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The rapid emergence of artificial intelligence (AI) and its incorporation into various sectors and industries has been transformative with notable advances in healthcare making a significant impact. The Kenyan healthcare system faces several challenges due to limited resources and therefore integration of AI goes a long way into enhancing efficiency of healthcare delivery to achieve the Quadruple Aim of Care. Currently, use of AI is already transforming healthcare delivery locally and while its clinical applications are promising, it raises significant concerns related to data protection and potential for bias, understanding the advantages and challenges will be integral in shaping a sustainable future for AI driven solutions.

Clinical Applications of AI in Kenya’s Healthcare system. 

In the realm of medical imaging, the use of AI algorithms in diagnostics and imaging analysis is allowing faster and more accurate diagnostics, by AI powered diagnostic tools. For example, the Ministry of Health in partnership with USAID, Centre for Health solutions and Tamatisha TB program launched a Computer Aided Detection (CAD) chest X ray screening and triage tool for pulmonary TB that has significantly improved detection by circumventing the inefficiency of inter and intra reader variability and automating and standardizing interpretation.

This is not only applicable to X-rays, but to CT, MRI and even cardiac imaging ensuring patients, even in rural and under resourced areas, can receive accurate diagnoses in a timely fashion.

AI is also being used to enhance clinical decision making by way of predictive analytics for patient risks. Machine learning models process vast data sets from electronic health records to identify trends, predict patient outcomes, suggest treatment plans and identify high risk patients in settings such as the critical care unit. This data driven approach then allows clinicians to forecast complications, intervene proactively, personalize treatment plans and have more efficient resource allocation.

Additionally, use of AI driven triage systems has brought about the automation of triage and workflow optimization in emergency care and outpatient settings. This serves to streamline patient flow, reduce waiting times and improve the efficiency of care delivery, especially in the emergency setting.

Furthermore, AI is playing a crucial role in telemedicine with AI powered telemedicine platforms enabling virtual consultations. Remote patient monitoring is another viable option where patient access is limited. It is enabled by AI monitoring devices or wearables that can be used to alert clinicians and allow timely interventions, reducing hospital admissions as clinicians can intervene remotely.

Data protection and Bias challenges

However, with access to this frontier emerges the challenge of the ethical and responsible handling of data. AI systems require access to vast amounts of sensitive health information which raises the concern of data security and privacy. Aligning and complying with the tenets of the General Data Protection Regulation (GPDR) and Health Insurance Portability and Accountability Act (HIPAA) globally, and the Data Protection Act of 2019 locally, is a step in the right direction.

Some of the practices outlined in these policies that should be enforced include:

• Transparent collection of all data with informed consent which fosters patient trust and accountability.
• Data anonymization and de-identification before being entered into AI models to protect patient identity by removing any Personally Identifying Information (PII) and application of pseudonyms where necessary. Data is therefore anonymized even when handled by third parties.
• Data minimization, where only necessary data is collected.
• Use of secure data storage and access controls where encrypted storage systems that comply with standards such as ISO 27701 for information security management are employed. This will restrict access to sensitive data highly, requiring multi factor identification and role-based access permissions, which minimizes risk of unauthorized access.
• Having a data governance framework and regular auditing to track data handling, access and security protocols.

The challenge of bias can also not be ignored. AI systems developed in different cultural demographics and healthcare ecosystems may not perform optimally locally where factors like genetics, disease prevalence and even healthcare infrastructure differ. Bias monitoring and inclusive data practices that recognize that AI models can be biased should be carried out, and data sets should be assessed for demographic diversity to ensure that they are representative of patient populations.

What does the future hold?

Looking ahead, Kenya must invest in developing robust regulatory policies with clear guidelines on how AI algorithms should be developed and tested to minimize bias. Challenges such as lack of secure data sharing protocols between health institutions impede the potential of AI in healthcare delivery and must be addressed in our data protection law. Patient privacy should be safe guarded while allowing AI systems to function effectively.
The expansion of telemedicine and mobile health applications also promises to make health care more accessible by overcoming barriers posed by geography and limitations in healthcare infrastructure.

In conclusion, the future of AI in healthcare delivery in Kenya has the potential to be revolutionary. Provided the challenges are addressed conclusively, Kenya can build a healthcare system that utilizes AI to improve health outcomes for her people.

Dr. Cynthia. N. Kamau
Member, KMA Policy, Advocacy and Communications Committee.

The Kenyan healthcare system is at a crossroads. The demand for quality healthcare is rising even as the workforce responsible for delivering these services is facing immense challenges. Inequitable distribution of healthcare professionals (HCPs), few training and employment opportunities, poor working conditions, and the amplifying issue of brain drain are straining the Kenyan healthcare system. Achieving Universal Health Coverage (UHC) will remain an uphill battle if these pertinent issues remain unaddressed.

Recognising these pressing concerns, the Kenya Medical Association (KMA) has contributed to the Healthcare Professionals Policy 2025. This policy aims to remodel how healthcare professionals are trained, employed, deployed, and retained.

At the heart of KMA’s recommendations is the establishment of a National Health Services Commission, a body structured to bridge the gap between the health workforce and government policy implementation.

What’s Going Wrong?

Kenya’s healthcare workforce faces perpetual challenges because of:

1. Poor Coordination Between National and County Governments. Leadership turnover at the county level erodes institutional memory. Additionally, there is poor collaboration between National and County levels of government, leading to the stagnation of health policy implementation, particularly at the grassroots level.
2. Inadequate Planning and Financing. Training programs don’t align with population health needs, and resources are often misallocated, with health facilities understaffed and under-equipped.
3. Shortages of Trained Professionals. Medical schools aren’t producing enough HCPs to meet the healthcare needs of all Kenyans. Career progression for HCPs in government employment also remains unclear, leading to poor employee retention and high turnover.
4. Poor Employment Conditions. Counties lack adequate budgets to hire and pay healthcare workers on time, making job security a major concern.
5. Healthcare Worker Migration. Brain drain is worsening due to poor working conditions, lack of career growth, and inadequate compensation for services rendered.
6. Weak Professional Regulation. Some HCP cadres operate without oversight from instituted regulatory bodies, leading to malpractice and unethical behaviour.
7. Lack of Reliable Data on Human Resources for Health. There is no centralised system to track healthcare professionals, leading to inefficiencies in healthcare workforce planning.

The Kenya National Health Services Commission: A Potential Solution to Kenya’s Healthcare Workforce Crisis

To address these challenges, KMA proposes the institution of a National Health Services Commission that would oversee the management of the entire Kenyan healthcare workforce.

The Commission would:

1. Improve Governance and Coordination. The Commission would act as a link between HCPs and the government, streamlining healthcare leadership and preventing delays in policy implementation.
2. Ensure Adequate Staffing and Retention. By tracking training and workforce needs, the Commission would facilitate better planning for HCP education, employment, and career progression.
3. Strengthen Health Regulatory Frameworks. A HSC would develop and enforce policies on licensing, training, and professional development for HCPs across all cadres.
4. Address Brain Drain. The Commission would support the retention of skilled HCPs by advocating for better working conditions and employment incentives.
5. Strengthen Workforce Data Management. The Commission would oversee a centralised HCP information system that would help in tracking workforce distribution, training needs, and deployment strategies.

The Way Forward

Kenya’s healthcare system can’t function without a well-supported workforce. A National Health Services Commission, through supporting better healthcare planning, could significantly contribute to building a more resilient health workforce that meets the healthcare needs of all Kenyans.

Written by Dr. Wairimu Mwaniki. KMA Policy Advocacy and Communications Committee Convener.

Date: 3rd October 2024
Moderator: Dr Victor M. Wauye, Member, KMA Policy, Advocacy and Communications Committee (KMA PAC), & Lead, KMA PAC Climate and Health Subcommittee
Panellists: Ms Lilian Khalai Mulaa, Project Officer, Pan African Climate Justice Alliance; Dr Martin Muchangi (PhD), Programme Director, Population Health & Environment, AMREF Health Africa; and Dr Dave Ojijo, Chair, KMA Planetary Health Committee

Author: Dr. Victor M. Wauye

Introduction

Climate change poses a significant threat to the health sector, necessitating collaborative efforts to build climate-resilient healthcare systems. The Kenya Medical Association (KMA), through its Policy, Advocacy, and Communications Committee, organized a panel discussion to explore the relationship between climate change and health, aiming for health decarbonization and green healthcare in Kenya.

Relationship Between Climate Change and Health

Climate change impacts health through environmental determinants, leading to storms, droughts, waterborne and vector-borne diseases, food insecurity, malnutrition, and premature deaths. In Kenya, cholera outbreaks and new malaria hotspots and breeds have recently been reported. Mental health issues, often overlooked, are also significant. Extreme weather events damage infrastructure, hindering healthcare delivery and access. Additionally, climate change drives communities into poverty, reducing their ability to afford healthcare.

Conversely, the healthcare sector contributes to climate change mainly via three scopes as in Fig.1. In Kenya, it is primarily through waste disposal practices like dumping and burning.
burning.

Figure 1: Healthcare sector greenhouse gas scopes

Role of Healthcare Sector in Climate Change Mitigation and Adaptation

The healthcare sector's role in climate change mitigation and adaptation in Kenya can be viewed through the WHO health system building blocks:

• Governance: Kenya has made strides with the Climate Change Act and Climate Change and Health Strategy, providing a policy framework, though the position of climate change in the health ministry remains unclear.
• Health Workforce: Few healthcare workers who are mainly driven by passion in Kenya understand the health impacts of climate change. However, passion alone is insufficient without proper systems.
• Health Information: Kenya lacks innovative surveillance systems to interpret and warn about climate change scenarios.
• Service Delivery: The healthcare workforce is not well-empowered to handle climate change impacts.
• Healthcare Financing: Climate funding is unstable, and the health sector has not fully leveraged available funds like the green climate fund.

Health Sector Decarbonization Strategies

Various strategies can be adopted in Kenya:

• Renewable energy sources like solar panels, as seen in Rwanda.
• Electric vehicles for ambulances instead of diesel-fuelled ones.
• Transition to public transport or cycling, as in Sweden.
• Paperless systems and telemedicine to reduce waste and transport-associated emissions.
• Improved medical waste management, including innovative protocols and grey water recycling.
• Education of healthcare workers on climate change and health.
• Eco-friendly manufacturing of medical supplies from local materials.

Conclusion

Climate change is a significant health crisis, primarily caused by human activities. It adversely affects health, but the healthcare sector also contributes to climate change. Building a climate-resilient healthcare system is crucial for mitigation and adaptation. By adopting innovative strategies, there is an opportunity to decarbonize the healthcare sector and establish green healthcare in Kenya.

Recommendations:

• Conduct health systems carbon emissions audits.
• Invest in local capacities for manufacturing medical supplies.
• Involve communities in addressing climate change health challenges.
• Improve medical training curricula to include climate change and health.
• Develop innovative surveillance and response mechanisms.
• Allocate resources for implementing climate change and health policies.
• Explore funding opportunities by collaborating with governmental and non-governmental organizations.
• Advocate for a coordinated multisectoral approach.
• Develop innovative waste management strategies.

The Kenya Medical Association is a voluntary membership association of all doctors registered to practice in Kenya. It is mandated to Champion for the Welfare of Doctors and Quality Healthcare in Kenya.

On this World No Tobacco Day (WNTD), the Kenya Medical Association joins the World Health Organization and affiliate countries, the Ministry of Health Kenya, the Tobacco Control Board, Civil Society and other Global Tobacco Control Organizations in commemorating this year's WNTD.

We celebrate this year’s theme ‘We Need Food, Not Tobacco’ cognizant of the negative impact that tobacco growing and curing has on farmers through green tobacco sickness, exposure to carcinogenic chemicals and chronic lung conditions.

We further recognize, the negative impact tobacco growing has on the environment, its’ effect on food insecurity and the poor labor and business practices by tobacco the industry that make it difficult for tobacco farmers to make a profit or switch to alternative crops that are more profitable.

As Kenyans, we are proud to host this years' Global Celebrations in Migori and to have the farmers recognized for being the pioneers of the ‘Tobacco Free Farms’ initiative. This has seen at least 2000 farmers in the county transition from growing tobacco to high iron beans providing them with healthy, economically viable alternatives and impacting on the local supply of tobacco leaf.

Lastly, we appreciate the devastating role that tobacco products old and new, continue to play as the biggest modifiable risk for disease and responsible for the deaths of 6000 Kenyans annually. We shall continue to work with the Ministry of Health, the Tobacco Control Board and all other organizations to ensure full implementation of the Tobacco Control Act. We shall further play a very specific part in sensitizing the public on the harms of tobacco use and in ensuring that we champion for and provide access to tobacco cessation services wherever possible.

KMA PUBLIC HEALTH COMMITTEE
31.05.2023

DOWNLOAD THE STATEMENT HERE