Rural-urban divide hampering digital health innovation in Kenya
By Janet Onyango
Just as the Ebola and now the Covid-19 crises galvanised digital innovation in healthtech, across Africa, The Covid-19 pandemic brought with it a surge of Kenyan digital innovations in the health sector. However, infrastructure and other challenges continue to limit the reach of health digital innovations.
Tibu Health, Zuri Health, Nadia, TeleAfya and Penda Health are examples of telemedicine apps that connect patients to doctors and other primary healthcare workers, local pharmacies, ride share apps etc affordably. Damu-Sasa helps hospitals source blood from donors and from other hospitals, while tracking the donation histories. Ilara Health offers affordable mobile phone and tablet-based diagnostic equipment to patients and healthcare providers in peri-urban areas. Afya Poa allows users to pay for health insurance premiums on a daily basis for inpatient care and save for outpatient care. The product extends the cover to the user’s family. CEMA, a platform developed in a partnership between innovation lab Qhala, the University of Nairobi and Kenya’s Ministry of Health, aggregates epidemiological data from government and other sources and uses data engineering and data visualisation to make the data accessible to the general public for research purposes.
This surge was made possible partly by a supportive regulatory framework. Kenya’s National E-Health Policy 2016–2030 prioritises, among others, the development and use of mobile technologies for health (M-Health), as a means of delivering quality health care to all. There is, arguably, space for more digital health innovation in the areas of maternal health, contact tracing, mental health, health data and others that would strengthen Kenya’s chronically underfunded health sector. However, systemic challenges continue to deepen a pre-existing urban-rural divide, hampering the ability of health digital innovations to scale.
Infrastructure
Digital innovations, including health innovations, in Kenya tend to be concentrated in urban and peri-urban areas for reasons related to infrastructure. Grid power is uneven in the rural areas, making the cost of internet connectivity higher in rural areas than it is in urban areas. This high cost, combined with the fact that incomes are generally lower in rural areas, is part of the reason why only 17% of rural populations in Kenya have access to the internet, compared to 44% in urban areas, according to World Bank statistics. Access to 4G internet is still largely concentrated in and around urban centres[1].
Innovation ecosystem
In addition to infrastructure challenges, as Jacob Mugendi of Engineering for Change points out, innovation hubs tend to be located in urban areas not rural areas, contributing to the lack of an innovation ecosystem outside of the cities. This locks out of the digital scene potential local innovators who understand local problems that need solutions.
Low digital literacy
Despite the roll-out of the Kenyan government’s Digital Literacy Programme, many schools across the country, particularly primary schools, still do not have computers or access to them. Digital literacy levels remain low. Where digital tools are in use there is low availability of support, particularly for older, less savvy users[2]. Despite Kenya’s high smartphone penetration, digital innovations in general tend to be the preserve of residents of urban and peri-urban areas.
These challenges are, in reality, three aspects of the same persistent rural-urban divide, deepened by systemic factors. Until these challenges are addressed, or until the digital health apps are designed to be more inclusive, the digital innovation in the health sector will not be able to scale within the country, no matter how much funding they are able to secure.
[1] https://www.engineeringforchange.org/news/challenges-implementing-digital-technologies-rural-kenya/
[2] https://www.engineeringforchange.org/news/challenges-implementing-digital-technologies-rural-kenya/
