OPINION: Why Kenya's Social Health Insurance Fund must embrace a Digital Health Ecosystem

By Gilbert Muthee

One promising use case to improve healthcare access, affordability, and quality is supporting the new Social Health Insurance Fund (SHIF) with a robust digital health ecosystem. This digital health ecosystem would streamline health information exchange and employ a national health terminology service to enhance healthcare delivery and management.

Imagine a healthcare system where clerical errors are minimized because all healthcare providers use consistent medical terms. This standardization ensures clarity and accuracy, reducing mistakes that often lead to the loss of millions of funds.

Transitioning from manual entry of records to utilizing API calls from a national health terminology service would enable seamless integration and communication between different healthcare systems, ensuring that all health information is standardized and interoperable, reducing errors and inconsistencies.

A key component of this digital health ecosystem would be a comprehensive client registry, free from duplicate records which lead to misidentification, treatment errors, and fraudulent claims.

By maintaining an accurate client registry, the SHIF can effectively prevent these issues, maintaining a single, reliable source of truth for patient identification and reimbursements. This would help preserve the fund's integrity and financial stability.

Imagine a shared health record system where healthcare providers can access and update patient information across different facilities. A centralized system of shared health records would allow doctors to access a patient's complete medical history, no matter where they received care.

This would eliminate the need for redundant tests and procedures, not only improving the quality of care but also ensuring continuity, as doctors can make informed decisions based on comprehensive patient information.

Estonia serves as an exemplary model for Kenya. Estonia's e-Health system integrates various healthcare services into a single platform, offering several benefits. Their standardized health terminology ensures consistency and accuracy across all medical records.

Citizens have a comprehensive digital health record accessible by authorized healthcare providers, enhancing the quality and continuity of care. Estonia's highly accurate population registry significantly reduces the risk of duplicate records and fraudulent claims.

The success of Estonia's digital health system demonstrates the potential benefits for Kenya. By adopting a well-managed health information exchange, supported by a national health terminology service, shared health records, and an accurate client registry, Kenya can improve healthcare delivery, reduce costs, minimize errors, prevent fraud, and enhance the overall efficiency of its social health insurance fund.

Gilbert Muthee is a Healthcare Information Technology Expert