SIMUAFYA mass RH Telemedicine Platform

COVID19 has negatively impacted health service utilization. As service providers and facilities struggle to ensure continuity of essential services, it has become urgent and necessary to redesign the traditional model of face to face close contact interaction between the provider and the patient to minimize infectious disease, including COVID19, transmission within health care facilities. Telemedicine is a viable platform for initial public - healthcare interaction to enable manage facility visits, observe workload rations according to facility capacity and allow facilities to observe COVID19 prevention transmission without conferring added morbidity and mortality to the emergency and routine users of health care services. Kenya has a high mobile use penetrance and this intervention will be tapping on existing infrastructure to advance health access and equity in the country.

There has been a drop in essential health service utilization due to COVID19 (https://drive.google.com/file/...). Faced with emergency health needs, women are dying at home due to inability to access care and fear of contracting COVID19 in health facilities. avoid overwhelming hospitals with surging infections of COVID19. As a result, reports indicate upsurge of morbidity and mortality form indirect disease burden transfer to the household due to suboptimal access to skilled health care. Measures to contain the pandemic are further complicating health service access. Women and children are disproportionately affected by challenges of accessing skilled care occasioned by the COVID19 Pandemic due to background COVID19 threats to the traditional health delivery system for the country that is heavily dependent on close patient provider face to face interaction. Measures put in place to contain the pandemic have created anxiety among patients who have faced enormous challenges accessing health facilities during periods of movement restriction. Health care providers are wary of being overwhelmed by a surge in morbid patients likely outstripping the limited facility response resources. SimuAfya aspires to cure all these through a toll free mobile telemedicine platform that puts the hospital and health provider in the hand of the patient.

Riding on the high mobile penetrance and literacy in Kenya, each health facility will be provided with a unique toll free data and voice call line that is geo-locked to a facility. Simuafya national platform will embed unique mobile handsets and operationally re-route any patient call to a health facility to the nearest GPS identified facility. The platform is designed simple and patient friendly and will act as the first consult platform linking the nearest health care provider to the patient caller. The platform will further be linked to the Emergency Response Service and in an emergency can automatically activate rescue operation with real time location and route access generation from the point of distress. It is projected that using this platform will lead to increased organized utilization of health care services, increase skilled birth attendance, reduce health emergency response time nationally, save costs through triaging facility visits to those that are necessary, reduce morbidity and mortality attributable to lack of correct health information or restricted health facility access in emergencies, fragile contexts or natural disasters that impede health service access. Through this platform, health facilities will manage client flow and schedule of visits to eliminate overcrowding in health facilities. 

The primary beneficiary of this intervention are Pregnant women facing emergencies and marooned by fear of contracting COVID19 as well the current pandemic control measures such as lockdowns and curfews. SimuAfya is a human centered concept that involved the end user in its design and has been tailored to to solve an identified maternal health problem of access and quality that has led to an upsurge of maternal deaths. Over 10 Million Kenyans using the 6,000 public health facilities across the country will be the initial direct beneficiaries of SimuAfya. The platform has been piloted in the 950  public facilities offering emergency reproductive health care services and through this grant will taken to scale in more than 8,000 health facilities in Kenya. It is expected that SimuAfya platform will handle a daily call volume of over a million calls as projected from feasibility piloting . SimuAfya will also offer a platform for general health enquiries by the public on health matters from their local facility and allow facilities to schedule visits and respond to emergencies swiftly. This platform also introduces a patient loop into the communication and offers an opportunity to harmonize and standardize a quality nationally ubiquitous telemedicine platform. 

Majority Pregnant women in Kenya during the COVID19 pandemic are not accessing quality health care due to fear of contracting COVID19 in health facilities and heart wrenching encounters navigating COVID19 containment curfews and lockdowns. Many mothers have died during the COVID19 period without being identified or attended by a skilled health care provider. The SimuAfya platform flips this scenario and " brings the hospital to the palm of the mother"  via simple unique toll free mobile call. Any mother anywhere in the country will be able to access skilled quality health care and be guided through health seeking decision making.

A unique toll free mobile platform that enables a patient to place a call and be routed to the nearest GPS health facility and get connected to a health care provider 

Geo-locked GPS homing enabled call and data line handset able to route calls to the nearest health facility to the caller

National COVID19 toll free numbers have been a huge reprieve as sources of information, Kenya has high mobile penetrance and telemedicine has been revolutionary. This adds an innovative essential piece that will save lives and transform health system delivery models in low resource settings

A toll free number that is easy to memorize by the public and links you to your nearest geographical health facility will inspire women to seek professional information about their health, help health facilities to organize and schedule hospital visits, enable patient follow up, increase health literacy by targeted health profiled messaging, reduce costs of health care by eliminating unnecessary visits and delays, lead to universal access to quality health care and ultimately prevent maternal deaths through increased skilled birth attendance. 

1. Current number being served through the pilot phase: 120,000 women
2. Projected number to be served in one year at scale: 1,500,000
3. Projected number to be served in 5 years: More than 20 Million 

1. Immediate goal is to get SimuAfya scaled up to give women in dire need of accessing essential health care services an opportunity to be managed by a trained skilled health care provider which is a proven intervention to reduce maternal deaths 
2. By next year, I plan to expand partnerships to take this lifesaving innovation to scale to be able to reach more than 8,000 public health facilities from the limited scoping pilot in 900 facilities 
3. Once the basic platform is popularized, a population level patient  centered morbidity triaging and risk categorization app will be embedded on to SimuAfya platform that will revolutionize health messaging and create patient provider sustainable low cost  real time linkages in low resource settings. 

Financial capital to purchase ,configure and geo-lock SimuAfya platform mobile handsets for each public health facility ( USD 4 Million) and initial recurrent costs to ensure platform is manned on a 24 hour basis ( USD 21,000). Plans are advanced to get government funding and ownership once the initial catalytic financing to increase government degree of belief in social returns to the public. The government has agreed to offer its human resource for health to run the platform in 8,000 public facilities when and as needed. 

Risks

Likelihood

Risk impact

Mitigating Strategy

Limited skills potentially leading to a flawed project design

Medium

High

Technical Division to take lead role in design and technical oversight of project. Expanded team with technical lead persons by performance field

Errors in project strategy

High

High

Multi-disciplinary project scrutiny and strategy review team 

Planning

Governance risk

low

Medium

Governance nested and reporting to PI

Production risk

Low

Medium

Technical engagement and education  of procurement team to monitor equipment production to respond to strict timelines and shared technical specifications

Schedule risk

High

low

Develop a Project timeline , Due diligence  and high level advocacy to fast track project processes as scheduled

Implementation

Operational risk from poor implementation

Medium

Medium

PI undertakes due diligence and carry out feasibility studies  

Schedule risk: Projects falls behind  scheduled

High

Medium

Sensitization and advocacy, due diligence to eliminate procedural delays , project pitched at highest possible office 

Resource Competition with other projects

High

High

Include in MTEF and explore Cost & volume guarantees from Lead Telkom and Communications Authority

Credit and liquidity( Telkom lead)

Low

High

Inter operable platform across multiple networks

Legal risks:

• Confidentiality
• Monopoly by Safaricom
• Brand conflict with global health project

High

Medium

Incorporate MOH legal team as part of project design  and oversight 

Escalation of costs

High

Medium

Cost guarantees, strict adherence to project timelines 

Performance Monitoring

Project will fail to produce results consistent with project specifications

Low

Low

In-cooperation of process, outcome and impact indications at project design, M&E framework from conception 

18 Full time staff, memorandum of understanding with Ministry Of Health  Kenya gives access to more than 20,000 health care workers to operationalize the platform once we take the platform to scale. 

A dedicated motivated team made of highly trained and skilled medical, public health, IT, mobile health , monitoring and evaluation  individuals that are very passionate in innovating to save the lives of women. The team lead developed the concept and rallied the team that has successfully piloted the platform. The MOH, excited by the prospects has availed its workforce and technical supplementation to ensure success in the event it is taken to scale. 

Multiple Health NGOs, the Government and the Ministry of Health Kenya

Offering an essential service solution to all pregnant women by helping connect patients with a health care provider in their locality. Platform will accelerate realization of the  governments commitment to Universal Health Coverage , as well as reduce costs of health care  while ensuring equitable access to quality health services

SimuAfya has already received volume guarantees from the major Telkom in Kenya and the government MOH is seeking to co-partner and co-finance to ensure national coverage. Once taken to scale, the SimuAfya brand will be valued and listed to raise regional expansion ( Africa or LMIC). SimuAfya Platform will act as the national docking platform for telemedicine innovations and the space renting or synergy will be a major source of operational funds 

A catalytic fund through a prize award will financially allow the SimuAfya platform to be positioned to harness the call volume guarantees and call cost concessions already explored and extracted from Telkom giants in Kenya, Linkage with funding agencies will enable SimuAfya to scale and increase the degree of believe in the business model and theory of change for the government to eventually take over the platform( a similar approach worked for a mobile money transfer platform called mPesa and it is envisioned SimuAfya will be the new telemedicine currency of operation. 

SimuAfya is the basic foundation very much like the international space station. The potential and possibilities for futuristic health apps docking on the SimuAfya  platform are phenomenal. MIT has outstanding expertise in matters IT and innovation and a partnership will increase brand visibility and value. More important , MIT experts could mentor and oversee app developments that will ensure SimuAfya platform remains a leader in a space of mass telemedicine it is pioneering.  

MIT Mobile Health Faculty, Telekom Engineers and Donor agencies that focus on Maternal Health 

Kenya is home to millions of refugees and it is heart breaking how the COVID19 Pandemic has led to inhumane marginalization of an already marginalized vulnerable population. SimuAfya platform will empower refugees to access quality essential health care at per with other Kenyans as the platform does not discriminate based on sociodemographic characteristics. It will be the primary platform to access affordable quality health care services by vulnerable populations in fragile contexts especially refugees.  

The primary beneficiary of the SimuAfya platform innovation are vulnerable women who have no access to timely quality health care services. This innovation will flip how marginalized women and vulnerable populations will overcome barriers to access to emergency care and quality health services within ones locality. 

COVID19 has stretched an overstretched health workforce especially in low resource settings, The SimuAfya innovation allows healthcare workers to guide patients in health seeking decision making and allows the provider to jointly plan care with the patient without the costly encumbrances of making unscheduled physical visits to a facility that put the health worker at risk of contracting COVID19 among other contagious diseases. This innovation dramatically increases efficiency of the healthcare worker and the patient by eliminating physical, monitory and skill barrier to accessing a health care worker. It also offers a platform for CME for healthcare worker and offers a highway of rapid peer support to the healthcare worker. 

COVID19 has stretched an overstretched health workforce especially in low resource settings, The SimuAfya innovation allows healthcare workers to guide patients in health seeking decision making and allows the provider to jointly plan care with the patient without the costly encumbrances of making unscheduled physical visits to a facility that put the health worker at risk of contracting COVID19 among other contagious diseases. This innovation dramatically increases efficiency of the healthcare worker and the patient by eliminating physical, monitory and skill barrier to accessing a health care worker. It also offers a platform for CME for healthcare worker and offers a channel of rapid peer support to the healthcare worker.This platform will minimize facility overcrowding and hence minimize transmission risk for COVID19. It is a major stab at eliminating maternal and newborn deaths due to unskilled birth attendance by promoting health equity and access.

This innovation is futuristic and, at full operation,  will save millions of mothers dying due to lack of access to skilled care during child birth in the worlds most vulnerable , poorest and least resourced communities. The SimuAfya platform is a concept drawn form the International Space Station in which the SimuAfya Platform will connect the patient to the healthcare provider and offer enormous docking space for telemedicine mobile apps enabling wide and swift access to skilled care within ones locality.