After months of talking and thinking about Miti Health and working with the exceptional developers at Mindflow Associates, our team has converged in Kenya, ready to learn as much as possible about the pain points that people have as they move through the health system and prototype around this.
Our first site visit was to a public health facility near Nairobi that was well run, with friendly and efficient staff. We moved from room to room, getting a sense for patient flow and understanding the services they provide. We were also especially keen to understand the various pieces of paperwork that the nurses fill out for each patient, since this seems to take up an unexpectedly large portion of their time.
We were surprised to find that Kenya has recently implemented a policy making medication free at all public health facilities. While the clinicians were enthused about this policy in theory, in practice they found that it had exacerbated existing issues around stockouts. As a general rule, they found that the government supplier was able to fill only 25% of their medication orders, and that they anticipated that if the drug orders were filled every 3 months, they could expect that 2 of these months, they would be lacking many essential medications. In these cases, they wrote a prescription for the meds to be filled elsewhere, but found that because of high medication prices in the area, people did not fill the prescription. They also noticed that people would often travel all the way to Nairobi to fill medication orders because prices were significantly higher in this semi-rural area.
As we wandered around the grounds, we noticed a private health facility that had set up shop at the entrance of the public facility. The nurse who ran this center did a good business in serving people who didn’t want to wait in long lines, weren’t able to have lab tests run or prescriptions filled at the public clinic due to stockouts.
A team member joked that we should just set up a franchise of chemists at the entrance of public facilities across Kenya. We burst out laughing, then fell silent, wondering if we had hit on something interesting.
We started Miti with a technology in mind, but as we’ve talked to more people, we’ve realized that the technology can only be as good as the system that it supports, and that our team is passionate about more than just building things for smartphones. We want to solve big problems that affect many people. And we may have found one in the supply of good (i.e. real) medication, with better inventory management, price consistency, and quality assurance. There’s a significant role for technology to play in this, but it’s also a complex problem with many factors.