Kumar Pratap, Paton Chris, Kirigia Doris
Institute of Healthcare Management, Strathmore Business School, Nairobi, Kenya Health-E-Net Limited, Nairobi, Kenya.
Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Arch Dis Child. 2016 Oct;101(10):974-9. doi: 10.1136/archdischild-2015-308556. Epub 2016 Jun 13.
Mobile technology is very prevalent in Kenya-mobile phone penetration is at 88% and mobile data subscriptions form 99% of all internet subscriptions. While there is great potential for such ubiquitous technology to revolutionise access and quality of healthcare in low-resource settings, there have been few successes at scale. Implementations of electronic health (e-Health) and mobile health (m-Health) technologies in countries like Kenya are yet to tackle human resource constraints or the political, ethical and financial considerations of such technologies. We outline recent innovations that could improve access and quality while considering the costs of healthcare. One is an attempt to create a scalable clinical decision support system by engaging a global network of specialist doctors and reversing some of the damaging effects of medical brain drain. The other efficiently extracts digital information from paper-based records using low-cost and locally produced tools such as rubber stamps to improve adherence to clinical practice guidelines. By bringing down the costs of remote consultations and clinical audit, respectively, these projects offer the potential for clinics in resource-limited settings to deliver high-quality care. This paper makes a case for continued and increased investment in social enterprises that bridge academia, public and private sectors to deliver sustainable and scalable e-Health and m-Health solutions.
移动技术在肯尼亚非常普及——手机普及率达88%，移动数据订阅量占所有互联网订阅量的99%。虽然这种无处不在的技术在低资源环境下彻底改变医疗保健的可及性和质量方面具有巨大潜力，但大规模取得成功的案例却很少。在肯尼亚等国，电子健康（e-Health）和移动健康（m-Health）技术的实施尚未解决人力资源限制问题，也未考虑此类技术的政治、伦理和财务因素。我们概述了一些近期的创新举措，这些举措在考虑医疗保健成本的同时，有望提高可及性和质量。其中之一是通过建立一个全球专科医生网络，并扭转人才外流对医疗造成的一些不利影响，来创建一个可扩展的临床决策支持系统。另一个举措是利用橡皮图章等低成本的本地生产工具，从纸质记录中高效提取数字信息，以提高对临床实践指南的遵循程度。通过分别降低远程会诊和临床审计的成本，这些项目使资源有限环境下的诊所能够提供高质量医疗服务成为可能。本文主张继续并增加对社会企业的投资，这些企业能够弥合学术界、公共部门和私营部门之间的差距，提供可持续且可扩展的电子健康和移动健康解决方案。
