Trust, not technology, bonds patients and providers

“At Johnson & Johnson Impact Ventures (J&J Impact Ventures), a fund within the Johnson & Johnson Foundation, we are committed to transforming health systems and driving equitable healthcare by not just investing in a technology, service or delivery mechanism, but also the people behind them who have demonstrated interest and commitment to building trust into their market-driven solutions. This is key to our investment philosophy and why we put capital behind enterprises like Penda Health and work with organizations like Village Capital to fund projects that strengthen patient trust.

Penda Health is a tech-enabled network of health facilities across three counties (Nairobi, Kiambu & Kajiado) in Kenya and led by Stephanie Koczela, a passionate entrepreneur who puts patients at the heart of their mission. As a signatory of the Ethical Principles in Health Care (EPiHC), Penda Health has adopted 10 fundamental principles designed to promote ethical decision-making and behaviours that build transparent, trustworthy and resilient health systems. It has become one of the largest outpatient health care providers in East Africa, owing in large part to their focus on relationships. Their success stands upon a foundation of trust they have built externally with their stakeholders in the health sector and internally with staff at their facilities.”

By impactalpha.com

Health Care Africa

The wide smile and easy demeanor of Stephanie Koczela is quite disarming. However, her drive, passion and determination to change the face of healthcare in some of Nairobi’s highly populated, low-income areas shines through, as you engage with her and meet her teams at the company’s medical centres around Nairobi.

We meet for the first time with Stephanie at her company’s head office, located not far from Nyayo National Stadium in Nairobi, and the discussions start in earnest about Penda Health – the firm she helped co-found and has been running since 2012 – and many other issues of the time, such as the raging Covid-19 pandemic.

Attentive and engaging, Stephanie comes out as a leader who is truly passionate about the important role a functional healthcare system can contribute to better the lives of individuals and families in Kenya.

Having spent most of her early years in social impact projects in developing countries and Kenya in particular, Stephanie clearly embodies her company Penda Health’s mantra of providing healthcare that each patient can trust, with love at the core of each team member at the company, beginning with herself.

Penda in X-ray, Ultrasound Services deal

Penda Health has partnered with Phil- lips Foundation to provide X-ray and ultrasound services to clients at its Kimathi Street Branch. Nairobi. The branch serves as an in-network referral centre for Penda patients who need more specialised services. Penda Health chief operating officer, Karim Moldeina said the aim is to bring provide quality healthcare to the low to mid income level patients. "We intend to work together with Philips Foundation towards more cooperation as we venture into the future in line with our goals," he said.

Other specialist services offered in the Kimathi Street branch are physician. gynecologist. pediatrician consultations. dental services. advanced ultrasound, and advanced diagnostics and lab tests. Penda offers outpatient healthcare service to over 250,000 yearly.

"We believe that with this collaboration. which helps to overcome the obstacle to cover for investments in equipment up front. we can help enable Penda to fulfill its ambition to grow the number of hubs and spokes," Phillips Foundation Director Margot Cooijmans said.. – Lynet Igadwah

Service Milestone

A nurse at a Penda Health clinic, Repha Mandela, examines Victorline Awuor on Friday, the healthcare provider's one-millionth patient since its inception in 2012. The firm has 21 medical centers

Happy Millionth Patient

Penda Health Chief Medical Officer Robert Korom (left) is joined by Thika Road Regional Manager Beatrice Moraa (right) to celebrate the health provider’s one millionth patient Victorline Awuor. Penda has served a million patients since inception in 2012. It has over 21 medical centers in Nairobi, Kiambu, and Kajiado counties.

Medical services firm opens referral centre

Penda Health, a medical services provider operating in Nairobi and its environs, has opened a referral centre offering specialist services. The firm is expanding its affordable healthcare model with an eye to serve more than 400,000 patients this year.

The facility in Nairobi's central business district will provide services such as paediatric, gynaecology and dental consultations, and advanced ultrasound, diagnostics and laboratory tests. This is in addition to the primary care services offered by the provider's other centres. Penda Health General Manager Kenya Marion Kago said the referral centre will serve as a hub for advanced clinical support to patients who will not have to seek services in other health facilities. thus offering convenience.

The healthcare provider is also strengthening its tech-enabled clinical health plat-form dubbed 'Pigia Penda' as part of its telemedicine strategy, to deliver services to patients virtually. "Early on, we realised that telemedicine will be an essential component of healthcare," Ms Kago said in a statement. "We are currently receiving over 1.500 calls monthly. mak-ing over 2,000 proactive out-reach calls to our patients and coordinating home drug delivery." [Peter Theuri]

Penda Health spreads its footprint, opens referral centre in Nairobi CBD

Medical services provider Penda Health has opened a referral office in Nairobi increasing its footprint to 21 centres. The referral centre located in Nairobi’s Central Business District will provide specialist services such as pediatric, gynaecology, dental consultations, among others.

“This new referral centre is part of the firm’s goal of expanding access to quality primary health care to Kenyans,” Marion Kago, Penda Health General Manager Kenya said in a statement. She added that the new centre will serve as a hub for advanced clinical support to patients as they will not have to seek services in other referral health facilities.

“The new centre has high quality clinical and diagnostic services and a supportive team ready to walk the journey with our clients to achieve and maintain good health,” said Dr Sarah Kiptiness, Penda’s Head of Quality Improvement. Kiptiness reiterated that the 10-year old health facility’s goal is to offer a one-stop shop where patients, both insured and uninsured, can get quality specialist clinical and diagnostic care.

Outreach calls

Kago stated that the facility is currently receiving over 1,500 calls monthly, making over 2,000 plus proactive outreach calls to their patients and coordinating home drug delivery, while

supporting electronic medical records. Telemedicine is a method of using technology to deliver health care to patients remotely. It links doctors and patients reducing health care delivery costs and improves efficiency. [Bernard Sigei]

Value over volume – how Penda is leading the way on value-based healthcare

By Rob Korom, Chief Medical Officer, Penda Health

In Kenya, most of us have friends and family members who have left a hospital or clinic with tons of labs and a small drug store for a simple cough. It’s no surprise that we as patients frequently feel frustrated and taken advantage of by the healthcare system.

This feeling isn’t wrong – incentives within the health system are poorly aligned.  Doctors and hospitals make money by doing more – ordering more lab tests, more ultrasounds or x-rays, and prescribing more drugs.  At the end of the day, patients have spent a lot of money, but have they actually gotten any better?

Current incentives in healthcare focus on profit over outcomes.

In my last post, I discussed how children with diarrhea receive improper care more often than not: fewer than 40% receive Oral Rehydration Salts (ORS), and only about 1% receive zinc sulphate – the proven therapy for reducing the duration and recurrence of symptoms.

Now consider how much a healthcare provider can make from selling a course of Augmentin (about 2000 KSH), as compared to selling ORS (50 KSH) and zinc (100 KSH).  Under a fee-for-service system, prescribing Augmentin is far more lucrative than prescribing the evidence-based (but cheaper) treatment for diarrhea. Why provide the right care when it makes you less money?

We need to compete on VALUE instead of VOLUME.

Harvard Business School Professor Michael Porter coined the term “Value-Based Healthcare,” or VBHC, to describe a system whereby healthcare providers compete on value, as opposed to the fee-for-service approach that favors high-volume care. Value-based healthcare is simple: it means that we aim to achieve the highest quality of care for patients at the lowest cost. But the challenge lies in implementation.

Note: Penda’s leadership has attended the HBS short courses on Value-Based Healthcare in Boston and we’re eager to connect with others who are interested in the concept!  

Penda Health is implementing value-based healthcare within our chain of 20+ medical centres across Nairobi.  

Penda Health assesses the “quality” part of the value equation by consistently measuring the following:

• Patient experience: For every visit, we send our patients a single message: “How likely are you to recommend Penda to a family member or friend?”  This single broad metric (the Net Promoter Score) is a terrific marker of overall patient experience.  Our network-wide average NPS of >55% is orders of magnitude higher than the industry average for healthcare in Kenya of -5%.

• Adherence to validated process measures:  As outlined in my post about how Penda uses technology to achieve high-quality care, we continuously and automatically measure dozens of well-validated process measures for quality care in the primary care setting.  We pride ourselves on high adherence to such metrics, including treatment of acute conditions like malaria to diagnosis and management of chronic illnesses like hypertension.

• Patient outcomes:  As critical as adherence to process measures is, we need to make sure our patients are actually getting better.  We ask our patients a simple question in our routine follow-up calls:  “Are you feeling better from when you first came in?”  This data helps us to identify early any patients who are not getting better as expected as well as to analyze why some patients seem to improve more than others.

On the “cost” side, we are also able to gather many insights. Our end-to-end electronic medical record not only gives us precise costs for pharmaceuticals and diagnostic tests, but also detailed human resource costing for a patient visit.  Time-Driven Activity-Based Costing is a method of allocating detailed staffing costs to specific patient visits.  Since our electronic medical record automatically records the time spent with the patient by each staff member down to the second, we’re able to know with a high degree of certainty how much various visit types cost Penda.  While we don’t charge patients according to the amount of time spent, these insights help us optimize our operations and reduce overall costs.

We are leading the shift from fee-for-service (volume) to capitation (value).

Ultimately, our aim is to shift from a fee-for-service model to a capitation model, and we hold ourselves responsible for prioritizing outcomes over profit. Penda aims to be Kenya’s national leader in outpatient capitation models because we excel at providing outstanding quality and outcomes while maintaining extremely low costs.  Under capitation, payers or patients pay us a set amount for unlimited coverage over a one year period – a system that prioritizes efficient, high-value care instead of volume of services provided.  

We now have several capitation agreements with various payers, ranging from commercial insurers to large corporate clients.  Our capitation partnership with the government payer, NHIF, is our largest and most successful capitation model to date!  Patients under these agreements love that they can access high-quality care anytime without a copay, can take advantage of any of our 20+ branches around Nairobi, or call our telemedicine hotline Pigia Penda. Payers love that they have predictable, fixed costs for the entire year and that their patients have access to high-quality care.

Leading the way, Penda Health hopes that more of the Kenyan healthcare market will take notice and align incentives to produce value for patients over volume of services. 

Bridging the implementation gap – how Penda is using digital technology to deliver the future of primary care

By Rob Korom, Chief Medical Officer, Penda Health

A mother brings her two-year-old daughter to a local hospital with several days of diarrhea.  Although diarrhea is a common condition, it can also be deadly. In 2011, diarrhea was the leading cause of death in children under five in Kenya. 

Unfortunately, all too often, children do not receive appropriate treatment for diarrhea. 

While many clinicians are quick to prescribe antibiotics for childhood diarrhea, the most effective, evidence-based treatments are actually Oral Rehydration Solution (ORS) and zinc sulphate.  A CHAI study in 2013 showed that despite guidelines clearly recommending ORS and zinc as the mainstays of therapy for diarrhea, “less than 40% of children in Kenya used ORS and less than 1% used zinc.”

The difference between what guidelines recommend as evidence-based treatment and what is actually delivered to patients in the real world is referred to as the “implementation gap.”  There are various reasons for the discrepancy, including insufficient clinician training, busy and chaotic working environments, and inability to easily access guidelines in real time while the patient is in front of you.  

Penda Health is closing the implementation gap with clinical decision support.

Penda Health is a global leader in closing the implementation gap in primary care.  We do this by heavily leveraging technology throughout the patient’s visit to any of our 20 outpatient medical centres around Nairobi.  The core of our approach is to use Clinical Decision Support at the point of care in as many visits as possible.  This means ensuring standard guidelines are linked automatically to diagnoses within our Electronic Medical Record system.  We have jointly built this point of care decision support tool with our fantastic EMR colleagues Easy Clinic in India.

To give a sense of how this directly improves patient care, imagine you are a healthcare provider diagnosing diarrhea with moderate dehydration at Penda Health.  Here is what will pop up on your screen as soon as you enter that diagnosis:

Importantly, we don’t allow healthcare providers to move on in the visit without acting on these suggestions one way or another.  Clinicians still have the option to reject suggestions in case the unique circumstances of the case require a different approach.

The implementation of the Clinical Decision Support guidelines is only half the battle of closing the implementation gap and achieving high-quality care for our patients.  The other half is continuous, automated measurement of our performance in each of these areas and responding to areas of concern.

Making data actionable is the other half of closing the gap.

Thanks to our outstanding data analytics team at Penda, we’ve built detailed, real-time, interactive dashboards using Microsoft Power BI to constantly monitor our performance against our own internal guidelines.  Because the acceptance or rejection of the various guidelines is in structured data fields, we’re able to easily view the provision of quality care across our branches, over time, and even down to the level of individual clinicians.  This has unlocked an ability to immediately discover areas that require additional clinician training or further assessment.

Gaps in providing recommended care are not always due to clinicians themselves, but can be related to very low-tech structural challenges.  In one example, we used our automated dashboards to assess how often we recorded the patient’s oxygen saturation when they presented with possible Covid-19 symptoms.  Our dashboards showed that one of our medical centres was performing much worse on that metric than others, which prompted me to visit and ask questions.  

We quickly discovered that because one of the pulse oximeters in the clinic had disappeared, the team had decided to keep it under lock and key in the pharmacy area.  That had created a significant barrier to clinicians using the pulse oximeter to measure and record the oxygen saturation of our patients, and they only took the time to do it when the patient appeared very short of breath.  We agreed with the team that we needed to make the pulse oximeter more accessible to clinicians, even though there was a risk the device would be lost again.

We would never have been able to even identify that problem if we didn’t have access to automated, real-time, comparative data across our network.  It is clear how much potential there is in tech-enabled quality measurement in primary care.

As of early April, we have clinical decision support recommendations for more than 100 common conditions – or about 60% of visits – and real-time visibility into our performance on all of them.  Our goal is to expand our automated quality measurement to include more than 90% of all visits at Penda (that’s over 900 per day across the network!) by June of 2021.  

When we think again of the child who comes to a medical centre with diarrhea, it should be clear that Penda’s Clinical Decision Support and automated quality measurement make it vastly more likely that she will get safe, effective, and evidence-based care. 

Penda's commitment to rapid, effective, and equitable vaccine distribution

By Rob Korom, Chief Medical Officer, Penda Health

As we watch many parts of the world work through the challenges of effective vaccine distribution at scale, we are seizing this opportunity to learn everything we can about how to be effective when our time comes.

Globally, this initial period represents a phase in which demand for the vaccine greatly outstrips supply.  At Penda, we still have hundreds of health care workers on the frontlines who are unvaccinated, and thousands of high-risk patients who would immediately benefit from the vaccine.

During this initial Phase 1 period, we are delighted to see that more than 1 million doses of the AstraZeneca vaccine have been delivered to Kenya.  While there are still a few things to be worked out, such as how exactly verification for vaccine priority will work and how vaccine administration will be recorded, we are thrilled to see the progress being made toward vaccinating frontline health workers in Kenya.

Penda Health is preparing in a few key areas:

1. Right infrastructure

   We consider both the physical assets of vaccine infrastructure such as refrigerators, deep freezers, and cold boxes, as well as the operational infrastructure such as vaccination rooms within existing medical centres.  Penda already operates 22 medical centres across Nairobi and already delivers more than 5000 routine childhood vaccinations every single month in collaboration with the Ministry of Health.  Our procurement department is prepared to increase our refrigerator capacity depending on the number of Covid-19 vaccines we are able to receive.

2. Right technology and data systems

   We believe a strong technology-oriented approach to vaccine delivery is important.  By maintaining electronic health records on our cloud-based digital health system, we are able to monitor in real time our vaccine distribution efforts across all our branches and analyze the data in order to deliver vaccines efficiently and equitably.  Our existing well baby vaccination program is already optimized to automatically flag patients who have missed a routine vaccination.  Penda clinicians working at our Pigia Penda call centre reach out to those patients proactively so that we can dramatically reduce the number of incomplete vaccinations.  This existing process will be extremely valuable for the effective vaccination of adult populations that require more than a single dose, like the AstraZeneca vaccine currently in the country.

3. Effective communication

   It is imperative that our communities receive accurate information about the vaccines from trusted sources.  Since our vision is built around trusted healthcare, we have a lot of experience with ensuring that accurate information from respected sources like the WHO and the Ministry of Health are communicated to our patients through various channels, including our social media pages, the television screens in our medical centres, and through our hundreds of trusted clinical staff.

4. Prioritizing equity

   Penda is committed to making sure that as long as the vaccine is a scarce resource, that we deliver it to people who need it most, not just those who can pay.  The Ministry of Health has already begun to define three phases of vaccine distribution: First, to our frontline healthcare workers.  Second, to those over the age of 50 and those over age 18 who have comorbidities like high blood pressure or diabetes which put them at higher risk.  The third and final phase will be to reach the rest of the population and may take until 2023.  Penda is deeply committed to supporting this equitable distribution timeline to ensure that the public good of the vaccine is maximized to those who will benefit most.  Our strong internal governance and clinical oversight will ensure that we are able to comply with these guidelines.

We are eager for the opportunity to vaccinate our staff, our patients, and our communities, and look forward to engaging with the various stakeholders on this important national effort.

High quality primary care delivers better outcomes for lower costs – why is it so hard to achieve?

By Rob Korom, Chief Medical Officer, Penda Health

A friend of mine recently suffered from a blocked ear.  He went to a locally renowned Ear, Nose and Throat (ENT) specialist.  After taking a quick history of the complaint and looking in the ear, the diagnosis was impacted cerumen, a fancy term for ear wax.  Within ten minutes, the ear wax was gently flushed out with warm water and his hearing was completely restored.  The total bill for the ENT was 8000 KSH (80 USD) for the consultation and the flushing procedure.

This is a common pattern in Nairobi: problems that could easily be dealt with at the primary care level are often treated in advanced specialist offices.  

For the wealthy, this is only somewhat inconvenient and expensive. But for those with more limited income to spend on healthcare for their family, the consequences are much more serious.  When your monthly income is 30,000 KSH, it’s simply not feasible to spend 8000 KSH to flush wax out of your ear.  So instead, many suffer with problems that should be easily addressed in a primary care setting at a fraction of the cost.

Please note this is not a criticism of specialists – rather, when specialists treat problems that ought to be addressed in the primary care setting, it is a poor use of two scarce resources: the patient’s (or insurer’s) money and the specialist’s time.  I want the specialist to be available for the patient with the ruptured eardrum, rather than flushing wax out of someone’s ear.

So what is the disconnect?  Why aren’t we more effective at meeting people’s basic health needs in a primary care setting? The short answer is that being excellent at primary care is really hard. 

To do it well, you must solve three challenging problems.  I want to explain a bit about Penda’s approach to each of them:

1. Primary care must be convenient and accessible. 

   Primary care must be available to people near where they live and work, at times that are convenient for them.  Penda’s expansion over the last few years now places every Nairobian within one matatu ride of a Penda Medical Centre.  In addition, we are open at least 12 hours a day, 7 days a week, and five of our branches are open 24 hours a day.  They never close so that we can be available for those who work odd hours, and for families who experience emergencies overnight.  Although you can make an appointment to see a clinician at Penda, 99% of our patients are walk-ins, and our average total visit time (including waiting time, lab, pharmacy, and billing) is under one hour.

2. Primary care must have a positive patient experience based on trust.

   If you visit any of our 22 medical centres around Nairobi, it will become clear to you within moments of entering that great patient experience is just as important to us as providing high-quality medical care.  When we recruit new Penda staff, the first thing we look for is whether they will put patients first.  Our branches are filled with clinicians, receptionists, lab techs, pharmacy techs, and cleaners who genuinely care about the patients we serve and often live in the communities where they work.  

   The end result?  Our Net Promoter Score, a common customer satisfaction metric, was 63% in January 2021, compared to a Kenya healthcare industry average of -5%.  Patients love coming to Penda. And ample evidence suggests that when patients have a great health care experience, they are more likely to stick with their treatment plan, more likely to feel better faster, and more likely to come back for re-assessment if things aren’t improving as expected.  We see all of these benefits adding up for our patients.

3. Primary care must have an evidence-based approach to dealing with a huge breadth of medical problems.

   Our clinicians vaccinate babies, treat malaria, stitch wounds, evaluate injuries, and manage chronic illnesses.  Until recently, it was next to impossible to provide guideline-based care for the hundreds of different conditions that are commonly encountered in primary care.  

   We are at a very special moment in the digital health journey which allows an organization like Penda Health to deliver evidence-based recommendations to our clinicians at the point of care across hundreds of common primary care conditions.  That clinical decision support, coupled with advanced data analytics, allows us to consistently deliver the highest quality primary care experience to tens of thousands of patients every month – and to refer them to specialists when necessary.  At the beginning of 2021, more than 50% of visits at Penda were supported by point-of-care decision support in our Electronic Medical Record.  This year, we’ve set an aspirational goal to have more than 90% of visits at Penda supported with electronic decision support and to have greater than 90% adherence to evidence-based treatment guidelines.  I believe if we can achieve this goal, we will be at the forefront of delivering outstanding primary care in accordance with national guidelines.

The power of high-quality, tech-enabled, patient-centred primary health care is evident – certainly to the patients themselves, but also to the community, insurers, and the health system as a whole.  Penda is overcoming the very difficult problems in executing this vision by combining a people-centred approach with world-class technology, and the results are incredible!

Penda Health launches referral medical centre in downtown Nairobi

Penda Health – a network of high-quality, affordable medical centres serving more than 250,000 patients annually – launched its newest referral medical centre in downtown Nairobi, located on Kimathi Street at the Old Mutual Building, opposite the Sarova Stanley Hotel. 

This new Kimathi Street location will serve as an in-network referral centre for Penda patients who need more specialized services. This represents a brand new service offering for Penda Health, including specialist services such as physician, gynaecologist, and paediatrician consultations, dental services, advanced ultrasound, and advanced diagnostics and lab tests. 

These specialist services are offered in addition to the usual suite of primary care services –  including lab, general consultation, and pharmacy – that can be found at their other 21 walk-in branches. In the upcoming months, they also plan to add x-ray services to the Kimathi Street location.

Dr. Sarah Kiptinness, Penda's new Head of Quality Improvement and resident family physician at this location, says, "Our Kimathi Street location is a clean, spacious, welcoming environment where high quality clinical and diagnostic services are offered to our clients at an affordable cost. Together with the 14 insurance partners, Penda Kimathi Street provides quality primary healthcare services in obstetrics, gynaecology, paediatrics, acute and chronic medical care and dental care. It's also the one-stop shop for your annual medical review. Best of all, you will find a supportive team of providers ready to walk the journey with our clients to achieve and maintain good health.”

Penda is committed to expanding access to quality healthcare, not only to uninsured patients but also those covered by corporate insurance. By offering low-cost care that allows insurance covers to last longer, Penda offers the CBD business community – and Nairobi at large – the quality expected from Penda Health at walking distance from their office buildings. 

Penda hopes to pursue direct partnerships with corporates for wellness packages, digital health offerings, and low-cost capitated cover for their employees. To learn more or to organize a tour of the centre, Penda encourages interested parties to contact Penda’s Head of External Affairs, Salome Mwaura (salome.mwaura@pendahealth.com).

Penda Health appoints CFO as growth phase picks momentum

Ms Freshiah Nganga

Primary health care solutions provider Penda Health has announced the appointment of key executives as it seeks to deepen its corporate leadership pool.

Penda Health, a growing operator of quality and affordable medical centres in Nairobi city and its environs, has appointed finance professional Ms Freshiah Nganga as its Chief Financial Officer. Joining Penda Health from Ethiopia based Investment firm, Flow Equity LLC, Ms. Nganga has been tapped to lead Penda Health’s Finance Management function.

Speaking when she confirmed the appointment, Penda Health General Manager for Medical Centres, Ms. Marion Kago, said Ms. Nganga would provide strategic financial leadership support for the health solutions firm, currently focusing on service and product diversification goals.

Penda Health, Kago said, currently operates 17 paperless, technology-enabled medical centres in Nairobi, serving more than 250,000 patients annually.

“At Penda Health, we are excited to welcome such a seasoned professional as Ms. Nganga to lead our Finance Management function. In her new role as the CFO and with her proven experience in financial reporting, fundraising, risk management, stakeholder management, strategic planning and execution, she will be partnering with our Leadership Team to make the company’s most important strategic decisions during this critical phase of our growth,” Kago said, adding that, “Alongside investments in our human capital base, we are currently expanding vertically by adding services, investing heavily in digital health capabilities, and partnering with insurance companies and major employers to provide affordable health insurance to Kenyan families.”

Before joining Penda, Ms. Nganga was serving as the Group CFO at Flow Equity which is one of Ethiopia’s leading venture capital firms with interests in the country’s agricultural sector. She has also previously served in Kenya as the Group CFO for KFC restaurants’ franchisee Kuku Foods East Africa Holdings.

A Masters in Business Administration - Finance option Degree graduate from the United States International University - Africa and a Daystar University Bachelor of Commerce; Accounting, Business Administration and Management Degree alumni, Ms. Nganga started her career as an Audit Senior with Deloitte East Africa.

Will telemedicine in Kenya outlast Covid-19?

By Rob Korom, Chief Medical Officer, Penda Health

Telemedicine has witnessed explosive growth globally during the Covid-19 pandemic. 

While the technology that enables telemedicine has been around for a long time, Covid-19 catalyzed its large-scale adoption by patients and providers for the first time. For good reason: limiting unnecessary interactions between people limits the spread of the disease. 

Is the current interest in telemedicine temporary? Or is this means of delivering healthcare here to stay? 

I believe telemedicine is here to stay. It will become a primary way that patients access medical care, long after Covid-19 is over. I say this with one big caveat: telemedicine is most effective when used as a tool within a broader, patient-centered healthcare system. 

When most people think of telemedicine, they picture a video call with a doctor. The patient could be at home, the doctor in her office (or even at home!), with the two interacting virtually through a screen. Through that “virtual visit” the doctor can ask questions about the patient’s condition. While the doctor may not be able to do a complete physical examination over a video call, she can look at rashes, see where the patient is pointing, and understand the patient’s general condition.

As a medical doctor, I know that many diagnoses can be made based on the patient’s history alone. However, many diagnoses require confirmation with laboratory or imaging tests. In some telemedicine platforms, such as Penda Health’s Pigia Penda or Daktari Africa, doctors can order tests which can be done at nearby laboratories and results relayed to them. Similarly, any medications required to treat the condition, could be prescribed remotely and picked at a local pharmacy, or even delivered to the patient’s home.

Besides laboratory testing and medications, many conditions require a detailed physical examination. Some sensitive ones are best suited for in-person conversation. Others may require measurements, samples, or biopsies, which necessitate in-person visits. In otherorder words, comprehensive healthcare cannot be provided through a screen alone –  a strong brick-and-mortar network helps doctors provide the full continuum of care that patients need. 

When does telemedicine work?

For chronic conditions, there is tremendous opportunity for patients to save time and money by addressing some aspects of care remotely through telemedicine. For example, patients with hypertension and diabetes can communicate their blood pressure and blood sugar readings with their doctors remotely rather than needing to go to a physical location. When those parameters are well controlled, no changes may be necessary. However, when doctors notice a series of abnormal readings, they could consult with the patient remotely to determine any changes to the treatment plan.

Similarly, for pregnant mothers, an important aspect of care is providing information on what to expect during pregnancy, and discussing common issues such as nutrition or swelling of the feet. Healthcare providers are already experimenting with innovative ways to deliver this critical information to their patients remotely. In many cases, this becomes more impactful and beneficial to the patient than what is typically received in the busy and crowded ante-natal clinics.

Even before the Covid-19 pandemic, there were several telemedicine solutions being developed. This includes Pigia Penda, Daktari Africa and MyDawa.

Penda Health, where I am the Chief Medical Officer, runs “Pigia Penda” — a 24-hour telephone hotline, where anyone can get their medical questions answered. It is meant to provide a high-quality option over the phone for people avoiding hospital facilities unnecessarily. We also wanted to make this service accessible to people who are cautious about their airtime and data consumption and prefer avoiding video calls. One thing users value about Pigia Penda is the convenience — a patient does not need to set up an appointment or download any application. One just needs to call 020 790 9045 and within seconds will be discussing the medical problem with one of our health care providers. Pigia Penda is backed by a network of brick-and-mortar health facilities all over Nairobi, in case one needs in-person follow-up, laboratory testing, or drug delivery. Health records are also immediately available to clinicians across the Penda Health network. It really helps to have providers who are familiar with the medical history.

Daktari Africa is a telehealth service that allows patients to connect with doctors for virtual visits. The website also serves as a repository of information about common conditions and has a “forums” section for patients suffering from conditions such as diabetes or high blood pressure to ask questions and get support from others.

MyDawa is an on-demand pharmacy delivery service to the doorstep once a valid prescription is sent. MyDawa is a fully-licensed pharmacy with over 1000 different products. The valid prescription can be sent in by the patient or the doctor to the convenient and accessible platform and medicines will be delivered in a few hours.

What, then, is the future of telemedicine?

After the pandemic, telemedicine will still thrive. Particularly, when patients can layer telemedicine services on top of their existing brick-and-mortar services, and integrating them seamlessly into a system of healthcare. 

Many providers are thinking about how to do this exactly. At Penda, we hope to share our lessons learned with the entire industry. At the end of the day, the goal is one – ensuring that patients get safe and effective health care conveniently.

Penda Health launches home delivery solutions and free virtual consultation for patients

Penda Health has introduced a home drug delivery solution and free virtual consultations for patients in a bid to bolster health outcomes to Kenyans during the COVID-19 pandemic. 

The service, dubbed “Pigia Penda,” allows patients to receive a free consultation and an over the phone prescription if needed. Any prescribed medicines are then delivered at a cost.

Speaking while marking the end of a one-month pilot phase, Penda Health’s General Manager for Medical Centres, Marion Kago, said that Penda Health is exploring new avenues of healthcare delivery during this exceptional time when the government is encouraging people to stay at home as part of COVID-19 containment measures. 

“The goal of any healthcare delivery system is to support optimal health outcomes for patients. With this service, we are providing cost-effective and patient-centred alternatives to visiting our branches physically,” Ms. Kago said. “While we remain open to serve patients in our Medical Centres, we know that many patients are not comfortable visiting for less serious complaints. This  virtual option enables us to still attend to patients without requiring the patient to leave the safety of their home.”

The available services under this option include: 

1. Free virtual consultations

2. Prescription of medicine

3. Delivery of medicine.

The service is available for outpatients and payable via mobile money. Patients can access this service by calling Pigia Penda at 020-7909045 24 hours, 7 days of the week. Through this service, patients also access up-to-date information on COVID-19.

On his part, Penda Health’s Head of Clinical Services, Dr. Gabriel Njue said that the coronavirus outbreak has been an accelerator of telehealth—delivery of health services remotely through computers and mobile devices— globally, enabling clinicians as well as patients to have access to service without actually getting exposed to the virus.

“We believe that telehealth is an important way that we can reach patients safely and conveniently, especially during this pandemic. The adaptation of health technologies is one of the ways in which we can continue providing quality healthcare services while ensuring the safety of all parties,” Dr. Njue noted.