With the continual increase in demand for health services, many public health facilities struggle with the demand, while private facilities are perceived as out of reach for the general population. This continues to increase the demand for remote health care; ranging from very basic tele-consultation on SMS, to more advanced real-time audio-visual interaction with health providers. Before we look at the strategies and options to overcome challenges, mentioned in the earlier blog ‘The challenges of health hotlines’, we invited Sema Doc, a Hello Doctor service in Kenya, to share a little about their service with us.
An overview of Kenya
Kenya, like many other developing nations, continues to face challenges as it tries to provide adequate, quality health service to its citizens. This is enshrined in the 2010 constitution, within which provision of the highest quality of health care is a right for every Kenyan citizen.
Low accessibility to quality health care facilities and to doctors is one of the main challenges. The status of the health workforce in Kenya is summarised in the table below:
|Cadre / Resource||Ratio to population|
|Physicians (all sectors)||1.8/10,000|
|Nursing and midwifery personnel (all sectors)||11.2/10,000|
|Primary health care units and centers||0.99/10,000|
Given the wide ratio between doctors and patients, and the inequitable distribution of the doctors in the country, it would take a very long time (approximately 116 days) for a doctor working 12 hours a day-non-stop, to see a patient at an average of 10 minutes each. Additionally, there is also an inequitable distribution in regards to the location where we find doctors, with a bigger percentage being found in the urban areas.
Such high ratios result in one of two situations: an extremely exhausted workforce, or an extremely underserved population. In many cases both.
An overview of Sema Doc
In view of this shortage and inequity, tele-medicine solutions such as Sema Doc, run by Hello Doctor, represent an opportunity to create a sustainable health infrastructure within Kenya. By providing reliable, high quality, online and telephonic health consultation, diagnosis and treatment for a number of conditions, the service widens access to care significantly. Coupled with advice on different topics such as exercise, diet and nutrition and a second opinion for several diseases like adjunct management of diabetes, hypertension and gastroenterology, Sema Doc was designed to fill in the identified gap.
Hello Doctor’s innovative platform, now in use in three countries, was created with a vision to provide affordable and accessible healthcare, by leveraging the ubiquitous mobile phone to provide 24/7 access to doctors and health education. Sema Doc operates on the Safaricom network with the approval of the Ministry of Health and is the only company in Sub-Saharan Africa licensed to-date to provide tele-medicine on a commercial basis.
Sema Doc is available as a monthly subscription service for only 300 Kenya Shillings payable via m-Pesa or m-Shwari. Users subscribe to the service by dialing the USSD short-code *220# on a Safaricom line, to access registration the first time, and to access the service options thereafter. The subscription package consists of:
- 24/7 mobile access to medical doctors (via voice or text);
- A health account dedicated to help you save for medical expenses;
- Access to instant health loans, a Ksh. 5,000 Hospital Cash Benefit; and
- Access to daily health tips.
Information and assistance provided is completely personal, confidential, validated and tailored to customers’ needs via their phone.
Unique challenges and opportunities
The mobile phones on the other hand have high penetration throughout Kenya. This presents a unique opportunity of increasing accessibility to quality health personnel by leveraging technology and creating access anywhere, to anyone, and at any time.
Some of the main challenges are:
- Changing the consumer behaviour i.e. the belief that when one is unwell, they can be assisted on the phone rather than face to face with a doctor;
- Ensuring that the education reaching the customer translates to behavioural change; and
- Changing the health-seeking behaviour of Kenyans from curative to preventive.
The above example from Sema Doc in Kenya demonstrates how the service has tackled three main challenges highlighted in my earlier blog. On the regulatory front, the service is licensed locally to operate, and on the business model, they offer a monthly pre-pay billing cycle giving the user access to the service throughout the month on a 24/7 basis. Health seeking behaviour is however expressed as a key challenge. This affects demand levels and the rate at which a service would scale up.
In the next blog, we will profile another health hotline service with a non-commercial approach.