain't one: Electronic and mobile health in low and middle income countries

Abstract

Mobile technology is very prevalent in Kenya-mobile phone penetration is at 88% and mobile data subscriptions form 99% of all internet subscriptions. While there is great potential for such ubiquitous technology to revolutionise access and quality of healthcare in low-resource settings, there have been few successes at scale. Implementations of electronic health (e-Health) and mobile health (m-Health) technologies in countries like Kenya are yet to tackle human resource constraints or the political, ethical and financial considerations of such technologies. We outline recent innovations that could improve access and quality while considering the costs of healthcare. One is an attempt to create a scalable clinical decision support system by engaging a global network of specialist doctors and reversing some of the damaging effects of medical brain drain. The other efficiently extracts digital information from paper-based records using low-cost and locally produced tools such as rubber stamps to improve adherence to clinical practice guidelines. By bringing down the costs of remote consultations and clinical audit, respectively, these projects offer the potential for clinics in resource-limited settings to deliver high-quality care. This paper makes a case for continued and increased investment in social enterprises that bridge academia, public and private sectors to deliver sustainable and scalable e-Health and m-Health solutions.

Digital health Systems in Kenyan Public Hospitals: a mixed-methods survey

“…However, the technology landscape is now quite different from 10 years ago, when the systems now in operation in the UK, US and Europe were specified by large national and regional procurement processes [7,13]. Cloud-hosted systems, mobile phones and tablet computers [14] and increasinglymainstream adoption of open source technology offer a different and perhaps more cost-effective path for countries looking to digitise their healthcare systems.…”

Using rubber stamps and mobile phones to help understand and change antibiotic prescribing behaviour in private sector primary healthcare clinics in Kenya

“…Mobile technologies can improve primary healthcare in diverse ways,46 but there is growing recognition that the focus on technology often ignores other factors critical to the success of digital health interventions 19 22. The ‘appropriate technology’ of rubber stamp templates addresses LMIC constraints (eg, financial and non-financial costs of training non-physician clinicians on computer-based information systems)47 and takes advantage of the ubiquitous availability and use of both paper and smartphones.…”

“…The recent revolution in access to mobile technologies provides a great opportunity to reach and support frontline health workers in LMICs 21. A combination of mobile technologies and paper-based documentation could potentially overcome the limitations of using traditional EMR systems in providing routine clinical management data 22…”

"Even though I am alone, I feel that we are many" - An appreciative inquiry study of asynchronous, provider-to-provider teleconsultations in Turkana, Kenya

“…Telemedicine has since advanced through a variety of communication modalities, and today is predominantly conducted over mobile phone and internet [3]. However, the promise that teleconsultations offer more practical, affordable and sustainable solutions than traditional consultations, especially in low and middle-income country (LMIC) health systems, has yet to be demonstrated at scale [4][5][6].…”