This document provides information on HIV/AIDS statistics in Kenya and Africa, the disproportionate impact of HIV/AIDS on women and girls, challenges in accessing healthcare in Kenya including shortages of healthcare workers and facilities, and prior mHealth trials in Kenya that faced challenges with scale and sustainability. It discusses the potential for mHealth solutions in Kenya that utilize international partnerships and collaboration across industries and sectors to develop culturally appropriate, autonomous solutions for increasing access to care, education and social support through mobile technologies and services.

1. JUDITH K. BOND
M-HEALTH
EMPOWERING WOMEN WITH
AIDS
I N K E N YA
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2. HIV/AIDS STATISTICS
K E N YA A N D A F R I C A
Judith K. Bond
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3. HIV/AIDS- GIRLS AND WOMEN
GLOBAL RATE OF INFECTION= 40 M people worldwide live with aids –
GLOBAL MORBIDITY RATE: 69% of GLOBAL deaths from aids occur in Africa
GLOBAL GENDER RATE=more than 50% are women.
In sub-Saharan Africa 57% of adults with HIV are women and women age 15-24 are
more than 3 times as likely to be infected.
Reasons – cultural/social = women have low social status, trade sex for survival, low
financial autonomy, depend on partners for support, intimate partner violence.
ART therapy makes AIDS both a chronic and an infectious disease – despite
morbidity rate decrease , a growing population of active chronic infections creates
potential to increase overall mortality rate, and adversely affect economies, well
being, and health
AIDS poses risks to health workers 2.5% of new infections are to health workers
infected by blood exposure needle pricks and exposure. Most workers are female.
African women likely to be caregivers for sick and dying as well as themselves
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4. AIDS ECONOMIC IMPACT, KENYA
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5. RELATIONSHIP BETWEEN FEMALE SEX WORKERS
AND HIV/AIDS IN AFRICA
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6. CURRENT GLOBAL HIV/AIDS STRATEGY IN AFRICA
WHO – MDG- TARGET GOALS TO BE ACHIEVED BY 2015.
Goal 6. Combat HIV/AIDS
6a. Have Halted by 2015 and begun to reverse the spread of HIV/AIDS
6b. Achieve by 2010 universal access to treatment for HIV/AIDS for all those who need it.
Progress 2011- reduction in % of newly infected- but increase of 2.5M
Treatment = In 2011 more than 8 M people living with HIV receiving antiretroviral therapy
(ART) in low and middle income countries. Another 7 M need 2 be enrolled in treatment to
meet the target MDG of providing ART to 15 M people by 2015.
Treatment suppresses symptoms – does not cure or prevent contagion of others
Non-adherence to antiretroviral therapy – side effects, adverse events including death
Testing = test reveals the presence or absence of antibodies to HIV in the blood. HIV may
not b detectable for 3-6 weeks after contacting the virus. Is infectious immediately.
Global burden of Disease www.who.int
WHO Millennium Development goals (MDGs) Fact Sheet www.who.int
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7. UNIQUE SELF-MANAGEMENT AND CHRONIC CARE
CHALLENGES FOR HIV/AIDS
US MODEL PROPOSED BY HEALTH RESOURCES AND SERVICES
ADMINISTRATION (HRSA) HIV/AIDS BUREAU 2006 ACKNOWLEDGES
UNIQUE CHALLENGES*
A. LOW ADHERENCE TO ART TREATMENT DUE TO RIGIDITY OF
MEDICATION, DIET, RESTRICTIONS, AND SEVERITY OF SIDE EFFECTS
B. DAILY SELF-MONITORING TESTS NOT AVAILABLE
C. STIGMA AND GUILT AND SENSE OF RESPONSIBILITY FOR ACQUIRING THE
DISEASE
SELF MANAGEMENT MAY INCLUDE EMPLOYING MEASURES TO
PREVENT INFECTION IN OTHERS
SOCIO-CULTURAL PERCEPTIONS OF SELF-MANAGEMENT
*Providing HIV/AIDS Care in a changing environment. (2006)HRSA http://hab.hrsa.gov/publications/march2006/
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8. AFRICA OFFERS HIGHEST ROI OF ANY
EMERGING MARKET- U. N. DATA
316 MILLION NEW TELECOM SUBSCRIBERS ADDED SINCE 2000
2008 Africans spent $860b on goods and services-35% more than Indians
KENYA M-HEALTH CURRENT
MARKET ASSESSMENT
A F R I C A C O N S I D E R E D O N E O F T H E M O S T R A P I D LY
E X PA N D I N G G L O B A L E C O N O M I E S *
*Chironga, Leke, Lund, & Wamelen(2013).
Cracking the next growth market: Africa. Harvard Business review www.hbr.org
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9. SOCIO-CULTURAL ENVIRONMENT
Population = 39,002,772
Size = 582646 K (approximately the size of Texas)
Language: English and Swahili
Religion: Christian majority; Muslim (Sunni) minority; Animism
Currency – Kenyan Shilling (KSH) 1$=70KSH
Capital: Nairobi, Population 3-4 M, Main airport
7 major ethnic groups (tribes) -can be placed above the nation
Transportation = 8,933km paved roads, 54,332km unpaved, 2,778km railways
CHALLENGES:
URBAN/RURAL, TRIBAL, RELIGIOUS DIFFERENCES
Communicaid Group 2010 Doing Business in Kenya
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10. ECONOMIC FREEDOM CHALLENGES
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11. ECONOMIC OPPORTUNITY THROUGH
MOBILE PAY TECHNOLOGY
M-Pesa mobile based money-transfer
Powered by Safaricom- leading Kenyan Operator
2/3 of Kenya’s financial transactions
by phone- $8.6b in first half of 2013
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12. MOBILE PHONE USE, KENYA
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13. MOBIL PHONE MARKET IN KENYA
FINANCIAL GROWTH OPPORTUNTIES: MOBIL PHONE MARKET
¾ of the current 5.3 b mobile phones globally are in the developing world
Kenya-6 M internet users in the country - 4 M access thru mobile phones
Kenya’s telecom market expected to generate $2.2B in 2017 up from $1.7B in 2012
Currently 4 Local telecom operators- U.S. firms preparing for entry
Mobile voice - primary operator with 63% of market share.
Prepaid phones = Currently 99 % Revenue= $1.1 B
Yolo – new device from Safaricom- smartphone $125 . More affordable.
New phone models- local and U.S. developed- with multi-functional features
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14. ENVIRONMENTAL CONSIDERATIONS
KENYAN POLITICAL ENVIRONMENT
Newly elected President and deputy in 2013.President= Uhuru Kenyatta son of Kenya’s first
President
Deputy = William Ruto. Both men charged under the International Criminal Court with
creating violence in 2007 elections. Creates instability and challenges .
Global Business Environment
Constant change -disruptive technology- no longer can employ statistics to predict outcomes .
Read: Outliers, Black Swan. Businesses must be agile, resilient, flexible adaptable to new
technology and environmental, economic, political and socio/cultural forces.
Muti-national trends
Emerging markets are becoming lead markets as well as talent pools
Kumar, N and Puranam, P. (2013) Have you restructured for global success? Harvard Business Review
Summer2013 www.hbr.org originally published in Oct 2011
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15. CONTEXTUAL HEALTHCARE SYSTEMS
HEALTHCARE = COMPLEX ADAPTIVE OPEN SYSTEM
Comprised of people and activities that mutually influence one another in complex
ways with often unpredictable outcomes. The system evolves as it interacts over time.
World Bank report 2012 sees m-health ecosystems as complex with multiple interests
of government, health care systems, technology, and finance.
Kenyan fragmentation and system complexity exacerbated by multiple multi-national
players with private interests, including NGO’s, donors, and Kenyan government
operating in silos. No universal healthcare delivery or funding system, minimal
interaction of players
M-Health business models developed in isolation aimed at solving specific problems in
narrow areas of the health system. Lack of coordination between donors, NGO’s
multi-national companies and government lacks system wide solution development.
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16. HEALTHCARE ACCESS CHALLENGES, KENYA
Health Worker Shortage –(2006) nurses 26,267- Doctors 3,855
Migration of doctors= 51 % 1.5 million needed in Africa
Hospital bed Shortage= Beds per 1000 (2006) 1.4 . Four major hospitals all
located in Nairobi with rural limited access clinics— HIV/AIDS clinics
primarily NGO funded and operated
Socio-Cultural Stigma=individuals known to have aids shunned, socially
isolated, fearful of being tested, low literacy rates
Under financed system=Out of pocket % of health expenditure (2007) 44%
Poverty -40% unemployment
Health inequities = Contraceptive use =by wealth, 17% lowest quintile to 48%
upper quintile. Education = 12% lowest quintile to 52% upper quintile
Births by skilled health professional – educational level =19% lowest
72% highest- wealth = 20% lowest and 81% highest.
World Health Statistics 2013 www.who.int.
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17. M-HEALTH IN KENYA
CHALLENGES- MOBIL MARKET
Profit margins on phones may be lower than in US. Phones priced at $100-150 usd have a
6-8% profit margin in Kenya compared to 30% gross margins from Apple
Pricing: of phones in Kenya has been above the average consumer= sh30,000 (Kenyan
Sheckels, though new lower priced models are now being introduced to consumers.
GLOBAL BARRIERS TO ENTRY
The WHO forum on data standards for e-health identified the following barriers : panoply
of proliferating standards, some that include high barriers in some areas; technical
complexity of systems and standards and language. Fragmentation of systems that cannot
talk to one another.
Governing regs e.g. HL7- rules that govern how healthcare systems exchange info and
SNOMED CT coded taxonomy used to define diseases- Neither of these r available 4 use.
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18. PRIOR M-HEALTH TRIALS IN KENYA
SCALE CHALLENGES:
World Bank reports 500 m-health studies ,yet no knowledge of likely uptake or best
practices for engagement, efficacy or effectiveness. Lacks a foundation of evidence. In
Uganda 23 of 36 initiatives did not move beyond the pilot stage.
SCOPE CHALLENGES
Most current trials employ text messaging reminders to improve attendance at
appointments. Trials were NOT done in resource limited settings . Evidence indicates
text message alone not effective. Must employ theories of behavior change. Messages
must be personally tailored and content relevant.
Scaling up mHealth: Where is the evidence? Plos Medicine Feb 2013 Vol10(2) www.plosmedicine.org--more barriers/obstacles
SUSTAINABILITY CHALLENGES: REPLICABILITY
Need good outcome measures and data. Data should include qualitative as well as
quantitative data and theoretical bases & understand why, what and under what
conditions it works. Evidence should be broad not just controlled studies.
PLOS Medicine www.plosmedicine.org Feb 2013 vol 10(2) A reality checkpoint for mobile health: three challenges to overcome
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19. INTERNATIONAL
DOMESTIC
MULTI-INDUSTRY
POTENTIAL SOLUTIONS
KENYA – M-HEALTH
I N T E R N AT I O N A L , M U LT I - I N D U S T RY / S E C T O R
C O L L A B O R AT I O N S , PA RT N E R S H I P S A N D C O A L I T I O N S
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20. CURRENT U.S. BASED M-HEALTH TECHNOLOGY
FDA APPROVED MOBIL APPS
BIOMEDICAL MONITORING DEVICES
BIOMEDICAL CARE DELIVERY DEVICES
DIAGNOSTIC AND TESTING
HEALTH COACHING
REMOTE PRIMARY CARE
CHALLENGE: INTEROPERABILITY
PRIVACY AND SECURITY PROTOCOLS
OPEN STANDARDS- DEVELOPED USING A CONSENSUS PROCESS
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21. POTENTIAL SUPPORT SERVICES
EDUCATION
SOCIAL SUPPORT
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•
•
•
•
•
•
Health literacy
Self-management
Nutrition
Hygiene
PATIENT ADVOCATES
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CHAT ROOMS
WEB SITES
SOCIAL NETWORKING
PATIENT/CAREGIVER
TRAINING
RESOURCES
INFORMATION
CARE COORDINATION
PERSONALIZE EXPERIENCE
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TECHNOLOGY
CARE GIVER
HEALTH WORKER
AGRICULTURE
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22. BUSINESS MODEL
E-COMMERCE
M-HEALTH
LEAN STARTUP
VISION:
INCREASE CAPACITY FOR AUTONOMOUS, INDIGENOUS PROBLEM
SOLVING TO PROMOTE SOCIAL CHANGE, HEALTH, AND WELL BEING
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23. CUSTOMER VALUE PROPOSITION
ACCESS TO CARE
SELF MANAGEMENT OPPORTUNITY
CONFIDENTIALITY
JOB CREATION – U.S. AND AFRICA
INCREASE AWARENESS, REDUCE STIGMA
REDUCE NEED FOR HEALTH WORKER TRAVEL AND EXPOSURE
AUTONOMOUS, CULTURALLY SPECIFIC, INDIVIDUALIZED SOLUTIONS
NOT IMPOSED BY OUTSIDE NGO’S OR GOVERNMENTS OR BUSINESSES
PERSONALIZED EXPERIENCE
ENCOURAGE PREVENTION STRATEGY DEVELOPMENT
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24. SERVICE/PRODUCT DEVELOPMENT CYCLE
RESEARCH
ADJUST, MODIFY,
IMPROVE
SERVICE
HYPOTHESIS
MINIMUM
VIABLE
SERVICE
DATA
COLLECTION
& ANALYSIS
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25. BUSINESS PROCESSES
AND CHANNELS
ARKETING:
INTERNET, WEB BASED VIA WEB SITE, SOCIAL MEDIA, ITUNES
ISTRIBUTION:
INTERNET, TRAINED LOCALS, PARTNERS (PRIVATE, NGO,GOV)
ONEY:
M-PESA MOBILE MONEY PLATFORM, PAY PAL, WEB SITE
SHOPPING CART
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