Consumer powered digital health care

Population Services International (PSI) is partnering with Ada to bring ground-breaking artificial intelligence health technology to consumers in Kenya. Together, our digital gateway will support consumers to manage their healthcare journey using their mobile phones. Our goal is to leverage this technology and data to improve health and well-being.

Hila Azadzoy, Managing Director, Global Health Initiative, Ada

Martin Dale, Director, Digital Health, PSI

We will address poor/inappropriate health seeking behaviour amongst young people (aged 18-29) in Kenya. A consumer's health journey should begin with knowledge and understanding of their health and with healthcare options at their convenience.

We undertook research with Kenyans aged 18-29 to better understand health-seeking behaviour. This research highlighted pain points that we aim to address, such as: 

• Prevention is not top-of-mind. They will go to a clinic, but only once extreme health risks arise. A delay in seeking healthcare may have an adverse affect on health improvement.
• Google > Providers. Why? Google is deemed non-judgmental. Young people Google to self-diagnose and treat. Hesitancy to engage providers due to social stigma (particularly sexual health) drives young people to Google, yet it tends to be an unreliable source as the information is not personalized or quality assured.
• Confidentiality is key, and time efficiency is valued. Young people want health information at their fingertips and in privacy. Competing daily priorities and responsibilities (e.g., work and school) limit the time available to pursue health support. 

With instant personalized and reliable access to health information, we can address these challenges and meet the consumer where they are most at ease.

Kenya has a population of over 50 million and over 20 million internet users, 97% of whom access the internet through mobile phones. Kenya is a predominantly youthful nation, with 75% of the population aged below 35 years. The primary target audience will be the younger population (aged 18-29) given their higher levels of mobile ownership and use.

Our research shows that young Kenyans want impartial and convenient access to information as well as knowing where to go to get the appropriate care. We will engage user centered design for this specific solution and will recruit a cohort of young designers to be actively involved throughout the implementation cycle, working in partnership with a local design agency in Kenya. We will leverage existing formative research findings to establish how best to position the solution with the target audience.

Our solution will be available for use on-demand by all internet users as the AI medical assessment and linkage to care digital solutions are accessible through a basic mobile web browser.

The proposed platform will be freely available to consumers with certain products and services being provided for free or at-cost as part of PSI’s behaviour change and demand creation activities. Signposting to health facilities will be free of charge to both provider and consumer and will act as a one-stop shop that directs consumers to the most appropriate facility for their situation.

Consumer data collected will be used to inform policymakers of bottlenecks in the system, unmet in-demand needs, signs of potential outbreaks, and health system inefficiencies.

Our goal is that more consumers will access health services due to ease at which they can access information and be directed to the appropriate care. We also expect reductions in out-of-pocket payments and unnecessary expenses due to misdirection by current triage services.

Activities: 

• Create the ecosystem for effective linkage to care by developing a mobile enabled web-based platform to integrate Ada’s AI symptom assessment tool, PSI’s digital health tools, and HMIS data systems
• Conduct human-centred design testing with consumers to inform creation of web interface
• Use Facebook analytics to understand potential consumer needs and digital health behaviours
• Revise literature and qualitative study to explore consumer insight and experiences with lower out of pocket expenses and more accurate triage
• Communications campaigns using social and mass media to inform consumers
• Conduct routine in-person satisfaction and mystery shopper surveys to continuously assess and improve consumer experience  

Outputs: 

• Mobile-enabled web-based interface to triage consumers to appropriate care and provide consumer with assessment reports based on user risk factors and symptoms. 

Outcomes: 

• Increased numbers of consumers seeking appropriate health care and reduction in out-of-pocket expenses
• Increased client satisfaction
• Strengthened health service to direct consumers quickly and appropriately to public and non-public health services 

Year 1 and 2: Scale of impact will be determined by the extent to which youth are exposed to, and interact with, the digital solution. PSI’s network member in Kenya is PS Kenya, one of the country’s leading social and behaviour change organisations. PS Kenya has a number of digital and non-digital youth brands that have captivated youth. For example, their youth focused Facebook pages have over 300,000 followers. We will leverage this existing audience base in year one to establish early momentum on uptake. PSI also has a global strategic partnership with Facebook that will potentially be leveraged to benefit the project through marketing support to amplify reach. PS Kenya has a network of over 400 franchised clinics and 3,000 pharmacies that will be utilised both as marketing agents and points of referrals. The audience base of these networks is in the millions.

Year 3: At the end of this project, we will have a proof of concept in Kenya and be at a point where we can expand to other markets and replicate the model we have developed.

Success of the project will be measured by:

• The number of impressions achieved through our digital marketing efforts to raise awareness on self-care and health seeking behaviour.
• Conversion of the impressions to consumers accessing the digital tools.
• Quality and depth of engagement with the digital tools based on pre-determined outcomes.
• Number of consumers signposted or referred to products and services.
• Conversion of referrals to self-reported product and service uptake.
• Repeat/continuous engagement with the digital tools.
• Client satisfaction based on systematic feedback following use of the tools.

One of the key barriers to digital innovation in Lower to Middle Income Countries is the cost of mobile data that is borne by the consumer. Although Kenya has the lowest cost of mobile data in Eastern Africa, based on consumer research, mobile data is considered to be expensive, hence the use of a platform that consumes mobile data may create a barrier to uptake. In order to address this, we will engage with Safaricom, Kenya’s leading mobile network provider, to explore the feasibility of eliminating the cost of accessing the digital solution URL. This is something PSI has achieved in settings such as Angola, where the URL in use for e-learning for health providers is accessible at no cost through a partnership with the mobile network provider. 

Other barriers include trust, both from the consumer and provider perspective, given that this will be a new technology in market. Consumers are accustomed to providers, such as pharmacists, over-prescribing medicines such as anti-biotics. The platform’s recommendation may well clash with consumers learned expectations and pharmacist’s recommendations. Behaviour change campaigns will need to address this risk and build trust in the platform’s recommendations.

Both PSI and Ada have successfully deployed their respective digital health tools but see great promise in combing the tools into an integrated platform. Funding is required to get the initiative up and running and to demonstrate the potential to larger institutional funders and corporate funders for scale-up in Kenya and further afield. The Trinity Challenge is a great opportunity to not only secure funding for this innovative solution but also provide strategic advice, access to an extensive network and the ability to promote the solution for use in other contexts.

Aviva, Swiss RE and Legal & General: Understanding how our solution can help expand insurance to under-served and youth populations

Microsoft, Bill and Melinda Gates Foundation, Patrick J. McGovern Foundation: Knowledge of related projects in Kenya and elsewhere that could be leveraged by this solution.

RB and GSK: Access to promotional networks to expand marketing of the solution to the target audience.

Bluedot, Zenysis and Infosys: Support with data analysis and visualisation for decision-making towards better consumer experience and driving efficiencies within the health system.