Opportunities And Challenges In Drug Monitoring

BMI View : Growth in the number of mobile phone users and wireless subscribers, and advances in the innovative application of communication technology to address health priorities have the potential to transform the delivery of healthcare across the world. This provides significant opportunities for companies looking to invest in the telecare sector, including drug companies, insurance providers, mobile operators and software vendors.

BMI defines telecare as the use of mobile and internet technology to provide clinical care and non-clinical services, such as health education, disease surveillance and drug monitoring. It is our view that the continued growth in the demand for healthcare, the sustained growth in mobile and broadband subscribers, and the growing sophistication of communications network infrastructure is driving new opportunities in telecare across the globe.

Focusing on emerging markets, governments are adopting telecare as a complementary strategy to strengthen healthcare systems - telecare increases populations' access to healthcare, which continues to be a major issue. Here we identify investment opportunities in drug monitoring, a type of telecare particularly suited to the characteristics of emerging markets, using Kenya as a case study.

Aiding Healthcare Delivery
Kenya: Cellular, 3G & 4G Mobile Phone Subscribers

Opportunities And Challenges In Drug Monitoring

BMI View : Growth in the number of mobile phone users and wireless subscribers, and advances in the innovative application of communication technology to address health priorities have the potential to transform the delivery of healthcare across the world. This provides significant opportunities for companies looking to invest in the telecare sector, including drug companies, insurance providers, mobile operators and software vendors.

BMI defines telecare as the use of mobile and internet technology to provide clinical care and non-clinical services, such as health education, disease surveillance and drug monitoring. It is our view that the continued growth in the demand for healthcare, the sustained growth in mobile and broadband subscribers, and the growing sophistication of communications network infrastructure is driving new opportunities in telecare across the globe.

Focusing on emerging markets, governments are adopting telecare as a complementary strategy to strengthen healthcare systems - telecare increases populations' access to healthcare, which continues to be a major issue. Here we identify investment opportunities in drug monitoring, a type of telecare particularly suited to the characteristics of emerging markets, using Kenya as a case study.

Medicine Shortages Create A Demand For Drug Monitoring Systems

Initiatives in the area of drug monitoring involve the use of SMS technology to track and manage the supply of medicines. The system works by sending an automated SMS to healthcare staff at local healthcare facilities, reminding them to check stock levels of drugs. The staff then replies via SMS to a central database system, detailing stock levels. Deliveries can then be managed centrally to manage drug supplies more efficiently.

Kenya's drug supply management systems, characterised by the tedious and time consuming manual maintenance of records, have not proved efficient. A shortage of drugs, including medicines used to treat malaria and tuberculosis, has continuously affected public hospitals, forcing patients to purchase drugs from costly private chemists. Furthermore, infectious diseases such as HIV/AIDS are a major problem for Kenya and a reliable, uninterrupted supply of antiretrovirals is crucial to the success of antiretroviral therapy. Automating the medicine supply chain can enhance record keeping and reporting processes and can help to improve the access to medicines for those affected. The advantage of employing a simple solution such as drug monitoring is that it uses the most basic mobile technology - which the government can use to ensure populations have access to medicines. BMI is forecasting robust growth of cellular, 3G and 4G mobile subscriber numbers in Kenya.

Aiding Healthcare Delivery
Kenya: Cellular, 3G & 4G Mobile Phone Subscribers

The Public Sector

In mid-2013, it was reported that the Kenyan Medical Supplies Authority (KEMSA) and Fintech Kenya are to roll out a mobile-based medicine tracking system that will aid in the monitoring of the drugs supply for health programmes in the country. The mobile-based service will enable public healthcare workers and county health management teams report the consumption of medical supplies, place orders for medicines and track drug deliveries. Fintech is an information technology solutions and services provider with operations in Kenya, Malawi, Mauritius, Uganda and Zimbabwe.

KEMSA was established in 2000 to replace the Medical Supplies Coordinating Unit (MSCU) and is currently responsible for supplying essential drugs to public facilities, which it procures through an open tender system financed by the Ministry of Health. The association's mandate includes the procurement, storage and distribution of pharmaceuticals and medical devices. It has been semi-autonomous from the government since 2003 and competes with other distributors, most notably the non-governmental organisation (NGO) Mission for Essential Drugs and Supplies (MEDS), in the private market. KEMSA currently has eight regional depots and delivers medical supplies directly to all the country's health facilities - public hospitals, rural health centres and dispensaries - of which there are more than 4,000.

The Private Sector

In May 2014, Kenya's ICT Authority named mobile application ZiDi the 2O14 innovation award winner in the health care delivery sector. The application was developed by Microclinic Technologies in conjunction with Microsoft (the system runs on the Microsoft Windows Azure Cloud) under the 4Afrika initiative. An innovative mobile health management system, ZiDi, was awarded a KES8.6mn (USD96,000) in the first GlaxoSmithKline (GSK) and Save the Children USD1mn Healthcare Innovation Award.

ZiDi is a mobile health management system designed to improve the quality of maternal and child care by providing access to real-time data to enable effective and targeted health planning decisions. Via the use of Windows smartphones and tablets, ZiDi can be used to capture and monitor a variety of health data, such as service utilisation, case records, care and training coverage and the consumption of vaccines and essential drugs. This information can then be used, for example, to identify those who have defaulted on immunisations, or other healthcare follow up services, to identify service or training gaps, or to accurately forecast demand for drugs and essential supplies. By saving time in data collection, ZiDi also frees up time for health workers to spend delivering services for patients. ZiDi is currently being used in over 5,000 health facilities in Kenya. Prior to the implementation of the technology, nurses would track over 160 commodities manually on cards which would be delivered to the KEMSA via courier services.

Barriers To Entry

  • Mobile services are concentrated in urban and semi-urban areas. Most rural areas lack adequate network coverage. More than 70% of Kenya's population live in rural areas, according to BMI data.

  • Fierce price wars in mobile markets can have a negative impact on operators' profitability and, consequently, ability to finance rural expansion projects. This means that many rural areas can remain underserved for longer than anticipated as network infrastructure build out in those areas is delayed.

  • Drug monitoring relies on sending data easily, ensuring the quality of information does not deteriorate. While the majority of developed markets have established broadband infrastructure, this is more of a restriction in emerging markets where fixed broadband

infrastructure is weak.

  • Providing healthcare workers with the necessary devices could be expensive, but older handsets and basic devices should have the capacity to run rudimentary services.

  • Devices to capture data are also important to the expansion of drug monitoring projects and services. In communities where devices are not replaced often, the durability and maintenance of these devices will play a key role in making services financially viable.

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