Life Saving Mobile Health Solution Reaches Remote Turkana

Turkana – situated in North West Kenya – is a sparsely populated, semi-arid and remote county.

Its health sector, like many others, faces challenges in delivering services. Foremost, it has an acute shortage of human resources, where only 2-5% of the total Kenyan healthcare workforce is stationed1. Secondly, Turkana’s largest facility – Lodwar County Referral Hospital (LCRH)– has to refer a good proportion of its complex cases to Moi Teaching and Referral Hospital (MTRH), which is 300kms from Lodwar town. This means residents have to travel long and treacherous distances to access specialised services.

To address some of these difficulties, Health-E-Net developed a mobile health (m-health) tele-consultation solution called n-REM. This platform brings the doctor to the patient, bridging the gap and reducing the geographical distances between health workers and patients in need of specialist care. It is a useful tool that provides clinicians in resource-limited settings with an opportunity to interact with specialists, thus ensuring skills transfer. This promotes early recognition of health complications and prompt referral to the next level of care.

How can a mobile phone bring a doctor - based hundreds of kilometres away - closer, at the click of a button?

The network – Referral Management (n-REM) teleconsultation platform allows clinicians in the lower facilities to upload complex cases, which are reviewed by the project clinician. The clinician then determines which kind of expert doctor will assist with the case, drawing from a pool of over 50 volunteer Medical Officers (MOs) and specialists. Once the appropriate doctor is identified, s/he engages with the clinician to provide specialized guidance. This may range from the kind of tests to be carried out, to diagnosis, and/or the correct medication to be administered. The platform improves coordination of referrals and ensures clients only move when the receiving specialists are available.

Simon Nanok, a nurse working at Lokwatubwa dispensary - over 100 kilometres from LCRH - faces challenges communicating with his colleagues at LCRH due to poor network in the area. However, the n-REM platform has an offline module that allows synchronization of cases once the network stabilizes. “I have experienced how the project has improved coordination of referrals between Lokwatubwa and LCRH, and has helped improve my knowledge and skills. It also allows me to interact with specialists locally and internationally. A good example is when I recently reviewed a child with delayed developmental milestones. This appeared to be a chronic condition that had never been reviewed by a senior health worker. I uploaded the case on n-REM and within no time a paediatrician responded and a diagnosis of cerebral palsy was made. An MO at LCRH further reviewed the report, and decided to refer the patient to LCRH for specialized services. This ensured the child was able to access services he would never have reached with our traditional referral system.”

The project estimates the cost savings during the two-year implementation period to be KES two million (approx. US$ 20,000). This is based on the transport costs that the County would have incurred to move clients from the peripheral facilities to LCRH, or to MTRH. The project has had over 100 teleconsultations uploaded and managed through the platform.

1 World Health Organization (2013): A universal truth: no health without a workforce.