The challenges posed by the Covid-19 pandemic have accelerated the creation, testing and adoption of digital health solutions in Africa, data from a recent study indicates.
The survey, Meeting In The Middle, conducted by Vodafone, Vodacom, Safaricom and Caribou Digital reveals that 41 per cent of internet users in Africa are regularly using their mobile phones to search for health information.
The report reflects a healthcare sector on the right path of transformation, with opportunities to improve health outcomes at a lower cost, indicating that 75 per cent of African countries have a digital health strategy in place.
“There is an all-time high of 180 digital health start-ups in Sub Saharan Africa. Covid-19 is playing out within a digital Africa: accelerating demand, testing digital health strategies and plans, and giving rise to new behaviours from consumers with digital access and health concerns,” the report reads in part.
An exponential rise in adoption of smartphones since the first case of the virus was reported in the continent, and a rising affordability in mobile internet are regarded as the key enabler to telemedicine access.
Smartphone penetration is expected to reach 65 per cent in Africa by 2025, and that could move the potential reach of telemedicine users to over 475 million, the study says.
A survey from IDC's Worldwide Quarterly Mobile Phone Tracker, conducted during the first three months of 2021, shows that the continent’s purchase of smartphones grew by 16.8 percent from the previous year.
“There are now 23.4 million more smartphones in Africa, while the overall phone market which includes feature phones rose by 14 per cent to 53.3 million devices.”
Research has shown consistent positive cost benefits from smartphone health interventions - with a study of peer-reviewed RCT results showing 100 per cent of mHealth interventions in Africa have had positive cost benefits.
Alongside the growth of formal government digital health strategies, the informal usage of digital health services and apps has also grown, with Kenya, for instance, having more than 40 telehealth service providers.
The report has established that most downloaded and used apps in many countries are global telehealth apps that provide the user with health information and symptoms checking whilst also offering paid access to doctors around the world via telemedicine services.
“In Kenya, after the government myNHIF health financing app, Byon8 is the most used app; and in Ghana it is eHealthGPS. Both of these apps are global services that enable the user to engage with a range of digital health content,” says the study.
Community Health Workers (CHWs) are also using smartphones in informal ways to conduct their work within formal health systems.
According to the report, Ghana and Ethiopia have only used mobile phones infrequently via formal channels at 12.2 per cent and 2.6 per cent respectively, but the majority of CHWs are using mobile devices informally for their work on a daily basis – 91 per cent in Ghana and 87 per cent in Ethiopia.
African governments, the study finds out, have responded to the May 2018 World Health Organisation (WHO) resolution to accelerate the adoption of digital health services, which called for health departments to assess their use of digital technologies for health in order to “identify areas of improvement, and scale-up greater utilisation of digital technologies, as a means of promoting equitable, affordable and universal access to health for all.”
Out-of-pocket health costs
In Kenya, for instance, the report says four out of ten people cannot afford hospital treatment and one million people fall into poverty every year because of out-of-pocket health costs.
But digital health platforms like M-TIBA that was founded in 2016 now enable millions of Kenyans to regularly save small amounts of money for future healthcare needs through a mobile money account.
Users who are short of funds can borrow money from other users through the platform to cover health costs. Family and friends can also donate to an M-TIBA account holder.
Data on the platform shows that it has connected four million Kenyans to 1,400 partner clinics and hospitals, in addition to healthcare payers including governments, insurers, and donors through a simple SMS-based system.
To ensure users channel the funds into health, money stored in M-TIBA can only be transferred to registered healthcare providers and the National Health Insurance Fund. Small healthcare providers who struggle to access traditional capital can also get loans through the same platform.
“There are countless cases where people are forced to sell their assets, where farmers sell their cows or land to pay for healthcare. So having a tool that enables you to save or send funds to family via their M-TIBA wallet, which can’t be spent on other things, is key for people to access healthcare,” says Edmund Buobu, DMAC Programme Director.
Another innovation is MomConnect, a free interactive South African SMS- and WhatsApp-based messaging platform, provides pregnant women with carefully curated information throughout the pregnancy stages.
The maternal health service is available in 11 of South Africa’s official languages, and enables women to ask questions about their health and the health of their baby and receive immediate feedback from qualified health professionals.
The mothers can also provide feedback on services they receive at antenatal care clinics to which health officials respond.
The platform is integrated with the country’s National Health Information System, providing important data to the health system staff.
“At least 80 per cent of the mothers giving birth in public clinics in South Africa are registered on MomConnect, and they are 10 times more likely to reach out and ask questions than those using other communication methods,” says the research.
In South Africa, where there are only 1.2 nurses for every thousand people and where it can be difficult for families in rural communities to get to health centres, a platform dubbed Mum and Baby has provided a lifeline for many parents.
98 per cent of the mothers and pregnant women surveyed said they had taken action to improve their child’s health because of the information they received on the app and 96 per cent agreed that Mum and Baby helped with their decision to vaccinate their child.
“It is estimated that more than 650,000 mothers and babies have been vaccinated as a result of the service.”
The mVacciNation app, an electronic health record solution that supports vaccination coverage, developed by Mezzanine is now helping users in Mozambique, Tanzania, South Africa and Nigeria deal better with persistent vaccine stock-outs, distribution inefficiencies, and poor record keeping.
“Pentavalent vaccines last 28 days after opening. Because of the unpredictability of numbers, vaccines were wasted when we had low numbers turning up. Now we have accurate estimations and we circulate vaccines before they expire,” says Rose Athumani Magambo, a midwife at Buganzo Dispensary, Tanzania.
Vodacom chief executive Shameel Joosub says by deploying modern technologies like 5G and Artificial Intelligence (AI), Africa could be on course to join the developed world in delivering better quality healthcare.
“Increased 5G speeds mean better hospital efficiency, streamlined communication and critical data sharing between departments, clinics and hospitals,” he notes.
With early clinical studies indicating that spine procedures can be conducted remotely on a 5G connection, he underscores the potential of the technology in helping millions of patients in rural parts of Africa receive surgery from remote specialists without the need for extensive travel.
“AI is dramatically accelerating the rate at which medical professionals can detect the likes of Covid-19 and lung diseases. By analysing x-rays and CT scans, AI models can significantly enhance diagnostic capabilities.”
The Lancet has predicted that Africa will be the best ‘breeding ground’ for digital health systems to become a reality but the report notes that only formal digital health systems - led by governments, enabled by the digital infrastructure, delivered by the private sector - will bring this prediction to reality.
“Now is the moment for governments to capitalise on this and work in partnership with the private sector to meet in the middle and use formal and informal platforms to digitalise services and improve health outcomes across Africa,” says the report.
The report sees the ability for many private sector platforms to work together in open and agile ways with government health departments as a key step to the success of future digital health ecosystems in Africa.
“It’s not often the technology on its own, it’s the relationships and the operating models that go with the technology and how they enable these stakeholders to work together,” says Dale Sandberg, managing executive, health and social innovation at Mezzanine.
And while Covid-19 accelerated the use of such innovations, for diagnosis, communications and prescriptions, the survey highlights that there are privacy concerns both for the patient and medical professionals, including where data is stored and how using the platforms crosses personal and professional boundaries.
The report warns that e-health services can widen health inequality because of patients’ varying levels of digital literacy and access to digital devices and mobile data.
Moreover, fighting health misinformation in Africa has been a challenge, especially due to overdependence and trust on social media content.
“To mitigate such risks there is a need for governments and the private sector to forge partnerships that ‘meet in the middle’ and facilitate greater access to digital healthcare across the continent.”
