This week reminded me of why we are in Kenya, and how so much happens once you get to Nairobi and start working with and talking to people.
We had three interns start this week, who we had interviewed and finally made offers to in the last month over the phone. It’s been exciting to have everyone come together and start! If I were to describe them in a few words – they’re all passionate about what they are doing in particular, eager to learn new things…and probably a little overwhelmed. Rather than telling them “we are building Product A, you do this, you do that, go,” we have said, we believe there is huge potential for technology to empower rural healthcare providers, by offering clinical decision support / electronic medical records, financial, and inventory management. BUT…we don’t know who exactly the user is. Ciiru (our operations research intern), that is what you will need to find out with us. Daniel (our UI/UX designer intern) – we can’t give you wireframes or even an exact product description yet, but create awesome visual mock-ups of screen shots of what *could* happen for us to share after we have done interviews and customer research (showing comes after, to avoid “leading the witness). And David (our developer intern) – start getting to know openMRS, ODK Collect and existing modules, and prepare to build something…we’ll tell you exactly what in a week or two.
Another critical step was getting into healthcare facilities. We had sent our v1.0 (IMCI protocols with clinical decision support) to some partners in Kenya, and received very focused feedback on what worked and didn’t work. What this failed to capture, however, was everything else that occurs in a facility surrounding this one protocol and the nuances of getting to actually see and hear how they work. I believe that immersion into the experiences and needs of our potential users is critical to building something that will truly be wanted and used. (It was gratifying to sit down with Mark, of iHub UX lab, to review our approach and hear how he’s taken a similar – though even more in-depth approach, to great success several times here in Nairobi). Seeing public, private and chemist in the same day clarified in our minds the differences between these potential users, from their processes to pain points, in a way that was not possible from Stanford/Berkeley. Understanding their challenges, such as limited cash flow by chemists, also has made us more sensitive to and ready to assess how things are different in the rural parts of Western Kenya that we head to next week.
After working at Jacaranda Health In Nairobi, I had felt pretty confident of my understanding of healthcare in Kenya. I had touched, at least in some small way or another, different points that it takes to run a clinic from buying supplies to hiring nurses and establishing our draft procurement / financial systems (which have since been far improved!). What these visits highlighted for me was how much more there is to learn about the healthcare ecosystem. It is one thing to order from a supplier in town, or buy painkillers from a chemist shop, and another to understand exactly what they do. This week has been a good start!
Some interesting observations
- Clinical decision support may not be a “hook” – the most common protocols are well-known, public providers are VERY familiar with IMCI, chemists are required to be diploma or degree pharmacists
- Private facilities and chemists are not just tolerated, but sometimes welcomed outside public facilities as a place for referrals when stock is out, or a way to alleviate the queue
- Kibera is a very tough place to visit and work, probably after decades of saturation by visitors. Probably not the “local test-bed” (accessible for a morning/afternoon) that we had thought it could be. Mathare?
- Chemists we spoke with (sample size of two) struggled to record everything on paper, taking short-cuts either in capturing individual transactions or totaling things at the end
- Cash flow and credit are important for chemists – for one, her supplier of choice was the one who gave her 3 month’s credit while for the other, cash on hand directly impacted and often constrained the number of drugs they could buy. The latter was unaffected since same-day deliveries were possible (though she also said it was the hardest part of her work, dealing with the hassle of it) – but I wonder how this changes when you move outside Nairobi and the urban center?
- Private health facilities are subject to the same amount of reporting to government and regulation, which is a lot – separate hardcover books for under-5, over-5, antibiotics, HIV/AIDS, MCH, and more… Sounds like a government push to go digital with this may be on the horizon, but it’s unclear yet what requirements, role-out plan or level of support for the transition will be (to us, anyways)
Things to explore
- DMOH reporting requirements, IF we focus on healthcare facilities
- Wholesalers (of drugs, supplies) – how do they operate, what are their challenges
- Buying a chemist shop? A crazy idea, but to really understand what is involved to operate one instead of starting from scratch / through interviews
- Agro dealers – a lot of ways agriculture is leading in use of technology, improving distribution, etc.
- Twitter (used prevalently in interesting ways in Nairobi – though will this be true outside of Nairobi?)