I N K E N YA

EMPOWERING WOMEN WITH

AIDS

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J U D I T H K . B O N D

M-HEALTH

Judith K. Bond 2

HIV/AIDS STATISTICS

K EN YA A N D A F RI CA

HIV/AIDS- GIRLS AND WOMEN

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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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AIDS ECONOMIC IMPACT, KENYA

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RELATIONSHIP BETWEEN FEMALE SEX WORKERS

AND HIV/AIDS IN AFRICA

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CURRENT GLOBAL HIV/AIDS STRATEGY IN AFRICA

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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

UNIQUE SELF-MANAGEMENT AND CHRONIC CARE

CHALLENGES FOR HIV/AIDS

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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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KENYA M-HEALTH CURRENT

MARKET ASSESSMENTA 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 *

316 MILLION NEW TELECOM SUBSCRIBERS ADDED SINCE 2000

AFRICA OFFERS HIGHEST ROI OF ANY EMERGING MARKET- U. N. DATA

*Chironga, Leke, Lund, & Wamelen(2013). Cracking the next growth market: Africa. Harvard Business review www.hbr.org

2008 Africans spent $860b on goods and services-35% more than Indians

SOCIO-CULTURAL ENVIRONMENT

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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

Communicaid Group 2010 Doing Business in Kenya

CHALLENGES:

URBAN/RURAL, TRIBAL, RELIGIOUS DIFFERENCES

ECONOMIC FREEDOM CHALLENGES

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ECONOMIC OPPORTUNITY THROUGH

MOBILE PAY TECHNOLOGY

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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

MOBILE PHONE USE, KENYA

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MOBIL PHONE MARKET IN KENYA

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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

ENVIRONMENTAL CONSIDERATIONS

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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 poolsKumar, 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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CONTEXTUAL HEALTHCARE SYSTEMS

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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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HEALTHCARE ACCESS CHALLENGES, KENYA

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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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M-HEALTH IN KENYA

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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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PRIOR M-HEALTH TRIALS IN KENYA

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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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POTENTIAL SOLUTIONS

KENYA – M-HEALTHI 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

DOMESTICINTERNATIONAL

MULTI-INDUSTRY

CURRENT U.S. BASED M-HEALTH TECHNOLOGY

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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

POTENTIAL SUPPORT SERVICES

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EDUCATION

• Health literacy

• Self-management

• Nutrition

• Hygiene

SOCIAL SUPPORT

• CHAT ROOMS

• WEB SITES

• SOCIAL NETWORKING

• PATIENT/CAREGIVER

PATIENT ADVOCATESTRAINING

RESOURCES

INFORMATION

CARE COORDINATION

PERSONALIZE EXPERIENCE

TECHNOLOGY

CARE GIVER

HEALTH WORKER

AGRICULTURE

BUSINESS MODEL

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E-COMMERCE

M-HEALTH

LEAN STARTUP

VISION:

INCREASE CAPACITY FOR AUTONOMOUS, INDIGENOUS PROBLEM

SOLVING TO PROMOTE SOCIAL CHANGE, HEALTH, AND WELL BEING

CUSTOMER VALUE PROPOSITION

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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

SERVICE/PRODUCT DEVELOPMENT CYCLE

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SERVICE

HYPOTHESIS

RESEARCH

MINIMUM VIABLE

SERVICE

DATA COLLECTION & ANALYSIS

ADJUST, MODIFY,

IMPROVE

B U S I N E S S P R O C E S S E S

A N D C H A N N E LS

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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