The Promise of Digital Health In Africa

By Odette Dzemo Kibu PhD, Asahngwa Constantine PhD, Wilfred Ngwa MSc, Charlotte Bongfen PhD, Ronald Gobina MD, NKengafack Fobella MD, Denis Foretia MD MPH MBA FACS  (Pdf Version)

1. Introduction

Digital Health holds enormous potential to improving access to health care services. It has been well documented that the African health sector is facing challenges in the delivery of high quality healthcare both in terms of development of high quality programs and also in increasing access to health care services. Despite decades of foreign assistance, few countries in the region are able to spend even the $34-$40 per person per year that the World Health Organization (WHO) considers the minimum necessary to provide a population with basic health care. In spite of the billions of dollars of international aid dispensed, an astonishing 50 percent of Sub-Saharan Africa’s total health expenditure is financed by out-of-pocket payments from its largely impoverished population.

Interventions that aim at increasing access to high quality healthcare in a cost effective way have the potential to greatly transform the health sector. Digital healthcare technology stands out in the 21^st century as a major game changer for the health sector and the African continent is well positioned to benefit greatly since technology can help tackle the rising burden of disease and major obstacles in infrastructure and the environment.

Achieving the promise of digital healthcare technology however, while avoiding its potential pitfalls, will require a comprehensive, systematic approach based on the principles of sustainability, equity and inclusion. This is because to ensure the use of digital technology to access health care services all class/category of citizens need to be included in its plan. This article highlights the contribution of digital health technology, major obstacles in implementing this technology and propose possible ways in which this form of technology can be effectively implemented in the health care system.

Contributions of Digital Health Technology in Africa

Since the early 2000s, Africa has witnessed a growing number of new private investments in health innovation and product development with enormous potential for up scaling and greater impact. Major eHealth projects in Africa include:

• Telemedicine Network for Francophone African Countries (RAFT) which helps to connect physicians in remote areas with specialist from developed areas to ensure a better management of complicated cases and it also provides distant medical education to healthcare professionals;
• HINARI Access to Research in Health Programme enables developing countries to gain online access to one of the world’s largest collections of biomedical and health literature resources;
• ePortuguese Network and Pan-African e-Network Project provides tele-medicine and tele-education to 53 African countries.

In Eastern Africa countries such as Kenya, Rwanda, Tanzania and Uganda have invested significantly in broadband internet infrastructure since 2009 and have national broadband strategies. Also, they have made large-scale, state-funded infrastructure investments. Most of these initial initiatives are private-sector driven, for-profit models. The recently signed African Continental Free Trade Agreement (AfCFTA) provides opportunities for larger markets and encourages more innovations in healthcare.

Patient connectivity and access to health care information through different technologies in Africa:

• In Tanzania, Airtel which is the second largest telecommunications company that provides a free service that facilitates text messages about infant care to mothers and pregnant women.
• The gifted mom platform in Cameroon helps to improve on antenatal care among pregnant women.
• The South African messaging platform MomConnect (a mobile messaging platform integrated with a national pregnancy registry and a help desk for questions and feedback) saw over 465,000 users adopt the service, demonstrating increasing maturity of digital participation.
• During the 2014-2015 Ebola crisis in West Africa the WhatsApp system allowed the BBC to use its platform to share lifesaving health information with people in rural and quarantined areas.

Digital health technology is helping to deliver and track essential commodities and services:

• Thanks to a partnership between the Government of Rwanda and the California-based robotics company Zipline, Inc, Rwanda is the first country in the world to use drone technology to deliver blood supplies.
• With public and private partners under the umbrella of the Roll Back Malaria Partnership, the SMS for Life program, led by Novartis, was established to eliminate stockouts of anti-malarial drugs in public health facilities.
• Today, around 27,000 government health workers in Uganda use a mobile health system called mTRAC to report on medicine stocks across the country.
• In Ghana and across three continents, the social enterprise mPedigree uses a simple sticker on the packaging, which, when scratched with a fingernail or coin, reveals a numeric code that can be verified by SMS, providing a direct confirmation of the drug’s authenticity.

Challenges of implementing Digital health in Africa

Despite the successes recorded in some African countries, the challenge is the ability to transform these initiatives to achieve large scale and long-term sustainability that can deliver healthcare to most Africans and especially to those in remote areas.

Infrastructure presents its great problems: less than half the population of sub-Saharan Africa has access to electricity which is a major limitation for the implementation and exploitation of digital health services. In addition, adequately trained doctors, nurses and technicians are needed in order to effectively leverage technology in the sector. African governments as well need to join the move as they can best address certain factors impacting the potential of digital health interventions such as: lack of an enabling policy environment; weak leadership and coordination; weak Information Communication and Technology (ICT) infrastructure and services; inadequate financial resources and limited awareness about eHealth.

Recommendations

The digital health services are on track to take center stage in the Health sector and to maximize these benefits, African governments need to take stringent measures and provide an enabling environment for its implementation.

• Capacity building of the local healthcare workforce is a major prerequisite to maximize the benefits from the innovations made possible with the spread of digital health technologies. Health care workers should be trained on digital systems and how to integrate this into their daily consultations and treatments, and verify prognosis, drawing from databases and the internet.
• Due to the limited supply of electrical energy, harnessing a widely available solar power and other alternative sources of energy to generate electrical energy is be very important to run and expand the ICT infrastructure base in Africa.
• Government should support and work in close collaboration with the private sector and other stakeholders that are focused on building tech companies with an accent on digital health to identify solutions that are scalable and can be adopted across hospitals and clinics in countries.

Conclusion

Africa is the region of the world with the highest disease burden. These challenges present unique opportunities to leverage digital health technology which can help governments to meet increasing demands for high quality healthcare delivery.