STONE HMIS

Digital collaboration for effective health interventions for under-served populations

We run a network of medical centres: Ubuntu-Afya Kiosks, targeting under-served rural communities in Kenya. We work with locally registered community groups to set-up and operate our centers. We co-own the clinic with the group and share expenses and profits. We pair the health service with other supplementary enterprises: themed around transport and financial services, and utilize the revenue  earned to cross-subsidize the cost of health-care and promote sustainability. We believe that by engaging communities in the health system, we enhance the relevance of our services and promote social responsibility. By incorporating supplementary enterprises, we make care more affordable, support financial inclusion, and address other healthcare access challenges in poor rural communities hitherto unserved.

To help manage and operate the centers, we deploy an in-house Health Information System: STONE HMIS®, a modular point-of-care system that integrates all components of the health system, including community, clinical and administrative modules. STONE HMIS® interacts directly with the government’s health data repository: the DHIS2, incorporates local administrative, clinical and pharmaceutical databases, and is easily adaptable for different clinical environments. STONE has newly developed capabilities for biometric identification to promote unique identification and cloud connectivity, supporting patient tracking at the community level and across different providers. 

Ubuntu-Afya and STONE HMIS help us to address the challenges rural communities face in accessing sustainable primary healthcare services. Maternal and newborn mortality remains highs in these settings: at least 1 mother dies for every 196 deliveries, 1 for every 25 newborn does not survive beyond the first year of life, and 1 out of 19 children do not reach their 5th birthday. These dismal health indicators are mostly a consequence of poor access. Rural communities are little served by public facilities and are shunned by private health enterprises because of perceived non-viability, making for poor access. Most rural settings are relatively sparsely populated compared to urban settings, and are therefore little prioritized for public health resource allocation although they contribute significant MNH morbidity and mortality in dis-congruence with their population sizes. Such bias in resource allocation is also partly attributable to weak health data systems crucial for informing public health interventions. The County Health Management Teams (CHMT) and existing health providers rely on feeble data systems resulting in inconsistent care because of broken records, multiple registration of individual clients, inaccurate reporting to the government data repository (the DHIS2), and poor health planning. 

Reaching under-served poor communities effectively with quality healthcare requires participation of the target communities, consideration for innovative solutions to promote sustainability and the development of robust data systems for effective and strategic interventions. Ubuntu-Afya Kiosks and STONE HMIS® are part of the solution. We are looking to expand access to STONE HMIS® to public and faith-based facilities that serve as referral points for our centres, linking them to our facilities in a wide area network and taking advantage of our biometric unique identifier system to track patients across the referral chain and into the communities that we target, facilitating optimal care.

STONE HMIS incorporates all the components of the provider health system and is a first in linking community health systems with provider health data systems, promoting better patient follow-up and community disease surveillance; and in facilitating inter-provider access to common patient databases, enabling coordinated care and smoother referral schemes. STONE directly connects with the government’s health data repository, making for accurate health data processing, and incorporates biometric systems, making each patient count uniquely in the health system. We are anchoring our digital health collaboration using STONE HMIS on an established model of offering care for under-served communities: the Ubuntu-Afya Model. 

To help manage and operate the Ubuntu-Afya network, we deploy an in-house Health Information System: STONE HMIS®, a modular point-of-care system that integrates all components of a provider health system. STONE HMIS® interacts directly with the government’s health data repository, incorporates local administrative, clinical and pharmaceutical databases, and is easily adaptable for different clinical environments. STONE has capabilities for biometric identification for unique identification, and cloud connectivity, supporting patient tracking at the community level and across different providers. STONE has served us in promoting efficiency in our operations, improving health outcomes, and supporting us in tracking our impact and revenue.

Over the next 12 months, we intend to:

- Implement biometric unique patient ideintifcation and facilitate network linkage within our network and with public health facilties that act as referral points for our network

- Develop analytical algorithms to help us develop machine learning capabilities, promoting the generation of best-practice evidence ot help us better serve our patients

- Develop a business model to support the commercialization of STONE HMIS fand avail it to third-party providers

- Expand the capacity of Ubuntu-Afya centres to offer enhanced MCH services and develop HIV care services, promoting our relevance to the communities that we serve

Over the next 5 years, we intend to:

- Establish a country-wide digital health environment anchored on STONE HMIS®, supporting efficient patient follow up, accurate and accessible health records; and  advancing evidence synthesis in health. We aim to be producers of reliable big data whose analyses would provide greater insights on health issues in sub-Saharan Africa, including determining emerging disease trends, and appropriate interventions for target communities.

- Set up 20 more kiosks across the country to reach more communities at the bottom of the pyramid

- Develop secondary health facilities to serve as referral hubs for our network, enhancing outcomes

The Ubuntu-Afya model specifically targets communities at the bottom of the pyramid by aggregating their health needs with financial and transport needs, providing a package that is economically viable for settings that would otherwise not be candidates for private healthcare investments. Thus, we are designed to select for poor communities in geographically challenging areas. In deploying biometric and cloud capacilities of STONE HMIS across our network, and facilitating linkage with other health providers, we are essentially reaching this cohort. We are working on a viable business model to support the deployment of STONE HMIS to government and other health providers, to facilitate sustainable access.

Over the past year, we have provided primary health services to over 31,000 people, 21,000 of them being women and children under-5. We have offered Non-Communicable Diseases (NCD) to more than 3000 people. Our interventions have facilitated access to crucial services, improving health outcomes for people who previously had limited access.

We expect to reach more than 100,000 individual patients over the next year through services at our kiosks, facilitated by STONE HMIS. Such access will impact on skilled delivery rates, ANC access rates, care for under-5s, HIV care services and NCD care: promoting better health outcomes.

ARA's operations are overseen by a Board of Directors which has members with a mix of skills in research, finance, law, public health and patient advocacy. The Executive Director, reports directly to the board, and leads the senior management team (SMT). Each SMT officer oversees relevant project teams including, site management and coordination, monitoring and evaluation, finance, procurement, and STONE HMIS®. Coordinators work closely with community committees to run the facilities and navigate socio-political challenges. The STONE programming team has great competencies in using Zend framework 2/3 and related systems,  in network engineering and in deploying biometric systems.

By employing business model innovations in the way we cover costs across our network, we are able to operate sustainably.  We offer services at subsidized costs and cross-subsidize care with revenue from supplementary enterprises. Increasing patient numbers and National Health Insurance Fund accreditation will help boost our revenue even further, promoting our sustainability. We receive health  human resource and commodity support from county governments and other partners, reducing our costs significantly.

In deploying STONE HMIS to other providers, we are looking to develop revenue, with considerations including pay-per-client, subscription, licensing models, and program support.

We hope to leverage on a community of thinkers, technology buffs and innovators to help us advance our plans to create a digital health environment to improve the efficiency of the health system and promote better outcomes for our patients. We expect to make our intervention more robust and position it for greater investment and scale-up, to serve the health system in Kenya as a whole.

Negative health-worker attitudes to digital health information systems (HIS) limit their uptake. We need to innovate and implement behavior change strategies to promote the uptake of STONE HMIS for routine care. 

Inconsistent electricity supply, poor telecommunication networks and other infrastructure barriers complicate the deployment of our HIS. Part of our intervention involves innovating ways to provide alternative power solutions and surmount the digital divide to make for effective implementation.

We need greater awareness, goodwill and investment by governments, policy makers and development partners to support the development of robust health data systems for effective health interventions.