Why Kenya will wait longer for blockchain solutions in healthcare

If you are a medical practitioner in Kenya, then you will admit that the health sector faces a number of challenges that have long derailed efforts towards efficient service delivery.

From managing patient data, licensing healthcare workers, curbing sale of counterfeit drugs and suppressing the theft and misappropriation of public funds, the country has suffered hitches that have become impediments in improving healthcare.

But when the Artificial Intelligence (AI) and Blockchain Taskforce tabled its research recommendations to the ICT ministry in July 2019, a ray of hope struck on the country’s inefficient health sector.

The taskforce recommended the aggressive use of blockchain technology to improve the integrity of medical records, consent management for greater patient data privacy, and in setting up reward systems for patients who present their data for medical research.

Blockchain, which in simple terms is a digitally distributed, decentralised, public ledger that exists across a network, also held the hope of enabling patients to trace the supply chain of medication, scotching counterfeit medicine and augmenting the skills of medical professionals.

The World Health Organization (WHO) estimates that about 100,000 Africans die every year as a result of counterfeit drug trade. The International Policy Network (IPN) global estimates show that 700,000 people die every year due to fake malaria and tuberculosis drugs.

“Deployment of the technology will lead to cost reduction. It will also transform drug safety through better traceability,” the taskforce report read.

But over two years later, the health sector remains in the same state despite a rise in the digitisation of data stored in traditional formats over the Covid-19 pandemic period that would make implementation easier.

Prof Bitange Ndemo, who led the taskforce, told HeathyNation that a lot has changed since the report was presented to the government for consideration for implementation, admitting that many sections of the findings need an upgrade.

“When we did the report, there was very little application of Artificial Intelligence. Today, it is everywhere. The discourse has changed,” he said.

He added that while blockchain could potentially transform Kenya’s medicare, AI must be used alongside it, noting that the taskforce is now focused on ethical AI,  which gives guidelines regarding fundamental values, patient rights, privacy, non-discrimination and non-manipulation of heath data.

But Benjamin Arunda, the first author of a book expounding on the possible use cases of blockchain in Africa – Understanding the Blockchain – said the crippling factor arises from the government’s wait-and-see approach in the application of blockchain.

“The Kenyan government seems to be watching the global blockchain adoption landscape before implementing,” he says.

The risk of being in the forefront in adoption, he explains, is something most governments will not be willing to take as it involves high costs of research and development.

For blockchain to take root in the management of the Ministry of Health, for instance, he notes that additional funding would be required to allow the taskforce or a dedicated ICT department to achieve successful implementation.

Healthcare, a highly regulated sector in the country but which still suffers a myriad of hurdles, can only be transformed through proper government intervention, according to Mr Arunda. “Most of the healthcare blockchain solutions are still in the proof-of-concept stage,” he adds, meaning Kenya would only adopt if such concepts are fully tested and mainstreamed.

In an efficient blockchain system, there would be a tamper-proof registry of licensed healthcare professionals that would help weed out quack doctors and unqualified medical staff.

Having a blockchain-based verifiable way to onboard medical professionals and manage finances would be better than a centralised one that can be compromised when collusion with corrupt health officials happens.

Corruption and embezzlement of public funds in Kenya’s health industry is nothing new, the most recent being orchestrated by Kenya Medical Supplies Authority officials who conspired with briefcase companies and took advantage of the pandemic crisis to rob the country of billions of shillings meant to shield Kenyans from a dangerous virus, earning themselves the ‘Covid-19 millionaires’ label.

“If blockchain was in place, this would not have happened,” affirms Mr Arunda.

David Chou, chief information officer at Children’s Mercy, a US paediatric medical centre, however, says there exists a cultural obstacle, especially from doctors who are used to paper work.

“Getting them to go from paper records to electronic healthcare records using blockchain is a big task. For example, doctors like leaving questions blank, a required field in technology makes this habit hard to break,” he notes.

Mr Timofeev believes the main obstacles to blockchain in healthcare will be around ownership – public or private.

As a potential solution, he cites Estonia’s government-backed blockchain initiative, which allows companies to create their own solutions on the blockchain and build a whole new ecosystem for healthcare innovation.

Estonia has over the years digitised 99 per cent of its medical services and it became the first country to deploy blockchain in healthcare in 2008.

Patients in Estonia now carry smart cards through which they can access over 1,000 online government portals to check their health records. 

Blockchain secures their online health records by making information immutable. Hackers, therefore, are not able to make any changes in the data.

All the digital transactions made with blockchain technology are recorded irreversibly and the records are difficult to change since they are shared across many computers in real time through a distributed ledger.

“Even with all the challenges facing us – I still believe that blockchain is a viable solution to move healthcare forward,” says Mr Chou.

In the end, he posits, everyone receiving and working in healthcare would benefit because of lower costs from the ease of data transfer and it would allow for more patient-centred care. 

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