The democratisation of health care: will Kenya be left behind?


“Young man, I would be dead without this device.” Mr. Ngatia[1] said as he shook my hand vigorously. Mr. Ngatia was in his early 50s and had spent much of his life in Korogocho slum in Nairobi. I met him about seven years ago when I was leading a community-based health research project on hypertension in Nairobi’s slums. My team of trained community health workers had visited thousands of slum residents in their homes, including Mr. Ngatia, to provide free screening for hypertension.

Mr. Ngatia did not initially receive his diagnosis of hypertension well. He did not have medical insurance and was worried about how he would sustain the roughly $2 a month that the medication would cost him for the foreseeable future. He was a shoe-cobbler and didn’t earn very much. Fortunately, my research project included a budget to provide highly subsidised hypertension treatment in Mr. Ngatia’s community over its three-year duration.

After my research project ended in 2015, I kept in touch with Mr. Ngatia. Our most recent encounter involved the device that he was thanking me profusely for ─a birthday gift. It was a low-cost digital pillbox that helped him remember when to take his meds. Although he was not always able to purchase his meds regularly, he had used the pillbox for a few months and was convinced that it was a life saver. Who was I to argue? I was simply glad that I could help ease his health burden, even if marginally.

Later that day as I reflected on my encounter with Mr. Ngatia, I was dismayed at the failings of health care systems across Kenya. I was angered by the persistent health inequality, the lack of strong political will and the continued neo-colonisation of global health.  Indeed, I am thankful that the COVID-19 pandemic has not devastated the continent as had been predicted. However, I remain ever so conscious about how vulnerable we are. I wonder if health care in Kenya would ever be democratised.

Recently, I  had come across a report on health care democratisation, which could generally be defined as a state in which patients are empowered in their own care. The authors of the report argued convincingly that “for the first time in history, there is an opportunity to truly democratise health care”. This, they say, is because health data is growing and flowing across a wide range of stakeholders faster than ever before. This transformation, as they call it, puts patients at the center of healthcare, and is encouraging the spread of medical knowledge in unprecedented ways. The authors also pointed out that new technologies such as recent breakthroughs in data science and artificial intelligence, and investments by industry players such as tech giants Apple and Google, are taking medical knowledge from a “human scale to a digital scale”. For example, Apple is recruiting 400,000 of its smartwatch wearers to participate in the Apple Heart Study aimed at early detection of potentially deadly heart conditions.

The report identified several roadblocks to the democratisation of health care like concerns over data privacy and improving the interoperability. However, it was silent about what this all meant for the developing world. This is not a criticism ─the report was primarily intended for a US audience.

Overall, the report got me thinking about how unprepared and ill-equipped Kenya is for health care democratisation. Our health data systems need a lot of improvement and our data scientists still rely heavily on international funding initiatives such as the US NIH’s Harnessing Data Science for Health Discovery and Innovation in Africa.  Also, the policy and regulatory environment for data science and digital health across much of Kenya remains quite underdeveloped.

I take solace in the fact that there are examples where technological advances have been favourable to Kenya . For example, mobile money payment platforms such as Kenya’s Mpesa have been lauded for catalysing financial inclusion on a scale that no aid initiative or program could ever have achieved. I have also been inspired by how some African governments have responded decisively to the COVID-19 pandemic and how they have mobilised their own resources effectively. It’s also been quite encouraging to see innovations from African research institutions. For example, students at Kenyatta University invented a low-cost ventilator for COVID-19 patients.  The private sector has also been very much engaged in the pandemic response.

My call to action is for Kenya to carry this momentum into other aspects of health care. Let’s build on the decisive governance that some of our political leaders have shown, the innovativeness of our academia, the resilience of our people and the resourcefulness of our private sector. If we can do this, then I see no reason why any Kenyan, including vulnerable patients like Mr. Ngatia, should be left behind in this promising global trend of health care democratisation.

About the author

Dr. Samuel Oti is a public health physician and co-founder of the Network of Impact Evaluation Researchers in Africa

Conflicts Statement

The author declares no competing interests.


The author would like to acknowledge Mr Jide Olatunbode for reviewing previous drafts.

Handling Editor Soumyadeep Bhaumik

Post-publication notes: Some edits were made post-publication to remove generalization over Africa in discussion with author.

[1] Mr. Ngatia is not a real name and certain aspects of the story have been modified to protect identity

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