Kenya’s top 20 towns on Facebook

Social media giant, Facebook estimates that there are 4 to 4.5 million Kenyans who are its monthly active users. Facebook usage patterns in Kenya are arguably strong indicators of the country’s internet connectivity patterns. Over 60% of Kenyans (2.5 – 3 million) accessing facebook at least once a month are based in Nairobi.  This is very telling especially as Kenya\’s second internet exchange point in Mombasa struggles to make business sense due to having too few users.

I used the Facebook audience insights tool to rank Kenyan cities and towns according to their monthly active users on Facebook. Below are the top 20 cities and towns in Kenya as at 9th June 2015.
City / Town
Facebook Monthly Active People
% of Kenya Facebook Monthly Active People
2.5m – 3m
300K – 350K
50K – 200K
100K – 150K
100K – 150K
50K – 60K
40K – 45K
35K – 40K
30K – 35K
30K – 35K
30K – 35K
25K – 30K
20K – 25K
20K – 25K
15K – 20K
15K – 20K
15K – 20K
15K – 20K
15K – 20K
10K – 15K
10K – 15K

Skyline of Machakos Town – Ranked 13th with
20-25 thousand people monthly active on Facebook 
While Nairobi is the capital city and much economic activity is expected to emanate from such a city, its lion’s share of internet traffic points at concentration in economic activity. This could be an area of concern for leadership of counties which represent devolved economic units. It may also be a major concern for government paid ICT promoters such as the Communications Authority and the ICT authority. Its telling of the success or failure of tax funded initiatives such as the universal access fund and the National Optic Fiber Infrastructure (NOFBI) to advance digital inclusion in the country.

There are areas where the internet and its benefits
can only be imagined and mimicked
A few months back I wrote about the significance of social media platforms such as facebook in agriculture and ranked the top 10 agriculture themed facebook groups in Kenya. There is evidence that internet connectivity and tools promote economic activity. For everyone concerned about using internet related technology to spur economic activity in towns outside Nairobi, the above trends should elicit action.
Internet progressive nations in the region such as Rwanda are reporting advances toward blanketing their smaller land mass with high speed Long Term Evolution (LTE) connectivity. A big question begs as to whether execution of Kenya’s broadband strategy will bear fruit in bridging the country’s vast digital divide.

mAgric Innovations – Do they matter anyway?

Over the last decade, contribution of Kenya’s agriculture sector to the nation’s Gross Domestic Product (GDP) has been below 30% but above 25%. Across East African countries, contribution of Agriculture has been similar to that of Kenya or declining altogether. The chart below shows the trend since 2001 in Kenya, Tanzania, Rwanda and Uganda.

Contribution of Agriculture to national GDP remains significant but sub-optimal

Weight of the matters

Perhaps there’s no need to worry about this trend if it can be seen as a deliberate outcome of economic diversification strategies among individual countries. However agriculture continues to be the mainstay of most East African economies. Agriculture accounts for 61% of total employment in Kenya for instance. Contribution to national employment statistics by agriculture seems even higher among other East African countries as indicated in the chart below.

Agriculture contributes to the majority of employment opportunities

With such significance of Agriculture in employment creation, a question of proportions begs. That is the question of why the many jobs attributable to agriculture do not result in a commensurate contribution to national GDP growth by the sector in East Africa.

Necessary Mind Shift?

Everyone is capable of a radical mind shift at some point in their short lives. Health IT, eHealth and mHealth have been my favorite ICT4D areas for over half a decade. In 2013, I found myself shifting interests away from health towards agriculture. For avoidance of doubt, health is a great field to achieve results at a personal level, institutional level or otherwise. I wrote much about eHealth or related topic here in the “yester-years“.

In East Africa, the health sector has employed many brilliant minds especially in NGOs and government – from health care workers to health systems practitioners. Opportunities for innovation, entrepreneurship and even job careers in health continue to knock at doors of the region’s talented workforce. However this article in the East African based on a report titled  “Investments to End Poverty” by Development Initiative’s (DI) does much to present an alternative view which is validating my shifting focus.

According to DI’s report, “East Africa received nearly $9 billion of aid in 2011, with the biggest chunk channeled to the health sector“.  This according to the report is disproportionate to the real needs expressed by people in developing countries. The report suggests, “On the other hand, there are few political champions for those issues that top the list of citizens’ priorities in sub-Saharan Africa or Latin America, such as jobs/income, security or infrastructure.” Furthermore, a World Bank Development Report in 2008 indicated that among developing countries, 1 percent GDP growth originating in agriculture potentially reduces poverty by at least 2.5 times as much as the same GDP growth originating in the rest of the economy. 

An all season water mass in a Kenyan rural under-utilized for Agriculture

Job creation and income generation for poverty eradication are the reasons I am betting big on mobiles for agriculture (mAgric) in 2014. It could be either mAgri or mAgric am referring to, or both. To me they both refer to the application of mobile technologies to help increase efficiency and productivity in agricultural value chains.There is the mAgri program of the GSM Association (GSMA) that makes generic use of the term mAgri difficult. To avoid confusing the GSMA program and the emerging discipline around mobiles for agriculture, I shall stick to mAgric as my reference abbreviation. 

Needless to say, mobile phones have become ubiquitous computers and communication devices in most developing countries. Mobile technology therefore appears top on the list before any other technology for fostering development in East Africa. This is already demonstrated in the area of financial inclusion. I have had my own observations, rants and raves on this in previous articles here. Ostensibly then, not much effort should be spent explaining the narrowing act of embracing mobile technology in development and not all information and communication technology in general. 

Agriculture is complex; Why mAgric anyway?

It should not be easy to convince everyone that advancements in mAgric innovation will single handedly solve the matter of sub-optimal productivity in East Africa’s agricultural sector. I shall argue though, that innovations and entrepreneurship in mAgric can play a big role in revitalizing and optimizing activities in agricultural value chains.

In his book “The New Harvest – Agricultural Innovation in Africa”, Calestous Juma, a renown professor of innovation and sustainable development argues that “Agriculture needs to be viewed as a knowledge-based entrepreneurial activity”. It is access to information and transactional efficiencies for value chain actors possible through mobile applications that I would bet on in mAgric. Such applications are bound to enhance the knowledge-based entrepreneurial activities that Prof. Juma refers to. 

growing array of mAgric innovations by local entrepreneurs

 Arguably, for developing nations serious about uplifting agricultural productivity, the role of mAgric in revitalizing agricultural practice is big. This is validated by the notion that for national economies to grow sustainably, deliberate premium has to be placed on a learning culture and improved problem solving skills in the productive population. These can be fostered through promotion and use of appropriate mobile applications in the case of agriculture.

Is mAgric stalling?

Many mAgric applications including Mfarm, iCow, eSoko, and M-shamba have been introduced to East Africa\’s agriculture actors over the last three years. Although it would seem obvious that uptake of such innovations will be rapid in East Africa, that has not been the case. m:lab East Africa has since 2012 organized a series of focus group discussions dubbed \”Wireless Wednesday\” that have highlighted issues bedeviling mAgric and the opportunities in the region. A recap of one such meet-up held in October 2013 highlights many issues including awareness and ease of use. Observations made in April 2012, are similar to those made in the more recent meet-ups and this beg the question of whether progress is being made. 

A video clip taken of Qureish Noordin (pardon the quality) from AGRA elaborating concerns from enablers\’ perspective below may help to demonstrate the complexity of issues affecting uptake of mAgric innovations in East Africa.

More efforts continue to be made to attract more innovations in the ICT for agriculture (ICT4ag)space. This is exemplified in CTA\’s ICT4ag competition in 2013 among other similarly themed contests targeting innovators in developing nations. The emerging concern among actors and enablers in the mAgric space is therefore whether any of the new or existing innovations can amass significant uptake for meaningful impact in the agricultural sector to be realized while achieving sustainability. 

Adjusted blogging interest ..

2013 had its own highlights and disappointments. One major highlight for me was a win against procrastination, whereby I got to register for long overdue doctoral studies. It is the apparent slow uptake, and sustainability challenges of mAgric applications that I shall be investigating in my PhD thesis throughout 2013 and beyond. That may explain the increased analysis and \”opinionation\” about mAgric applications, and the promise for agricultural prosperity throughout East Africa in this blog as 2013 comes along.

For now I shall leave you with another video clip (pardon the quality) taken of Safaricom\’s Peter Gichangi sharing his thoughts with developers at a Wireless Wednesday meet-up addressing the challenges for uptake of mAgric applications.

Child Count for A growing mHealth scene in Kenya

As the pivot25 competition progresses,  I have been getting curious over the nature of applications coming up in the category for mHealth. I thought to myself that perhaps an analysis of locally existing albeit underutilised mHealth applications will help to manage my curiosity.

Useful perspective

For some reason a lot of my last 8 years was spent working on information systems to improve community based health services. It is a shame that I did not get myself interested enough in SMS based data collection platforms for health service delivery  until recently. Earlier in the year, while reading through @mberg\’s blog post I was even surprised by a prediction to see a lot less discussion about the differences in particular platforms (CommCare, ChildCount+, FrontlineSMS:Medic, Mwana, MoTeCH). I could be excused for my apparently slow uptake of these tools because the Kenyan Health IT scene to which I vainly contributed has over the years been mark-timing. The apparent stalling of Health IT in Kenya seems to be caused by a 7+ year old inconclusive debate of which tools are best for electronic medical records (EMR) systems.

First encounter

Great initiatives like ChildCount have a way of eventually popping up the stack despite being implemented with muted marketing effort. I first heard about ChildCount in one of the annual OpenMRS meetings. I was not only impressed that ChildCount seamlessly integrates with OpenMRS for its master database. The SMS based platform impressed me further with its easy application in Kenya’s remote areas empowering communities to improve child survival and maternal health.

How it works

ChildCount uses  uses SMS text messages to facilitate and coordinate the activities of community health care workers (CHWs). CHWs are community based health care providers. Any standard phone can be used by CHWs to register patients and report their health status to a central web dashboard for as long as there is a slight mobile carrier signal. The system supports messaging features for communication between members of the health service provision system alongside an automated alert system which all combine to reduce gaps in treatment for local communities. By providing a central web dashboard with information based on the processed SMS messages, ChildCount also provides a real-time view of health of in a community.

The new improved ChildCount+ works slightly differently from the initial deployment but the overall approach remains fundamentally the same.

A combination of noble efforts

The ChildCount platform is developed by the Earth Institute in collaboration with the UNICEF Innovation Team for the Millennium Villages Project. ChildCount is now free and open-source software available under the GPL License. It is build on yet another open source framework – RapidSMS. An important provision of phone handsets for CHWs to initially launch the service was facilitated by Sony Ericsson in early 2009. Airtel Kenya, then known as Zain also assisted in setting up a toll free number for the project . The project has also benefited from having in its team Matt Berg, as its Technology Director. Matt was in the 2010 list of Time’s top 100 influential people of the world


Like many other open-source platforms, it is difficult to know how many installations of ChildCount exist across the globe. For sure though, after interacting with some good people at the millenium villages project like Maurice Baraza, I know that ChildCount is instrumental to their exemplary service delivery at their project in Sauri in Kenya’s Siaya County. At Sauri, the project covers over 65,000 people  with child and maternal health care services. They have also deployed the system at the Dertu millenium village project in Kenya’s Garissa County.

In the larger East Africa, ChildCount is deployed in at least one millennium village in Tanzania. In regional health informatics circles, word has it that the Rwanda government is considering a national deployment of ChildCount to support its community based health service delivery system. This does not come in as a surprise as the Rwanda government has recently been a regional leader in taking up ICT to improve its service delivery with more action than speak.

Less speak for more action

More information on ChildCount can be found on the project’s website. This pdf report might be useful for those wishing to dig deeper into the rationale behind the project and its initial success as a pilot. It should interest local mobile application developers and mHealth enthusiasts to consider building on ChildCount’s successes as they seek to further innovate mobile solutions in health services. RapidAndroid is definitely a natural platform to look at in keeping this innovation wheel spinning. We can only hope that pivot25, the Android Developer Challenge and other developer competitions will spur innovation in this direction. I shall leave readers with a video of the health care service delivery works going on at Sauri Millenium Village that I found useful

Along Came Standards and Guidelines for EMR Systems in Kenya

An Electronic Medical Record (EMR) is defined as a computerized  medical record created in an organization that delivers care, such as a hospital and doctor\’s surgery – (in wikipedia). EMR systems, information systems used in health facilities to manage EMRs have remained a popular topic of discussion among Kenya\’s eHealth initiative\’s over the last five years.  

A knowledge-based economy

A nation wide adoption of EMR systems in Kenya promises to increase effectiveness of the national health care system from policy making, to financing,  and to service  delivery at health facilities. This is by strengthening the practice of knowledge management in health care. Among other things, it would support evidence-informed decision making at the various service delivery levels of the national health system.  

A health care system in Kenya with efficient knowledge management and decision making will not only create a healthier and more economically productive Nation. It will also foster development and harnessing of such knowledge as a resource for wealth creation within and across Kenya’s borders.

Entrenched Fragmentation

A significant number of fragmented, strongly entrenched and donor funded EMR systems have come into existence at our health facilities over the last decade. The fragmented initiatives have diverse approaches to issues like stakeholder inclusiveness, health data ownership, systems development and support, systems ownership and sustainability. The total cost of ownership (TCO) profiles of the fragmented initiatives are also diverse. They range from low cost open source community supported systems to high cost vendor supported systems thriving on the occasional waves of donor funding.

With the fairly uncoordinated setting above, the debate on a road-map for nationwide adoption of EMR systems has been emotive if not controversial over the years. About 6 years ago, in August 2004 to be specific, the World Health Organization (WHO) convened a meeting of EMR systems stakeholders in Nairobi.  The stakeholders included National AIDS Control Programs of five African countries, clinicians and developers of EMR sytems and learning experts.

Delayed conclusion of matters

The WHO meeting of August 2004 recognised among other things that “development and implementation of EMRs in Africa has resulted in numerous small projects without data content or data exchange standards, running the risk of creating a fragmented and chaotic information environment in which national data reporting and mobile patient tracking would be severely impaired;

In recognising the above challenge, the same meeting also called upon the WHO to “work with partners including African Ministries of Health, the CDC, developers of EMR systems used for Africa, and clinicians to establish basic standards to allow interoperability, mobile patient tracking, and the possibility of national and cross national data mining.” To further quote the meeting’s report, The WHO’s support was also to recognize the fact that “These standards include electronic information exchange standards, agreement on the approach to core minimal data sets, and the establishment of a common data dictionary”.

The state of affairs

6 years later, Kenya has continued suffer an unduly protracted debate on EMR initiatives whose systems are nowhere near nationwide, cannot inter-change data and are without a common concept dictionary. More information on the August 2004 meeting and some of WHOs initiatives on Knowledge management platforms for clinical care can be found here. It remains difficult to understand why it has taken long to confront the challenges highlighted in the meeting. The explanation can get as complex as the stakeholder’s interests.

Major strides forward

It should be with some relief that stakeholders will be seeing the official launch of the \’Standards and Guidelines for EMR systems in Kenya\’ this November. The standard and guidelines document has been developed with the support of PEPFAR through I-TECH, a collaboration between the University of Washington and the University of California, San Francisco. Development of the document has also benefited extensively from the leadership of the government’s Division of Health Information Systems and the National STI and AIDS Control Program (NASCOP).

The document should go a long way to improve the framework and environment for development, deployment and implementation of EMR systems in Kenya. It attempts to leverage on recognized national and international standards for health informatics. The document also attempts to build on learning from experiences of historical EMR system implementations.

In the document’s section two, it sets national standards for information interchange and interoperability. This will help to foster information exchange between EMR systems at different health facilities. This should address among other issues mobility of health care clients.  The interoperability standards will help foster a deliberate awareness among EMR systems of pharmacy information systems, district health information systems, financial management systems and other subsystems in a health facility’s enterprise architecture.

The document’s section 4 on governance and policy attempts to set standards for systems ownership, TCO profiles and sustainability. It also goes further to set a standard for health data ownership. The document also spells out the responsibility of the Division of Health Information Systems to ensure the standards are enforced.  The possibility of this responsibility being delagated to NASCOP and other disease programs is also specified in the document.

Areas of improvement

As with a majority of standards documents, The ‘Standards and Guidelines for EMR systems in Kenya’ still has much room for improvement. One of the weakness could be how the document addresses “the approach to core minimal data sets, and the establishment of a common data dictionary” – identified in the August 2004 WHO meeting. A gray area remains on how well the use of medical concepts and terminologies can be standardised for uniformity and comparability of data held or shared across computer systems.

The apparent inadequate engagement of stakeholders in the ICT industry in developing the standards and guidelines can also be flagged against the document. For such a document, there would have been a need to seek the views of the ICT private sector – companies and private practitioners.  If the synergies such as those described in my earlier article on EMRs sytems and the Kenya software industry are to be pursued, future enhancements of the document would require a meaningful engagement of the ICT industry. Key players in Kenya’s ICT landscape include the Kenya ICT Board, the Directorate of e-Government and professional communities such as the iHub and KICTANET.

An evolving set of standards and guidelines

Although the document could arguably have some weaknesses, the document was cautious enough to invite readers to view its content as ‘evolving guidelines’. It proposes to be a ‘living document’ and states that  “the process to identify and agree upon EMR requirements and recommendations presented in this document is more important than the guidelines contained in this initial version”. Dr Patrick Odawo, I-TECH’s Country Director also indicated that they would set up an official forum for discussing the document and its continual improvements on the Google Groups platform.

For readers interested in more insights about standards for EMR systems and their practical implications, I shall embed a video of a presentation made by Dr. Paul Biondich of OpenMRS two years ago.  
The presentation touches on the possibility of having standardized concept dictionaries for vocabulary management. It was made during a WHO conference on data standards in December 2007

Kenya’s Strategic Plan for Health Information Systems

Kenya has a brand new Strategic Plan for Health Information Systems (HIS) covering the period 2009 to 2014. The new strategic plan also brings along a HIS policy to guide its implementation. The two documents attempt to deliberately address the aspirations of the National Health Strategic Plan II , the Health Sector Monitoring and Evaluation Framework and the country\’s Vision 2030. The documents were prepared with the technical and financial support from the Health Metrics Network (HMN) and UK’s Department for International Development (DfID). Click here to access the two documents on Google Docs

Notably, among government dependent services, the health sector has been at the fore front adopting Information and Communication Technology (ICT) for improved service delivery to Kenyans. The progressiveness on the part of the health sector may be appreciated as a result of good leadership within the government. The same might also be dismissed as a mere side effect of immense donor interest especially with respect to HIV and AIDS. The extreme pessimist might dismiss the same as yet another fantastic set of paperwork that the government produces whose theory will not really be actualized in practice. The extreme pessimist will not be helped to note that whereas there is a very thin line between HIS and eHealth, another set of similar documents on the national eHealth Strategy are being finalised by a different department of the two Ministries of Health.

The strategic plan for HIS has a vision of making Kenya “a centre of excellence for quality health and health related data and information for use by all”. One of the strategic objectives in the document which should interest the local ICT industry is for \’Strengthening use and application of information and communication technology, in data management\’ . Cited strategies for this include enhancing data management functions with hardware and software, developing an integrated web-enabled database system, support for data flow (data connectivity), systems maintenance, data security, and developing capacity of ICT personnel. Given the plan’s budget of Ksh. 1.9 billion, the above strategies if implemented will surely have a spill over effect of further nourishing the country’s fledgeling ICT industry.

The plan aims to directly create jobs for 4,310 more health records and information personnel, 227 ICT officers and 221 statisticians. As meagre as these numbers may look, this should bring a little hope to the disillusioned Kenyan youth studying ICT related degree and diploma courses. Perhaps greater economic impacts will be felt in the ICT industry if affirmative action is enforced to more directly favour local entrepreneurs. Such a protectionist approach will yield even better results in the software industry if local expertise, based on widely tested, global community supported open source approaches, can be developed and tapped. Such an approach will also compare better to acquiring turnkey or off-the-shelf solutions that have dependencies on foreign software vendors with expensive licensing models.

Although it might sound fair enough for the health sector to insist that all they want is a working ICT infrastructure (software and hardware) in pursuit of the HIS strategy, it might help to look beyond an optimal solution for the short term. To gradually build capacity of the local software industry with a reasonable level of tolerance will provide optimal long term solutions in terms of Sustainability, Return On Investment (ROI to the country\’s economy) and the long term Total Cost of Ownership (TCO). Moreover such an approach should eventually improve the country\’s foreign exchange situation by exporting human resources and intellectual property developed throughout HIS implementation. The approach will also be in line with the ICT board\’s vision of making Kenya a top ten global ICT hub.

Lastly, of concern is the apparently dismal engagement of the ICT fraternity in developing the HIS strategic plan. Stronger participation of the ICT board, local solution providers, and associations of ICT practitioners in such an ICT related domain is called for in the future. Such involvement of the domain experts will help to address the economic dimension which exists in the bigger picture of the country’s vision 2030.

Dining with your predator – the essence development dynamics

It has been said, quite often that there is by far more talk about national paperwork on everything development than actual execution of development agenda in Kenya. Such paperwork will be called national strategy, national policy, national plan of operations, national assessment, national report and everything else national that can be put on paper. Of course developing the paperwork requires consensus building, which in turn requires government officers, bi lateral partners, UN bodies, solution vendors among other stakeholders to deliberate and dine in exotic hotels.

The stakeholder meetings will be called workshops, seminars, conferences, trainings, and any other name that represents a group of privileged people who do not normally meet at their routine work places to say the same things over and over again. Needless to say, participants of such meetings also have to draw a handsome allowance to facilitate the temporary displacement from their normal work station. The stakeholders will also get a chance to share the best and worst practices across their industry while consolidating positions in exclusive clubs of globe trotting workers – increasing their tallies in the frequency tables of global workshop participants.

Now, before you get me wrong, putting our paperwork right is always important and the consensus building meetings are indeed useful. The issue that our government officials of integrity should beware of though is the need to answer a question of – Which of the stakeholders / participants is really genuine? It is also the question of who else is seeking to contribute fairly in the execution of your most well thought, noble development agenda.

Is it the multi-lateral partners?
Common wisdom has it that that UN systems are really just inefficient bureaucracies of first class world citizens. The elite bodies and their exclusive clubs inevitably have armies of globe-trotting elitists enjoying tax contributions from member countries. Needless to say these elite members themselves hardly feel the burden of heavy taxation regimes like that of Kenya. Enjoying a handsome, untaxed pay is not bad after all for the well connected, hard working elite. However beware of the less genuine UN elite who will procure and connive with a vendor or a shrewd consultant to drive the weirdest of agendas for a host country.

Is it the bi-lateral partners
Bigger countries will always want to look like they are taking care of their smaller sisters in the developing world. The US in the name of USAID, PEPFAR, CDC or whichever other vehicle fronted as a Donor agency are set up to look after America\’s own interests. It is easy to be flattered, that we have a big brother offering a hand of support. Watch closely and you might see that their most genuine interests will boil down to some economic value to the big brother. It may not matter whether it is the Chinese – Kenya partnership, Japan and JICA, UK and DfID. They are innocently ensuring that some modern day imperialism is propagated to the future. When the spotlight reaches the real agenda they will say it is globalisation and we shall nod our heads in helpless concurrence. Such predatory patterns might be more obscure where intellectual property such as research data, software licences and royalties are at stake. Moreover, beware of paying too much attention to some under skilled or unprofessional individuals off-loaded to Africa with strange sounding titles such as Technical Advisers.

Is it the solution vendors?
Whether it is the software company representative, the training solutions provider, the hotel salesman, the travel company executive or the storage hardware provider ranting away, they remain nothing else but businessmen. No matter how elegant they sound about the pertinent issues, all they want is some revenue stream from your development agenda. The more perpetual the revenue stream looks for them the better of course. Wanting to do business with the government is not necessarily bad – as government should not really be the solutions provider to its people. However beware of those predators who will only see a perpetual revenue stream for their business, whether or not it helps you efficiently deliver on your noble mandate of actualizing your tax financed development projects. Furthermore beware of interesting deals, recently baptised Public, Private Sector Partnerships – PPP. No matter how innocently you look at them, for graft ridden developing economies like Kenya, you need to be an angel to execute a fraud free PPP initiative.

Or is it yourself?
And lastly for the most statistically represented predator, ourselves – you and I. Have you ever prioritised the country\’s development agenda higher than your new investment project, your MBA, your house under construction or your junior\’s school fees? I need not say more about these as genuine stakeholders – lest I get arrested for presenting white lies.

 Enjoy the week!