Offline-first tablets for 26 rural clinics in Kenya

Paper records and a two-hour drive

A nurse at a dispensary outside Bondo sees somewhere between forty and ninety patients a day. Every one of them is recorded by hand in a register, and once a month somebody drives those registers to the sub-county office to be typed up. If a patient turns up at a different clinic, their history stays in the book they came from.

The county has a digital records system. It assumes a working connection, and at eleven of the twenty-six clinics we surveyed the connection works for less than four hours a day. Software that fails without a network is not a records system in this context; it is a form that occasionally submits.

What we are deploying

A rugged seven-inch tablet running a local-first records app. Everything is written to the device first, encrypted at rest, and synchronised opportunistically whenever a connection appears — mobile data, a passing phone hotspot, or a weekly hop when the supervisor visits. Conflict resolution is handled at the field level, not the record level, so two clinics editing the same patient do not overwrite each other. The tablet charges from a solar bank and runs eleven hours on a full charge.

• Two tablets and a solar charging bank per clinic, fifty-two devices in total.
• Local-first sync, so a clinic that is offline for a fortnight loses nothing.
• The app is being built with three clinical officers who will actually use it, not designed for them.
• Data stays on county infrastructure; we hold no copy and want none.

The budget, clinic by clinic

Roughly £2,100 equips one clinic completely for three years, and that is the number we would like you to hold on to.

• $31,200 — 52 rugged tablets and cases IP67, gorilla glass, a two-metre drop rating and a replaceable battery. We tested four candidates by dropping them onto a concrete floor sixty times each.
• $9,800 — Solar charging banks One 60W panel and a 40Ah bank per clinic, sized to keep both tablets alive through a week of cloud.
• $8,400 — Three years of data and device management Bundled SIMs, because a tablet nobody can afford to connect is a clipboard with a screen.
• $6,600 — Training and the first six months of support Two days on site per clinic and a WhatsApp line staffed by someone who answers.
• $4,100 — Field engineering and spare parts Screens, batteries and a pool of four loan devices held in Kisumu.
• $2,200 — Platform and transfer fees The unavoidable cost of moving money across borders.

The system does not have to be clever. It has to still be working on a Tuesday in March when it has rained for nine days and nobody has seen a signal since Friday.

Who is behind this

Lumen Robotics builds the hardware and Riverbend Community Foundation holds the relationships in Kisumu and Siaya counties, where they have worked since 2014. The clinical design work is led by three clinical officers seconded one day a week from their own dispensaries, and they are paid for that day. The county health records office has signed a memorandum covering data ownership: everything the tablets collect belongs to the county, and we get no access to identifiable records at any point.

Risks and challenges

The hard part of this project is not the software. It is what happens in year four when the batteries fade and the campaign money is gone, which is why three years of connectivity and a spare-parts pool are in the budget rather than assumed away. The second risk is staff turnover: clinics rotate people frequently and a system that only one trained person can use will die quietly. We are answering that with a two-hour refresher that any clinic can request and by keeping the interface deliberately dull. Import duty on the devices is the last unknown; we have budgeted at the full rate and will return the difference to the field if an exemption comes through.