Developing countries like Kenya suffer from a severe lack of healthcare professionals.Access to primary care is further limited when large distances must be travelled for basic medical care,and often times the decision to seek professional help is made too late. Preventive health services cansave lives by diagnosing serious medical conditions early and subsequently reducing the likelihood oflife-threatening diseases. The rapid increase in the global incidence of chronic diseases like diabetes,hypertension, and heart disease makes preventive health services particularly important. Trainedcommunity health workers (CHWs) operated the Mashavu telemedicine system in Nyeri Countyof Kenya over the course of fi ve months. The Mashavu system comprised of a netbook computer, aweb camera, and other basic supplies. CHWs provided patients with two alternative services: (1)body measurements including blood pressure, weight, and body mass index (BMI) or (2) a fullconsultation that supplemented the measurements with health indicators and a brief survey. Alightweight website was developed to allow CHWs to send this information to a nearby nurse. Thiswebsite was accessed by leveraging the 3G cell networks that are ubiquitous in Kenya. During thefi ve-month pilot, 777 patients paid for these services. Nearly one-third of patients used the serviceas an opportunity for a routine health check. The median age among patients was 40 years and 35 %of all patients were between the ages of 21-35. The pilot described in this paper demonstrated toCHWs that community members value health information and are willing to pay a small fee for it.This pilot suggests that as developing countries struggle to address the double burden of chronicand infectious disease, fee-for-service preventive health services can serve as an innovative meansto achieve economic development and improved community health.
Multisectoral Preventive Health Services in Sri Lanka: Lessons for Developing Countries in Providing Public Goods in Health