As early as 2005, the World Health Organisation (WHO) recognized the potential of e-Health to strengthen health systems and improve quality, safety and access to healthcare. The WHO encouraged member states to take action to incorporate e-Health into health systems and services. 

Kenya acknowledged the call to adopt eHealth solutions, and in 2016, developed the national ehealth policy 2016-2030. The policy seeks to: 

• Enhance interaction between clients and health providers; 
• Accelerate achievement of universal health coverage; and
• Enhance electronic exchange of health data and information. 

E-Health solutions used in the Kenyan health industry are at varied stages of development. The common solutions include:

• mHealth: Use of mobile phones and other wireless technology in medical care, including  disease surveillance, treatment support, epidemic outbreak tracking and chronic disease management.
• Health Information Systems (HIS): Systems designed to manage healthcare data. These include systems that collect, store, manage and transmit a patient’s electronic medical record (EMR), a hospital’s operational management or a system supporting healthcare policy decisions. 
• Telemedicine: Allows patients to communicate with a healthcare provider using technology, as opposed to physically visiting a doctor’s office or hospital; and 
• E-learning: To educate and train the health and social care workforce.

Section 104 of Kenya’s Health Act (2017) recognized the importance of e-Health and required enactment of additional legislation to ensure the enhancement of e-health. Against this backdrop, the County E-Health Bill, 2021 was incepted. 

Highlights of the Bill

The Bill seeks to provide a framework for the establishment and management of communication tools for use by healthcare providers in the delivery of healthcare services. In addition, the Bill intends to facilitate the availability, timely access to, and transmission of information necessary for the effective delivery of e-Health services. Crucially, the Bill aspires to facilitate innovation and optimal use of ICT in the health sector. 

 The Bill enumerates the following criteria for the establishment of a county e-health system: 

• Mechanisms for the accessibility and coordinated delivery of healthcare; 
• Development of common standards on data structure, technologies and messaging for the secure sharing of patient information and treatment options across geographical and health sector boundaries; 
• Establishment and implementation of software certification or accreditation of e-health solutions to be implemented by e-healthcare providers;
• Define the standards of delivery of e-health services;
• Establish mechanisms for exchange of patient data to e-healthcare providers nationwide;
• Training workforce to effectively use e-health system;
• Decentralise the delivery of e-health services to the lowest unit of service delivery at the county level of government; and 
• Strategies and plans for the continuous development, operation and maintenance of the e-health system.

Other key sections of the Bill include:

• Identify the roles of national and county government in the provision of e-Health systems 
• Registration of telemedicine and e-healthcare providers
• Interoperability and health data exchange requirements
• Duties and obligations of persons involved in the delivery and registration of e-health systems
• Discretion to establish county health data stewardship committees. 

Challenges

Despite the ambitions of the Bill to digitalise and improve the efficiency of Kenya’s healthcare model, there are significant challenges that need to be addressed: 

• Determining acceptable standards for the e-Health system. The use of multiple health data collection tools may affect the system’s ability to standardise the format of the data collected. 
• Large up-front investment and development fund required to roll out the project. 
• Possible violation of patients’ privacy and confidentiality
• Improve internet connectivity and supportive infrastructure nationwide to ensure universal access to the e-Health system. 
• Lack of ICT competencies and skills by the healthcare professionals that shall be using the e-Health system. Use of e-Health solutions needs to be incorporated into the medical school curriculum. 
• There is a likelihood of inadequate coordination between the two levels of government in implementation of policy and guideline documents. The conflict arises since eHealth has centralising tendencies in a decentralised government. 

E-Health projects in Kenya 

In recognition of the huge financial layout required for the roll out of an interoperable county and nationwide e-Health system, the Bill has a provision enabling the government to collaborate with relevant stakeholders and leverage on their existing human, financial and technical resources in the implementation of the e-Health system. 

As such, the Ministry of Health and the respective county executive committee members  for health can collaborate with private sector entities that are developing or have existing e-Health projects. Below are some examples: 

M-TIBA 

M-TIBA is a health financing technology platform. The product has over 5 million users and close to 4,000 health facilities countrywide. It also has an e-wallet on M-PESA, which enables users to save towards healthcare expenses starting from as little as KSh10. Over KSh1 billion worth of health expenses have been paid out to date. 

Afya Moja 

Afya Moja is a simple, mobile-based digital health passport that receives and securely stores patients’ data. It allows users to access their health information and can share it with trusted health providers. Furthermore, doctors, upon receiving consent, have access to patients’ medical backgrounds and therefore respond effectively to their needs. The project has been designed to ensure the system is streamlined enough to ensure standard healthcare services real-time and anywhere. 

Daktari Smart

M-PESA Foundation and Gertrude’s Hospital Foundation on February 28 launched their telemedicine initiative, Daktari Smart, in Samburu County. The programme targets over 32,000 children in Lamu, Samburu, Homa Bay and Baringo counties and aims to reduce the number of referrals of sick children by allowing county health facilities to have access to specialists. The initiative seeks to reduce patient referrals, save on costs and make treatments more prompt. The bandwidth requirement for the equipment is low, ranging from 512Kbps to 2Mbps. This means that the platform can be installed in rural and underserved areas that do not have fibre connectivity.