Kenya’s pursuit of Universal Health Coverage (UHC) focuses on investing in primary
health care, in line with the Astana Declaration on Primary Health Care of 2018.
Achievement of UHC in the country is challenged by unequal access to health care
services as a result of an inequitable distribution of facilities.

Although the number of health care facilities in Kenya has increased, many people still have
to travel long distances to see a health worker. On average, people live 9.5km from a health
facility. This distance needs to be reduced in order for Kenya to realise its UHC aspirations.

Increasing access to health facilities conventionally calls for significant financial investment as
building health facilities comes at a cost. However, a private sector entity in the country is
pioneering a low-cost model that leverages digital health to increase access to primary
health care

Access Afya provides primary health care through an integrated network of micro-clinics and
mobile health programmes. Its asset-light clinics located within informal communities offer a
variety of services including consultations, lab testing, chronic condition management,
immunisations, family planning, maternal and child health, first aid and emergency care.

The clinics are run by clinical officers, not doctors. Clinical officers are guided in their work
through the use of digital clinical decision support tools that give prompts on the right
questions to ask or laboratory tests to order. If further assistance is needed, the connection to
a remote doctor is made via telemedicine. The clinical officers also access continuous health
education via an e-learning platform.

The clinics deploy mobile outreach teams into the community that conduct screening for
non-communicable diseases via a mobile phone application. The application displays a risk
score that informs community health workers on the need to refer a patient to a clinic for
treatment. This hub and spoke model allows the clinic to expand its penetration into the
surrounding community.

Access Afya also operates pharmacies with integrated telemedicine and rapid test services
making pharmacies sites of first entry into the health system. In between follow-up visits and
medication refills, SMS texts are sent to patients providing health education and medication
reminders. To enhance operational efficiency, the network of clinics runs on a digital health
information system that collects patient demographic, medical history, treatment,
purchasing and outcomes data.

Realising that most of their clients are not covered by health insurance, Access Afya partnered
with a local finance company to provide a range of health financing options including
insurance, health micro-loans, savings and memberships. Patients can take up a micro-loan
of up to $5 that is repaid via mobile money.

To expand its reach, Access Afya acquired Merck’s CURAFA franchise of clinics. Launched in
2018, CURAFA had a similar model of integrated point of care health facilities that combined
pharmacies, primary health clinics, digital health devices, financing solutions and
telemedicine to improve health access in underserved communities. The purchase increased
Access Afya’s network of clinics to 15 sites across four counties in Kenya, where they have
served over 240,000 patients.

As part of its digital health strategy, the Kenyan government sought to implement an eHealth
systems registration and audit framework for creation of a database of certified and licensed
eHealth systems. Access Afya became one of the first licensed digital health companies.
Access Afya aligns with the government’s strategy to use digital health technologies to
enhance equitable access to healthcare working with the private sector to promote the use
of telemedicine to increase reach to the underserved counties in Kenya.

Key lessons: