By Pauline Odhiambo
Cradling her infant son in a protective embrace, Jaclinah Chichongue would spend hours queueing up in public hospitals for the child's routine check-ups.
That was before the pandemic struck a little over four years ago, changing in many ways how the world functions.
Before the outbreak, doctors in Jaclinah's native South Africa were legally required to consult face-to-face with their patients.
Not any longer, as the prolonged Covid-induced lockdown forced a dramatic shift towards comprehensive digital solutions, including in healthcare.
While the advent of telemedicine dates back to the use of emerging radio and telephone technologies for remote medical consultations in the early 1900s, what happened during the pandemic was radically expansive.
Johannesburg-based Jaclinah, 24, now seeks basic medical care almost exclusively through Kena, an app developed for South Africans without access to private healthcare.
"I saw a post on Facebook about Kena and decided to download the app to try it out. I first used it for my son when he had colic. I consulted a paediatrician through the app and received a digital prescription," she tells TRT Afrika.
"It also turned out to be cheaper than in-person consultations at hospitals."
Convenience and cost
According to a survey by Statistics South Africa, 45 million people in the country out of a total population of 60 million are still largely dependent on public healthcare.
A typical medical consultation in a public hospital in South Africa costs approximately 55 rand (US $3) – a steep sum for many low-income families without the bulwark of health insurance.
For Jaclinah and millions like her, telemedicine apps like Kena provide them access to even private healthcare at a far lower cost than they would otherwise have to bear.
"Normally, an in-person visit to a doctor for my son's medication would cost 300 to 400 rand ($16-21). With the app, the overall cost of treatment is lower. I also get recommendations for pharmacies that charge the lowest prices for the prescribed medication," says Jaclinah, who juggles her education with the responsibilities of a new mother.
"Since I started using the app, I don't have to deal with long queues in public hospitals. My transport expenses have also declined."
Bot-enabled interface
The Kena app is equipped with voice and video call options in addition to CHAP (Challenge-Handshake Authentication Protocol) for enhanced privacy.
First-time users of the app get up to three free consultations before charges kick in.
With the help of a bot called "Linda", users can key in their medical history onto the app via guided questions.
"Linda collects information like the patient's name, surname and date of birth. Afterwards, a nurse analyses that information and asks follow-up questions," explains Saneke Ncube, a nurse clinician who works with apps like Kena.
"Being an online nurse allows me to discuss very sensitive information with patients, unlike when I see them face-to-face. Once I have gathered the relevant information, I forward the patient's profile to the doctor."
Since most of Saneke's patients can speak basic English, language generally isn't a barrier.
"But when patients see my name, most Xhosa speakers immediately switch over to that language," says Dr Nomacete Tshume, who also speaks Zulu and Afrikaans.
Data-pricing challenges
In many South African languages, Kena means "welcome in". But despite the obvious benefits of the app, some users find themselves locked out by the cost of telecom data services.
"At least 58% of our users engage through texts rather than voice or video calls because of the cost of mobile data in South Africa," Kena Health's CEO Saul Kornik tells TRT Afrika.
"That shows people's comfort in doing asynchronous texting to get the healthcare they need. We have designed a category of consultation where the user can choose the text-only option."
Kornik points out that most medical consultations in South Africa are tied to a medical scheme that primarily serves the wealthier sections of society.
Apps like Kena, therefore, seek to include patients who do not have health insurance.
The idea is to open up healthcare and online prescriptions in compliance with the Electronics Communications and Transactions Act in South Africa, which makes it legal to collect medication from a pharmacy via prescriptions generated on the app.
Amended guidelines
All information shared by Kena users stays on the app for a maximum of seven days before it is automatically wiped out. Before the pandemic, digital healthcare services in South Africa were limited because of regulatory challenges.
The Health Professionals' Council of South Africa later amended its guidelines to include remote diagnosis and treatment of patients, albeit with the cautionary advice that it should not be used as a replacement for face-to-face consultations.
As Kena gains in popularity – the Android version of the app has been downloaded by over 100,000 users — the roadmap for adopting digital healthcare is more defined than ever.
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