Midhill Hospital, Kawangware Nairobi KE

Problems

• Reduced numbers of patients for Ante-Natal Care as many users are avoiding visiting hospitals due to Covid-19
• Children born with “complications” that require emergency surgery or specialized care immediately after birth.
• Mothers are making choices between quality healthcare based on price
• Higher prevalence of C-section for deliveries due to mothers not seeking adequate prenatal care 

Solution

Develop a mobile application that provides easily accessible quality healthcare and connecting patients with Doctors that they would not normally have access to due to cost or proximity.

Positive Change

The mobile application available in Android and iOS will leverage availability of APIs being available from 3rd parties like Zoom, Banks, Telcos to reduce development costs and great customer experience and service for patients. Recent country data indicates that due to Covid-19, the number of teen and young mother pregnancy rates have increased increased, increasing the need for ante-natal, maternity care.

In Kenya, mortality rate for children under 5 years old is 52 deaths per 1,000 live births, according to a report from the Kenya National Bureaus of Statistics (2015). WHO (2013) has estimated the first-year infant mortality rate for Kenya as 39.38 deaths per 1,000 live births (Ogletree, Bass, Benson, Kinuthia).

Limited availability of medical services (e.g., access to an infant-care monitor) while they are pregnant (UNAIDS, 2011) may discourage mothers from bringing newborns to medical care for regular evaluations and, thus, decrease the amount of service and support they receive after pregnancy.

Mid Hill hospital located in Kawangware,Nairobi is a low-income area. The settlement occupies 3sq/km with a a population of 800,000. The area is  characterized by a shortage of safe drinking water, water borne diseases, respiratory pneumonia, malaria, and airborne diseases.

Despite the challenges and income levels, Kenya is a leading consumer of Internet via use of smartphones, making mobile technology in healthcare crucial to improving healthcare provider-patient communication and accelerate the patient care process. To lessen  mortality rates, we propose a mobile application that provides easily accessible quality healthcare and connecting patients with doctors that they would not normally have access to due to cost or proximity.

Solution will leverage availability of APIs from 3rd parties e.g. Zoom, Banks, Telcos to reduce development costs and great client experience & service.

Why will it work?

• 80% of target demographic (women aged 20 - 35 years) in the community have access to a smartphone
• Availability of Banking and Mobile Banking services
• Wide acceptance of Mobile Services e.g. Mpesa
• Sustainable – App will pay for itself within 3 years once it achieves 20,000 members 

Benefits

• Reduce cost of access to quality healthcare for our patients who earn an average of US$2-5 per day.
• Safer delivery in a clean hospital facility that is well staffed, with a fully equipped operating theater for emergencies.
• Convenience for patients to access high quality health care at an affordable rate without additional cost of transport

Features

• Payment for services using small daily amounts instead of lumpsum payments per visit.
• Uber-like service to call-in closest doctor to patient in case of emergencies
• Registration of Doctors & other service providers
• Integrate Zoom APIs for consultation to patient any time, anywhere
• Schedule in-person appointments that enforce “social-distancing” rules for services:
  • ANC guidance
  • Delivery
  • Lab tests
  • Radiology and Ultrasound
  • Pharmacy
  • Triage (Weight, Temperature, Symptoms Review)
• Multi-language (English and Swahili)

Healthcare landscape is a focus of Kenya’s Vision 2030 Plan. Significant reforms towards achieving Universal Health Coverage (UHC), a Big Four Agenda Pillar of the administration have been made but challenges remain in attaining quality and affordable healthcare. For UHC, of which maternal and child health is a primary focus, to be achieved equitable health access and improved quality of health services must improve.

Midhill Hospital began as a 2-room medical clinic in 1989 and evolved into a maternity home with 28 beds. It is located in Kawangware, Nairobi, a low-income area about 12 km west of the city. We work closely with the sub-county health dept, National Hospital Insurance Fund and PharmAccess, a Netherlands-based NGO dedicated to improving access to quality healthcare in Africa.

Kawangware and the environs occupy 3 sq. km with a diverse population of 800,000. It is characterized by shortage of safe drinking water, waterborne diseases, pneumonia, malaria, and airborne diseases resulting from the inadequate drainage system. Electricity supply is unreliable. The community that we serves includes nearby neighborhoods but patients also come from nearby counties. Many families live in single room homes. The main form of transport is via buses (matatu) and motorbike (bodaboda).

Limited availability of medical services and health care costs (UNAIDS, 2011) discourage mothers from attending ante-natal, hospital deliveries, post-natal care, and child welfare clinic. Many mHealth applications use SMS, a low-cost communication medium commonly used on basic mobile phones in Africa. However, the health applications use one-way, push messaging, where generic messages are sent to many users with no way to respond.

Our solution offers a personalized service. The solution will reduce the cost of quality healthcare for our low income patients by services in a hygienic well staffed hospital with a fully equipped operating theater and delivery rooms.

There are several competitors in the field of mHealth in Kenya who operate at various levels. Some of these mHealth solutions are uber-like ambulance services, pharmacy delivery services, SMS messaging services, mWallets for health saving, etc. The model of many these apps is high revenue generation by targeting middle income populations.

The difference with our solution is to focus on providing digital services for low income clients who have little disposable income that they can put toward healthcare and healthcare insurance. Kenya's main population is low to middle income, and forms over 65% of the population, a majority of which is under 35 years of age and working in the informal sector, self-employed, or unemployed.

Even as we seek to earn income from the hospital, we believe that we have a social and economic responsibility to contribute to our community and we will maintain our goal to offer ‘Affordable Quality Healthcare.' As a social enterprise, we continue to offer our services while adding value in various ways that seek to create a balance between the community, the environment, income, and service.

Keeping with the vision of the founder the late Dr  Gateri to serve the community remains at the core of Midhill Hospital. To do so we will focus on the following:

Social Impact and Responsibility
Keeping with the vision of Dr. Gateri to serve the community remains at the core of Midhill Hospital.
Community Service and Health Education
We continue to be of service to the community and provide emergency treatment to those with no income. We are a source of health education in our area in collaboration with churches and schools. We continue to liaise with the sub-county health department to provide subsidized services immunizations, TB clinics, HIV/AIDS testing.
Mobile Health (mHealth)
There are only 1.8 doctors for every 10,000 patients in Kenya, highlighting the shortages of trained health personnel. With such shortages, the health sector is turning to alternative ways of disseminating information.
NGO Partnerships
We seek to partner with NGOs whose missions align with our mission e.g., TB and HIV/AIDS education, gender violence outreach, and child safety.
Training Programs
As we attain more working space and services become available, we will offer affordable training classes to the community members
Environmental Impact and Responsibility
Dependability of water, electricity, and other utilities in Kenya remains a challenge. To ensure that we continue to provide uninterrupted services to our patients, we have installed generator power that serves as a backup during power blackouts.

The current number of people we are serving per year: Outpatient -10,000; Deliveries - 350

The number we will be serving in one year: Outpatient - 12,000; Deliveries - 500

The number we will be serving in serving in five years: Outpatient - 21,000; Deliveries - 1200

* Projections are based on current trends and recent new schemes that we have signed on to with the government insurance fund (NHIF) and micro-insurances.

Our goals are to maintain a health care facility that exceeds patients' expectations, serve the community's needs and provide high-quality health care to residents of the area.

• Expand a medical practice that will be able to survive off its cash flow in twelve months or less.
• Increase the number of patients by 30% per year through superior performance and word-of-mouth referrals
• Increase the number of maternity deliveries to 8 per da
• Reduce missed appointments to under 5%
• Increase the average visits per month to 100 patients per day within the first one year, and 200+ patients by the beginning of the second year
• Increase the number of maternity patients to five per day
• Grow from a capacity of 28 to 75 beds in five years
• Increase essential and complementary services while remaining affordable

• Create community awareness about our contributions as a social enterprise

This will be done through:

• Focusing on quality patient care
• Educating patients on the importance of preventative care
• Educating patients as to the importance of yearly check-ups
• Implement an aggressive and accurate system in which to remind patients to have regular check-ups

Barriers and challenges include the cost of technology, as well as access to tapping into local talent who have brilliant ideas but limited resources to work with.

Financial challenges in the current economic climate have also limited the possibility to which we can develop and market our mHealth solutions.

Kenya’s healthcare landscape, a key focus of Kenya’s Vision 2030 Plan is rapidly evolving but for medical practitioners, securing investment capital to purchase medical equipment is an ongoing challenge. Financial institutions are often reluctant to lend to small to medium enterprises (SMEs). Despite the challenge, the private sector is playing a significant role in providing healthcare services to reach more people in the country.

Patient privacy considerations must also be factored into the design. A difference in the cultural and local perspective of privacy is a goal we aim to ensure is well integrated in the solution.

Cultural issues related to health seeking behavior should also be taken into consideration. For example many clients would seek the services of Traditional Birth Attendants (TBAs) vs considering healthcare facilities.

To overcome these barriers,we will continually provide health education services within the facility and also through the use of Community Health Volunteers (CHVs).

Collecting, analyzing, and utilizing data on how mobile solutions impact mothers’ pre-natal and and postnatal care through participation in the mobile maternal health messaging intervention will be important.

Five people working on the solution

Full time: 2

Part time: 3

Our team is made up of healthcare providers, mobile app developers, programmers, educators, and project managers.

We partner with:

PharmAccess

The Dagoretti sub-country

National Health Insurance Fund (NHIF)

As an NHIF-accredited institution, we provide health care services to civil servants and to members of the national scheme who pay into the national fund. We accept NHIF cards from civil servants and the national scheme cardholders for available outpatient and in-patient services. We receive payments based on the capitation model and rebate model based on the serviced offered. 

All patients are welcome, including the ones with no insurance coverage. Everyone receives excellent medical care, and no one is turned away for emergency medical care.

Affordable pricing with various options of payment including cash, M-Pesa, insurance cards, and debit/credit cards.

We currently accept insurance coverage from various insurance companies where patients pay directly to us and file for reimbursement from their insurers.

• Market and create a presence in the community by giving talks to schools, churches, community events, and doing volunteer work
• Network to obtain referrals from other professionals, such doctors, specialists, local county and government health centers and hospital admissions offices
• Expand our web presence and digital media marketing approach

We will also in the future seek funding from the Medical Credit Fund (MCF) from PharmAccess

We seek donations for equipment that we cannot readily access or buy.

• Increase the numbers of patients for Ante-Natal Care as many users are avoiding visiting hospitals due to Covid-19
• Reduce the number of infants born with “complications” that require emergency surgery or specialized care immediately after birth
• Reduce instances of mothers are making choices between quality healthcare based on price
• Reduce the prevalence of C-section for deliveries due to mothers not seeking adequate prenatal care

We will also seek to partner with NGOs whose missions align with our mission for example TB and HIV/AIDS education, gender violence outreach, and child safety.

We partner with insurance companies

Approaching nearby small, medium, and large enterprises that may or may not offer insurance cover to their employees to consider Midhill Hospital as their preferred healthcare is a strategy we propose.

We are already working with the government in various capabilities to address similar goals to providing health care. 

We already receive free immunizations, some laboratory test e.g. HIV/AIDS tests and TB treatments from the sub-county government for our patients. We then collect data and reports based on our monthly treatments and submit them to them to the government for tallying.

As an NHIF-accredited institution,we provide health care services to civil servants and to members of the national scheme who pay into the national fund.

MIT faculty or initiatives

Solve Members

Our theme is maternal and child health. We focus on healthcare services and and health care education to improve whole family outcomes.

Currently, there is no program in place to inform new mothers many health care issue.  The infant-care monitor nurses will keep track of contacts from mothers and through doing so may discover some confusion or problem caused by one or some of the challanges, and we will revisit the solution and translations to address the problem. Over the period of the project, the staff will train hospital staff to monitor the program and maintain program records so that these responsibilities can be transferred to the hospital once the project has ended. Our technology solution will maintain the databanks of messages so that they can be made available to new hospital sites who want to implement the program.

Since its inception, Midhill Hospital has always focused on maternal and child health.

We strive to continue offering these as our primary services, for which we have become known for, in addition to providing other related and support services. 

Midhill Hospital provides general care for all ages, in addition to multiple services and procedures to create a complete health care solution. The charges depend on upon the materials use and the diagnosis.

Midhill Hospital philosophy is that the proper balance of exercise, nutrition, and education supports optimal health. Our goal is to educate our patients as well as treat them.

• Child Welfare Clinic and Pediatrics: Immunization, weighing, health education, newborn care, well baby clinic, annual physicals, and other preventative and routine services;
• Maternity and Gynecology: Antenatal clinics, health education, post-natal clinics, deliverywellness exams, family planning and contraception;
• Adult Medicine: Preventative and routine services e.g. malaria and typhoid treatment, diabetic and hypertension education and care, Voluntary Counseling and Testing (VCT) for HIV/AIDS patients, tuberculosis (TB) clinic