JMIR Publications

ABSTRACT

Background:

The rise of noncommunicable diseases in sub-Saharan Africa places strain on already stretched healthcare systems, that have traditionally focused on infectious diseases. Healthcare provision is fragmented, and there is a dearth of literature on the experiences, challenges, and solutions for improving the management of noncommunicable diseases in sub-Saharan private healthcare sectors.

Objective:

We investigated the management of hypertension in the Kenyan private healthcare sector to understand how a health information system could be used to address care continuity and quality challenges in the management of hypertension and other noncommunicable diseases.

Methods:

We conducted in-depth interviews and direct observations at 18 healthcare institutions in Kenya. We analyzed the data to identify the key challenges and proposed solutions to the challenges. We subsequently used the generated insights to propose the design of a digital health solution for enabling care quality and continuity at the study setting and similar ecosystems.

Results:

The private healthcare sector in Kenya is fragmented and faces challenges such as high cost of care, limited healthcare literacy, lack of self-management support, ineffective referral systems, inadequate care provider training, and inadequate regulation. Care coordination is hindered by suboptimal encounter data collection, limited view of patient histories, and little trust between care providers. Patient health records are siloed in multiple paper and electronic systems that lack integration. The proposed digital health platform system supports care coordination and continuity within fragmented healthcare systems by enabling patient-consented data sharing while ensuring that care providers in separate facilities have holistic views of the patient’s clinical and non-clinical history.

Conclusions:

Health information systems can play a pivotal role in addressing the care continuity and quality challenges in the management of noncommunicable diseases in sub-Saharan Africa private healthcare sectors. Leveraging technology and processes to support patients managing chronic noncommunicable diseases in disparate clinical and nonclinical settings (e.g. at home and in support groups) is critical.