Demonstrating demand for preventive health services in rural Kenya

  • Jeffrey D Lackey Pennsylvania State University
  • Stephen Suffian Pennsylvania State University
  • Rachel Dzombak Pennsylvania State University
  • Khanjan Mehta Pennsylvania State University
Keywords: community health worker (CHW), preventive healthcare, telemedicine, Kenya


Developing countries like Kenya suffer from a severe lack of healthcare professionals.
Access to primary care is further limited when large distances must be travelled for basic medical care,
and often times the decision to seek professional help is made too late. Preventive health services can
save lives by diagnosing serious medical conditions early and subsequently reducing the likelihood of
life-threatening diseases. The rapid increase in the global incidence of chronic diseases like diabetes,
hypertension, and heart disease makes preventive health services particularly important. Trained
community health workers (CHWs) operated the Mashavu telemedicine system in Nyeri County
of Kenya over the course of fi ve months. The Mashavu system comprised of a netbook computer, a
web camera, and other basic supplies. CHWs provided patients with two alternative services: (1)
body measurements including blood pressure, weight, and body mass index (BMI) or (2) a full
consultation that supplemented the measurements with health indicators and a brief survey. A
lightweight website was developed to allow CHWs to send this information to a nearby nurse. This
website was accessed by leveraging the 3G cell networks that are ubiquitous in Kenya. During the
fi ve-month pilot, 777 patients paid for these services. Nearly one-third of patients used the service
as an opportunity for a routine health check. The median age among patients was 40 years and 35 %
of all patients were between the ages of 21-35. The pilot described in this paper demonstrated to
CHWs that community members value health information and are willing to pay a small fee for it.
This pilot suggests that as developing countries struggle to address the double burden of chronic
and infectious disease, fee-for-service preventive health services can serve as an innovative means
to achieve economic development and improved community health.


Bolin, T., 1996, ‘Cost benefit of early diagnosis

of colorectal cancer ’. Scandinavian Journal of

Gastroenterology, vol. 31, no. S220, pp. 142-146.

Briscombe, B., Sharma, S. & Saunders, M., 2010,

Improving resource allocation in Kenya’s public health

sector, Washington DC: Futures Group, Health Policy

Initiative, Task Order 1.

Castro-Leal, F., Dayton, J., Demery, L. & Mehra,

K., 2000, ‘Public spending on health care in Africa:

do the poor benefi t?’, Bulletin of the World Health

Organization,vol. 78, no. 1, pp. 66-72.

Chen, S., Cheng, A. & Mehta, K., 2013, ‘A Review

of Telemedicine Business Models’, Telemedicine and

e-Health, April, vol. 19, no. 4, pp. 287-297.

Chuma, J., Gilson, L. & Molyneux, C., 2007,

‘Treatment-seeking behaviour, cost burdens and

coping strategies among rural and urban house

holds in coastal Kenya: an equity analysis’, Journal of

Tropical Medicine & International Health, vol. 12, no. 5,

pp. 673-686.

Ensor, T. & Cooper, S., 2004, ‘Overcoming barriers to

health service access: influencing the demand side,

Health Policy and Planning, vol. 19, no. 2, pp. 69-79.

Fleishman, A., Fleishman, A.J., Wittig, J., Milnes J.,

Baxter, A., Moreau, J., Mehta, K., 2010, ‘Validation

process for a social entrepreneurial telemedicine

venture in East Africa’, International Journal for Service

Learning Engineering, vol. 5, no. 1, pp. 1-24.

Food and Agriculture Organization, 1996, Rome

Declaration on World Food Security and World Food

Summit Plan of Action, viewed 29 July 2012,>.

Google Maps, 2014. Map. Nyeri: Google Maps.

GSMA, 2012. Safaricom – Kenya – Feasibility Study,

GMSA Head Offi ce, London, UK.

Gu, W., Wang, X. & McGregor, S. E., 2010,

‘Optimization of preventive health care facility

locations’, International Journal of Health Geographics,

vol. 9, no. 17, pp. 1-16.

Holmes, K., Suffi an, S., Lackey, J., Mehta, K., ‘Pilot

Results of a Health Social Franchise in Kenya: Early

Evidence of Sustainable Livelihood Creation’, paper

presented to Humanitarian Technology: Science,

Systems and Global Impact Conference, Boston,

May 2014

Kelly, J. M., Osamba, B., Garg, R.M., Hamel, M.J.,

Lewis, J.J., Rowe, S.Y., Rowe, A.K., Deming, M.S.,

, ‘Community Health Worker Performance in

the Management of Multiple Childhood Illnesses:

Siaya District, Kenya, 1997-2001’, American Journal of

Public Health, October, vol. 91, no.10, pp. 1617-1624.

Ochako, R., Fotso, J.C., Ikamari, L., Khasakhala,

A., 2011, ‘Utilization of maternal health services

among young women in Kenya: Insights from the

Kenya Demographic and Health Survey, 2003’, BMC

Pregnancy and Childbirth, vol. 11 no. 1, pg. 1.

Pandya, R., Grillo, D., Lycksell, E., Mieybegue, P.,

, ‘IMT-2000 Standards: Network Aspects’, IEEE

Personal Communications, August, IEEE vol. 4, no. 4,

pp. 20-29.

Qin, R., Dzombak, R., Amin, R. & Mehta, K., 2012,

‘Reliability of a telemedicine system designed for

rural Kenya’, Journal of Primary Care and Community

Health, vol. 4, no. 3, pp. 1-5.

Wachira, B. & Martin, I. B., 2011, ‘The state of

emergency care in the Republic of Kenya’, African

Journal of Emerging Medicine, vol. 1, no. 4, pp. 160-165.

Wang, L., Kong, L., Wu, F., Yamin, B., Burton, R.,

, ‘Preventing chronic diseases in China’, Lancet,

vol. 366, no. 9499, pp. 1821-1824.

World Health Organization, 2009, Country Statistics,

Kenya, World Health Organization, Geneva,


World Health Organization, 2011, World Health

Statistics, World Health Organization, Geneva,


Wynchak, S. & Fortuin, J., 2012, ‘Africa’s telenursing

today (and tomorrow?)’, International Journal of

Advance Life Sciences, vol. 2, no. 3 and 4, pp. 165-172.

Yonga, G., 2010, Case Kenya Study: NCD Situation,

Workshop on Country-Level Decision Making

for Control of Chronic Diseases. Washington, DC:

Institute of Medicine of the National Academies.