Improving Kenyan health care via text messaging

Marc Olsen had spent much of his young life believing a business model could solve most of the world’s problems.

The son of a college professor, he’d also embraced the value of education, and so when he started volunteering eight years ago in Kilifi, a rural town on the coast of Kenya, that’s what he wanted for the children there.

But soon after his first visit to the African country, something shifted in Olsen.

“I realized then that there were some needs more basic than even education; that some kids couldn’t even go to school because they were so sick,” he said recently.

He also realized that while it remained one of the poorest places in the world with 78 percent of people living in poverty, Kilifi had an excellent mobile phone network that could improve both health care delivery and education.

And so in 2009, Olsen helped launch a pilot program there called mHealth or mobile health, one of several efforts funded by Rotary International and staffed by volunteers to improve the health outcomes for more than half a million Kenyans.

The way mHealth works is a community health worker, typically a mother who cares about the community and wants to give back, is assigned to 20 households and uses her cellphone to collect health data, report it to the hospital and encourage household members to seek care.

“It’s very, very basic, but it’s changing people’s lives in big ways,” Olsen said.

Olsen’s work with the nonprofit Kilifi Kids began in earnest in 2006 during an email exchange with a fellow Rotarians already on the ground in Kenya. Janet Midega was looking for a partner for an educational project there.

Olsen, a longtime member of the Vinings Rotary, signed on.

They’d already stocked four computer labs and awarded 33 scholarships when in 2007, Olsen was touring a hospital and happened upon what he considered an even more haunting problem: childhood disease.

Indeed disease was so rampant in Kilifi, Olsen soon discovered, that as many as 50 percent of its children suffered from intestinal parasites.

He needed to make a choice, he said: “I could help one single child with $1,200 or 30 kids with the same amount of money because they could remain in school.”

Olsen, an investment banker turned director of operations at WellStar Health System, then launched a deworming campaign, administering medication once or twice a year to children. Wiping out a disease, he reasoned, would allow more kids to go to school.

“Infection rates went from 32 percent to almost nothing in two years,” he said. “That was kind of the genesis of how my life changed from corporate finance to public health.”

Olsen returned stateside and in 2010 realized that while he loved finance, he could do more good elsewhere.

“I started switching my clients to health care and in 2011 made the leap from corporate finance to Children’s Healthcare of Atlanta, looking at ways to grow the hospital,” he said.

Two years later, Olsen transferred to operations at Wellstar, and now oversees nearly a dozen of the health care system’s clinics.

While in the midst of the deworming campaign, Olsen said it became obvious Kilifi was getting healthier and more and more of its children were going to school.

That’s also when he noticed some 95 percent of Kenya was covered by cellphone towers; that 70 percent of people had cellphones or access to one, and the technology was already being used elsewhere to track weight, check exercise and count calories.

“My thought was we’re going to do the same thing in Kenya,” he said.

The only question was how.

People were already developing tools — Child Count at the Earth Institute of Columbia University and Medic Mobile at Stanford University.

“We picked Medic Mobile and began developing a low-level communication tool, connecting community health workers to the hospitals,” Olsen said.

Alex Macharia, a native of Nairobi and member of the Kilifi Rotary, said before mHealth, “one of the main challenges we faced was delivering health information from government clinics to the main hospital.”

Not only has the use of cellphones cut down on the number of trips health workers make to the hospital, Macharia said texting allows delivery of information in a more organized format, enables the country to monitor the delivery of care, and provides more timely feedback.

Since launching mHealth, Macharia said, care to pregnant mothers, children and other residents who require emergency medical assistance has vastly improved.

“We have seen the number of facility-based deliveries in clinics we support move upwards from 322 in 2012 to 521 in 2013,” Macharia said in response to emailed questions.

With some 900 community health workers expected to be trained this year, that number is likely to increase 20 percent during the first half of 2014 along with the amount of people they are able to reach, doctor’s appointments and immunizations, he said.

In addition, Macharia said, solar chargers have become a source of income for the community health workers besides their pay, making the project sustainable.

Macharia credited Olsen for much of the change.

“He has taken his time to not only mobilize for funds but also meet with the various stakeholders including the government officials and other private partners to discuss logistical issues,” Macharia said.

Olsen said that mHealth is now in its fourth phase with 1,000 community health workers looking after some 250,000 women and children.

“mhealth is exploding here and around the world, and it’s the cheapest way to improve the health of entire populations on a massive scale,” he said.

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