By Dr. Kariuki Muigua, PhD (Leading Environmental Law Scholar, Policy Advisor, Natural Resources Lawyer and Dispute Resolution Expert from Kenya), Winner of Kenya’s ADR Practitioner of the Year 2021, ADR Publisher of the Year 2021 and CIArb (Kenya) Lifetime Achievement Award 2021.*
Telemedicine has been taking root in Kenya, especially with the outbreak of the COVI-19 pandemic. The World Health Organisation observes that Information and Communication Technologies (ICTs) have great potential to address some of the challenges faced by both developed and developing countries in providing accessible, cost-effective, high-quality health care services through the use of telemedicine. Telemedicine uses ICTs to overcome geographical barriers, and increase access to health care services. This is particularly beneficial for rural and underserved communities in developing countries – groups that traditionally suffer from lack of access to health care.
The World Health Organization uses the following broad description of the term ‘telemedicine’: “The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities”. Notably, telemedicine is an open and constantly evolving science, as it incorporates new advancements in technology and responds and adapts to the changing health needs and contexts of societies.
Telemedicine episodes may be classified on the basis of: (1) the interaction between the client and the expert (i.e. real-time or prerecorded), and (2) the type of information being transmitted (for example, text, audio, video). In Kenya, a large portion of the population is unable to have face-to-face consults with medical providers and as a result, much of the care is triaged through community health workers and nurses and only those patients deemed to be in critical need of hospital services are transferred to see a medical provider. This situation is made worse by the fact that there is a shortage of approximately 50% of the needed health care workforce to meet the needs of the population in Africa. Telemedicine and other telehealth services are thus meant to address the very limited access to face-to-face medical consults and high medical cost which can consequently see a reduction in poverty, improved health and well-being, improved education, and economic growth.
In places such as Lamu County, where residents face extremely limited access to healthcare, the residents have now access to care-at-a-distance through the telemedicine project initiated by Huawei, Safaricom and local partners, which allows local healthcare workers and patients to remotely consult with specialists in towns and cities. There is a scarcity of licensed doctors and specialists in Lamu, and telemedicine is expected to transform medical care for low-income families in the region by reducing travel time and expenses; and 50% more patients will attend referrals each year, leading to significantly better patient outcomes. The Philips Foundation, a registered charity and platform for the worldwide societal activities of Royal Philips, has also since introduced mobile ultrasound technology, meant to improve maternal and child health, where ways will be explored to use mobile ultrasound technology at primary care level, performed by midwives and supported by remote experts through telehealth, to enhance availability of affordable services in the underserved communities and remote areas of Kenya.
While telemedicine is no longer new in Kenya, there is a need for the regulators to continually review the regulatory framework that will not only promote its growth and development, but also to ensure that those who use it are either held or benefit from the same standards of professional care as those under the traditional forms of medical care and data protection. Notably, the Health Act, 2017 defines “e-Health” to mean the combined use of electronic communication and information technology in the health Sector including telemedicine. Telemedicine and telehealth services can indeed supplement the investment in physical infrastructure in provision of health care services.
The Viability of Medical Tourism
A working health system is not only capable of ensuring that the citizens enjoy healthy lives and well-being, but is also capable of earning some extra income for the government through what is now commonly known as ‘medical tourism’, defined as the travel of people to a place other than where they normally reside for the purpose of obtaining medical treatment in that country. India has emerged as one of the countries that have heavily invested in medical tourism. Medical tourism is a multi-billion dollar industry that has been heavily promoted by governments and the medical and tourism industries for the potential mutual benefits.
India takes pride in being uniquely placed by virtue of its skilled manpower, common language, diverse medical conditions that doctors deal with, the volume of patients, and a large nonresident Indian population overseas. They have also invested in provision of dedicated services to alleviate the anxiety of foreign patients which include translation, currency conversion, travel, visa, post treatment care system, and accommodation of patient relatives during and after treatment. In 2019, India was ranked as the third most preferred destination for medical tourism, with the industry set to reach $9 billion in valuation in 2020, although the projection might have since been affected by the COVID-19 pandemic.
Notably, South Africa has also been making medical advances, and in addition to shorter travel times than India, South Africa advertises the added allure of safaris and spas. As Kenya pursues the dream of UHC as a key delivery under Vision 2030 and the Big Four Agenda, the government and all the relevant stakeholders in the health care sector should consider following in the footsteps of India and South Africa. In India, while the private sector has always been prominent as a source of medical care, since 1991 neoliberal government policies supporting the private sector have created conditions for its rapid growth. This may, therefore, take a while to achieve, but continuous investment in infrastructure and the medical personnel will see to it that we finally get there. While the country may not yet benefit from patients from outside the continent, it may first target patients from the region and the African continent in general.
Medical tourism, however, should not be pursued at the expense of the poor in the country: the Government should ensure that the general populace in the country can access health care services before it seeks to extend the same to the foreigners. Kenya should consider going the Cuban way where, Cuba, which has been a pioneer in medical tourism for almost four decades, has hospitals for Cuban residents and others for foreigners and diplomats. Both kinds are run by the government and Cubans receive free healthcare for life while tourists have to pay for it. In addition, the Cuban government has developed medical tourism to generate income which is then reinvested into the country’s medical sector to benefit its country’s citizens.
*This article is an extract from the Article “Ensuring Healthy Lives and Well-being for All Kenyans,” by Dr. Kariuki Muigua, PhD, Kenya’s ADR Practitioner of the Year 2021 (Nairobi Legal Awards), ADR Publisher of the Year 2021 and ADR Lifetime Achievement Award 2021 (CIArb Kenya). Dr. Kariuki Muigua is a foremost Environmental Law and Natural Resources Lawyer and Scholar, Sustainable Development Advocate and Conflict Management Expert in Kenya. Dr. Kariuki Muigua is a Senior Lecturer of Environmental Law and Dispute resolution at the University of Nairobi School of Law and The Center for Advanced Studies in Environmental Law and Policy (CASELAP). He has published numerous books and articles on Environmental Law, Environmental Justice Conflict Management, Alternative Dispute Resolution and Sustainable Development. Dr. Muigua is also a Chartered Arbitrator, an Accredited Mediator, the Africa Trustee of the Chartered Institute of Arbitrators and the Managing Partner of Kariuki Muigua & Co. Advocates. Dr. Muigua is recognized among the top 5 leading lawyers and dispute resolution experts in Kenya by the Chambers Global Guide 2022.
References
Muigua, K., “Ensuring Healthy Lives and Well-being for All Kenyans,” Available at: http://kmco.co.ke/wp-content/uploads/2020/12/Ensuring-Healthy-Lives-and-Wellbeing-for-All-Kenyans-Kariuki-Muigua-December-2020.pdf (accessed on 21st May 2022).