Technology Review – Last year College Senior Njenga and three classmates developed a program that will let thousands of Kenyan health workers use mobile phones to report and track the spread of diseases in real time—and they’d done it for a tiny fraction of what the government had been on the verge of paying for such an application.
The problem he had tackled was critical in a nation where one in 25 is HIV-positive (10 times the U.S. rate) and AIDS, tuberculosis, and malaria are among the leading killers. In 2010, the Kenyan government realized it had to do something about its chaotic system for tracking infectious diseases in order to improve the response to outbreaks and report cases to the World Health Organization. Handwritten reports and text messages describing deaths and new cases of disease would stream in from more than 5,000 clinics around the nation and pivot through more than 100 district offices before being manually entered into a database in Nairobi. The health ministry wanted to let community health workers put information into the database directly from mobile phones, which are ubiquitous in Kenya. The ministry initially sought a solution the usual way: it explored hiring a multinational contractor. It drafted a contract with the Netherlands office of Bharti Airtel, the Indian telecommunications giant that also operates a mobile network in Kenya. The company proposed spending tens of thousands of dollars on mobile phones and SIM cards for the data-gathering task, and it said it would need another $300,000 to develop the data application on the phones. The total package ran to $1.9 million.
Kenya’s director of public health made an urgent call to Gerald Macharia, the East Africa director for the Clinton Health Access Initiative (CHAI), a wing of the foundation started by former president Bill Clinton. Macharia then called an instructor at Strathmore, who quickly rounded up the four students. They spent the spring of 2011 at the CHAI offices, receiving internship pay of about $150 a month. They sat for days with the staff in the health ministry to understand the traditional way of gathering information. Then they pounded out the app and polished up the database software to allow disease reporting from any mobile Web interface. By last summer their “Integrated Disease Surveillance and Response” system was up and running at the ministry, obviating much of Bharti Airtel’s proposed costs. The process was “rough—but not too bad,” Njenga says. “There were some nights we worked until 2 a.m.” He and his colleagues are now finishing an SMS version so that health workers without Web access can make reports via text message from mobile phones of any make or model. The students are also working on another key problem: coming up with ways for the health ministry to track pharmaceuticals it ships to the government’s hospitals and clinics, to avoid shortages or waste.
Mobile phones are lifelines for Kenyans. Some 26 million of the nation’s 41 million people have phones, and 18 million use them to do their everyday banking and conduct other business; most use a service called M-Pesa, which is offered by the country’s dominant wireless provider, Safaricom. If mobile phones could play as big a role in Kenyan health care as they do in Kenyan financial transactions, the effects could be profound. A growing body of research worldwide is showing that beyond disease surveillance, mobile phones can improve public health by connecting people with doctors for the first time, reminding people to take medications or bring children in for vaccinations, and even enabling doctors in remote areas to view, update, and manage crucial clinical records.
An incident in Ushahidi’s formative days planted the seed for iHub. Ushahidi’s developers had initially offered the technology free of charge to the Kenya Red Cross Society and other NGOs monitoring the violence. But the NGOs didn’t want it; it wasn’t part of their existing plans and funding models. “We had so much resistance,” Hersman recalls. “We kept trying to say, ‘It’s free, we will hold your hand, we will help you communicate with the public to say how you are providing a service.’ They weren’t willing to do anything with it.” The experience taught Hersman, 36, that more might get done if local hackers would get together, write more code, and start some companies that had sustainable business models. He pitched the idea of a corporate-funded space for the tech community to companies including Google and Nokia. “Nobody wanted to set up a hub/lab space in Africa,” he says. “That sounded crazy in 2008.” Finally, the Omidyar Network, the philanthropy founded by eBay founder Pierre Omidyar, donated $200,000 to fund iHub for two years. Other donors, including Nokia, Google, and the African ISP Wananchi, stepped up with equipment and high-speed Internet service.
The incubator opened in 2010 and now counts more than 6,000 members, with an average of 1,000 new applications a year. Most members are merely part of iHub’s online community, but more than 250 of them use the space. Some 40 companies have launched from iHub, and 10 have received seed funding from venture capitalists. The most successful so far is Kopo Kopo, which helps merchants manage payments from M-Pesa and similar services. One key to iHub’s growth is that Kenya’s IT infrastructure has improved significantly. The first Internet fiber connection landed at the Kenyan coast in 2009 (previous service had come through satellite dishes in the Rift Valley), and the country’s first truly mass-market Android smart phone went on sale in 2010, for $80. Safaricom now counts 600,000 smart phones of all kinds on its network and expects them to make up 80 percent of the market by 2014.
MedAfrica illustrates the power of local entrepreneurship. Though it has few connections with the medical community or the health ministry, its health-care app has been downloaded on 43,000 phones, and the company is still only halfway through $100,000 in seed funding. The service can be delivered through an app or through a mobile Web interface (nearly all Kenyans who access the Internet do so through mobile devices). Soon it will be available through SMS—an essential feature, because 85 percent of Kenyan mobile-phone owners don’t yet have Web access. Kyalo hopes to aggregate other medical apps on the platform and ultimately sell sponsored messages from pharmaceutical companies, health-care providers, and others.
The challenge lies in organizing this emerging talent so that it can tackle large-scale projects. Last year USAID, a major funder of health projects in Kenya and other developing countries, requested proposals for help creating a unified, Web-based national health information system that would be “host country owned.” The five-year, $32 million contract went to Abt Associates, a consultancy based in Cambridge, Massachusetts, which has done extensive work in global development projects. But although it has expertise, so does the new tech class back in the host country—which also has a long-term stake in the solution and no U.S. overhead. “If you talked about an RFP for $32 million at iHub, people would go nuts! You’d fund 500 startups for that,” CHAI’s Jackson Hungu says. “And this country’s public health delivery would be changed forever. I have no doubt about that.”