Rebeca Mutiso @rebeccamutheu
A one-roomed office with minimalist décor in Nairobi’s city centre houses a team of seven people working relentlessly to save the lives of people infected with tuberculosis.
They are not dressed in white dust coats; neither are they carrying around stethoscopes – they use a simple innovation to solve a complex problem of people who are on TB drugs falling back on treatment.
Keheala, the mobile health company they work for, is improving healthcare access and treatment outcomes for TB patients through a mobile phone platform, which is free to download and a web platform. They remind them to take drugs at the correct time through an SMS. The patients can also raise any issue they are facing and can be connected to a doctor in case of an emergency.
The platform is available to the patients at any time of the day and the information shared is confidential, meaning that patients can ask questions they would be embarrassed to ask a doctor.
“We work closely with the national TB programme to ensure people stick to the treatment regime. This enhances cost-effectiveness. The process starts from the county coordinator, sub-county coordinator, clinicians up to the patients level,” says Edwin Nyakan, the project manager at Keheala.
Keheala means community in Hebrew and embodies their bid to increase treatment adherence among TB patients.
Their work is to reduce the TB prevalence rate in Kenya. According to the 2017 National TB prevalence rate survey, there are more TB cases in Kenya than previously estimated. The survey put the prevalence rate at 558 per 100,000 people while the World Health Organisation estimates that the rate is 222 per 100,000 people.
During the pilot study, 1,200 patients were enrolled into the system. 605 of them interacted with Keheala. They received SMS reminders to take their medicine and could contact clinicians working with Keheala anytime they needed assistance. The rest went through the normal treatment procedure where they are given drugs and visit the clinic regularly.
The pilot study had a treatment success rate of 96 per cent compared to 87 per cent of the standard of care group. Only 4.2 per cent of patients using Keheala did not successfully complete treatment compared to 12.6 per cent of patients in the standard-of-care control group. At scale in Kenya, the pilot study saved the government Sh9.3 million.
This impact translates to 1,553 lives saved, 329 few drug resistant cases and Sh2.4 billion in savings. The project will now be upscaled to eight counties including Nairobi, Kisumu, Kakamega, Machakos, Mombasa, Kiambu, Turkana and Wajir.
What is fascinating about the team made up of the founder, Jonathan Rathauser, an American based in Israel, Nyakan the team leader and Jill Ondigo, Fridah Njeri, Faith Muchiri, Lewis Muriuki, Alice Mwikamba and Teresa Adhiambo, all support sponsors, is how each one of them has had a personal interaction with the disease.
One is a TB survivor, one is a nurse who has worked with TB patients and others have taken care of a family member living with the disease or a chronic condition. They understand the struggles the patients go through and therefore give a human face to the interaction between technology and care.
“Some the patients were stigmatised by TB while others did not know the cause of the disease or how to manage it. I remember my interaction with a 19-year-old girl at a clinic. She was there to pick her drugs but she did not know a lot of about the disease. She associated TB with HIV/Aids. When she got into the project she adhered to the treatment and could ask many questions. At the end of the treatment she did not feel stigmatised,” says Adhiambo.
Rathauser brought the team together in 2016 after coming to face with the disease while teaching Lacrosse to youth in Mukuru slums how to play the game when he came face -to-face with the impact of TB in slums.
Based on the success of the project in Kenya, the United Nations Development Programme (UNDP) has hired the company to implement the intervention for TB patients in Zimbabwe.