The Challenges & Opportunities We Face with Introducing Cell Phones to Kilifi

In March, Isaac Holeman of Medic Moble visited Kilifi and gave us an assessment of the health system in the District.  Here are some of his notes that paint a picture of the opportunities and challenges facing us with our mHealth work.
The health system in Kilifi District revolves around a district hospital co-located with the KEMRI-Wellcome Trust. Approximately 40 health facilities report to the District Hospital and 30-50 Community Health Workers (“CHWs”) report to each health facility.  Most of the health facilities lack the proper staff and, in many cases, have no IT infrastructure to support their work.  Hospital and community staff use phones but mobile Internet is unreliable. Computer use is not the norm.  Modems may show no bars of network even when a phone displays 1-2 bars.

Some dispensaries have only one nurse; other clinics have four to five nurses and a clinical officer.  Prior to the introduction of cell phones, a staff member could spend the majority of his/her day delivering weekly reports to the District Hospital, closing the health facility if he/she was the only person on staff.

At the national level, Kenya’s strategy for harmonizing CHW programs describes Community Health Units, which includes two Community Health Extension Workers (“CHEWs” are volunteer coordinators).   CHEWs are based at each health facility and about 50 volunteer CHWs can serve approximately 5,000 people. Ten Kilifi facilities are roughly in-line with this national CHW strategy, having at least one CHEW, and 22 more (a mix of Ministry of Health and private) have a data clerk focused on reporting.

In terms of people, 1,500-2,000 volunteer CHWs have a 2-3 week orientation to provide mainly prevention and health promotion services.  Forty CHWs per health facility is typical; the national strategy calls for 50 CHWs but the proposed pilot facility has 36.  CHWs typically visit their health facilities about once per month to deliver Community Based Information System reports.

Due to constraints imposed by the paper based system, the health service is designed for virtually all communication to occur between CHWs in the community and CHEWs at the facility. No district staff are designated to directly support CHWs, which means that putting communication technologies in the hands of CHWs and district staff without also involving CHEWs at health facilities would either be useless or would require substantial restructuring of staff responsibilities to support CHWs.

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