MUGA: Universal health coverage well within reach

The really important conversations taking place right now, are those which begin with the words, “No matter who wins the upcoming presidential elections,…”.

For irrespective of who is finally declared to be the winner, certain problems that the current president, Uhuru Kenyatta, has struggled with, will remain somewhere near the top of our national priorities.

Universal health coverage is one of those priorities.

And it is deeply ironical that the lessons for how Kenya can provide such UHC come mostly from the terrifying days of the 2020 to 2021 peak of the Covid-19 pandemic.

This global crisis made clear the keys to effective public health policy. First, that vaccines, where available, are the surest means of guarding against deadly infections. Second, that where vaccines are not available, then prevention based on behavioural changes can go a long way towards slowing down the spread of any such infection. And finally, that the harnessing of ICT – and in particular the creation of smartphone-based medical records – must be central to any national level programme for fighting disease.

Now at the practical level, there are plans already underway to set up a vaccine manufacturing plant right here in Kenya, in collaboration with Moderna, one of the world’s leading vaccine research companies and a key player in the recent creation of Covid-19 vaccines.

But that is a topic for another day: I want to deal here with just the last two of these three.

First, the efficacy of behavioural change: I think most of us still carry vivid memories of dusk-to-dawn curfews; social distancing; and compulsory face masks. All these were seen as a great inconvenience by almost all of us.

But it was also clear that if these preliminary measures – which could be implemented at minimal cost to individuals – were to fail, then the next levels of public health interventions were bound to be inordinately expensive.

These next levels of interventions included quarantine of those suspected of being infected; and hospitalisation where such infection was found to have taken root and caused life-threatening illness.

And whereas it is a costly intervention to have people stay in designated hotels for 14 days or so while still under observation, that is nothing compared to the cost of hospitalisation for Covid-19.

In some of the countries most devastated by the pandemic, the question of life or death boiled down to how many ICU beds the country had; and particularly, how many ventilators were available for use by those who could no longer breathe on their own.

In terms of cost, it is an enormous jump from a disposable face mask to an ICU bed equipped with a ventilator.

And therein lies the first lesson for the public health policy of any developing nation (or even a lower-middle-income nation like Kenya) seeking to implement a universal health coverage programme: the most affordable interventions revolve around prevention through behavioural change.

This is not as easy as it might at first seem. There is some instinct in most of us that makes us reluctant to do whatever we are compelled to do by authority figures. And so, you find that this very simple intervention of wearing face masks was bitterly resisted in many quarters, even when the logical reasons for wearing them were perfectly clear. This was not just in Kenya, but all over the world.

But then came the life-saving vaccines. And I believe that this was the first time that ordinary Kenyans, not provided with health insurance by some private sector insurer, got to see just how efficient health management systems could be.

Immediately upon the first free vaccination, you got a mobile phone text message confirming this, and in due course another text message would remind you to go for the second vaccination if this was needed – all the way to the booster dose for those of us no longer young.

And these vaccination records were stored in the form of a QR code, a type of machine-readable optical label that contains data that can be read by an imaging device such as a camera.

So, we all got to carry our Covid-19 vaccination records in a format that is acceptable all over the world, and which could be used to establish our vaccination status.

If it had not been for the easy availability and widespread ownership of what has been hailed around the world as “the $20 smartphone”, I am not sure if there is any other method by which personal health data could have been generated as well as stored so easily and at virtually no cost to the beneficiary.

Thus, it is clear that the harnessing of ICT lies at the very centre of any affordable universal health coverage programme.

And fortunately, we have right here in Kenya an example of how medical expenses can be lowered, and accuracy of diagnosis increased through the use of ICT.

Doctors at the Kapsabet County Referral Hospital in Nandi county are already using Japanese technology to conduct medical diagnoses and provide better patient care.

This is through the use of JOIN, a mobile app developed by a Japanese company, Allm Inc., which enables doctors, nurses and pharmacists to manage patients’ data, including past records, prescriptions and test results in a highly secure environment, protecting patients’ privacy.

AllmAfrica briefing documents elaborate that, “The core mission for Allm is to provide solutions that revolutionize clinical communications, reduce healthcare expenditures, streamline clinical workflows, and improve quality of healthcare services and patient experience. We connect clinical providers at primary and tertiary healthcare settings to specialists in specialized health facilities to resolve healthcare challenges using [the] telemedicine platform called JOIN.”

The app also allows access to CT scans and ultrasound images, which can be shared with other doctors for referral.

This app is expected to address inequality of medical services by linking health professionals in rural areas to specialists in cities or even in other countries.

Consider the case of Rwanda. In that country, JOIN connects four hospitals in Kigali with university hospitals in Japan, allowing the Rwandese doctors to have access to the most advanced Artificial Intelligence diagnosis and chronic illness assessments by Japanese specialists.

This is many steps beyond the simple capture and storage of vaccination records. And it shows what is possible when you have the right kind of advanced technology made available to help make public health interventions affordable.

The greater and more widespread use of such technology will undoubtedly promote equitable access to quality medical services and contribute to the achievement of universal health coverage.