How technology can transform healthcare in Africa ?

Santé

Alexandra Fieux-Castagnet

August 2021

INTRODUCTION

Africa is the most challenging continent for health. Major progress has been done these last decades: treatment of HIV, malaria, etc. But on the other hands, chronic diseases such as diabetes, heart diseases, sickle cell anemia are rising.1 Sub-Saharan Africa has the worst healthcare of the world, according to the World Bank: only 1% of global health expenditures and 3% of world’s health workers. Since the 90s, digital is the promise of more accessible, better quality and fairer health, but telemedicine projects in the late 1990’ failed to improve access in Africa. How technology can transform healthcare in Africa today? We will tackle three challenges technology can help to take up: insufficient infrastructures that isolate some territories, shortage of doctors and health professionals and lack of data. 

How technology can direct limited medical resources where they are the most needed

Drones to transport resources in isolated territories 

Road density has decline in sub-Saharan Africa over the last two decades and less than half the population has access to electricity.Reaching these populations is a challenge, from knowing their needs to providing them with what they require. This involves unpredictable and often discouraging delays in the case of serious health problems. Drones, enduring most weather conditions, able to land almost anywhere, fast and able to carry heavy loads seem an ideal way of transport. Zipline has done a partnership with Novartis to deliver sickle-cell medicines by drone in Ghana2. Doctors place orders through an app, medical products, stored at Zipline’s centers, are packaged and flown within 30 min to any destination and then dropped with a parachute. Similarly, in 2019, South African National Blood Service start using drones to transport blood. Two thirds of death due to pregnancy take place in sub-Saharan Africa: this can help to tackle the huge mortality rate among women giving birth. 

Securing supplies to target patients efficiently  

With the increase in the number of chronically ill patients in Africa, the recurrent need for medicines is growing. In Gauteng, a South African province, Pelebox, a smart locker system, provide patients suffering from chronic illnesses their medicines. To unlock the box, the patient receives an SMS message with a unique code. Logistimo has constituted a medicines pack with birth control pills, HIV treatments, and other treatments against sexually transmitted infections, often contracted through rape. The local staff can notify Logistimo when stocks run short by text message. 

Ensuring optimal transport and storage conditions

Some medicines, such as vaccines, require very specific temperature and humidity conditions or they may expire prematurely. However, there is rarely dedicated transport for medicines with specific equipment, especially to the most remote areas. When trips are long, weather conditions are extreme and equipment is not refrigerated, it is important to stabilize the vaccine environment by other means. 37% of the vaccines may be lost due to bad conditions during transport and stockage.3 Most vaccines must be kept between 2°C and 8°C, but against all odds, freezing is the bigger risk. Parsyl is a software company that monitors supply chains of sensitive goods such as vaccines. Wireless sensors are placed inside refrigerators and alert the carriers all along the supply chain. In retrospect, the data can be analyzed to understand which stage of the supply chain compromised the proper storage of vaccines in order to make the necessary investments and adjustments.

How technology can help relieve the pressure on health care structures and staff 

Africa is experiencing a massive exodus of healthcare professionals to Western Europe and North America.

Take advantage of the wide penetration of the mobile phone to help patients at a distance

Mobile phone penetration is high in Africa: according to GSMA, smartphone connections in the region reached 302m in 2018 and are expected to rise to 700m by 2025. As SMS text messaging has become widespread, remote access to advice and diagnosis through apps is blowing up in Africa. Hello Doctor, in South Africa, provide information, advice and call back from a doctor for $3 a month. More simply, a simple SMS message, through even rudimentary mobile phones with low bandwidth, can transmit health prevention message and nudge to take medicines for tuberculosis or HIV.4 MomConnect operates through WhatsApp and free text messages to help pregnant women. Two thirds of pregnant women are actually using it in South Africa. It has since been replicated in Uganda through a Unicef program, FamilyConnect.5

The Praekelt Foundation has produced a Covid-19 messaging platform and is planning to launch a service that will prompt stable HIV and diabetes patients to obtain their medication. But, WhastApp only supports French, English, Afrikaans and fews African dialects. Tanzania, with its 59 million inhabitants and only one doctor for every 25,000 people, speaks only Swahili. The digital doctor, Ada Health’s chatbot symptom checker app, now speaks Swahili6. Local have been involved in the app-building process to tailor the service to the population and their needs. 

Internet of Things for remote diagnosis and initial treatment

Smartphones can capture audio, visual data or monitor movement and share information to help a doctor, even far away, understanding medical conditions. For instance, Kimetrica, backed by Unicef, is exploring face scanning to predict children malnutrition. 

Rather than travelling to a health care centre that is often far away and without transport, some medical devices can go to the patient. Matibabu has developed a clip on a finger that can diagnose malaria, with red beam of light detecting the parasite in blood cells.2 The result can be viewed through an app in 15-30 minutes with 80% accuracy rate. 

How technology, with the help of data, can drive the health system upwards

Data, as R&D fuel 

Data can help better understand which project is needed and how to make it cost-effective. For instance, AI-powered computing system can diagnose infectious diseases (malaria, typhoid fever, tuberculosis). With a blood drop inserted in the machine, the AI can correlate that data with libraries of academic anonymized data.7 In addition to help with diagnosis, by cross-checking wide range of data, machine learning may identify patterns and help in disease surveillance and forecasting. For instance, satellite images and heat maps help measure economic activity, used during the Covid-19 pandemic. Satellite images can also help vaccination workers and anti-mosquito insecticide sprayers, especially to reach remote communities.8

One challenge is that in Africa, data is not often shared and harmonized. To better extract data value, some companies such a Zenysis helps clean, aggregate and integrate all the data to produce a coherent picture and help decision makers using machine learning to make predictions. Zenysis helped tacking cholera outbreak by identify sources of water contamination, where to prioritize cholera vaccination. It is now helping to identify tuberculosis in Ethiopia, Rwanda and Vietnam.9

Data, as a way to finance projects? 

Many of the solutions we mentioned earlier have been developed thanks to partnerships with Big Pharma and Big Tech, which, in the absence of financial compensation, are paid in data. This is therefore a solution for the poorest countries to maintain an innovation that will obviously not be profit-centered. Commercialization of data, especially from Africa to Europe and USA is fueling a debate over confidentiality and ownership and some caution “data colonialism” such as Nick Couldry from the London School of Economics.8 A UK genome research center, The Wellcome Sanger Institute, was recently accused of commercializing a gene chip without consent of African people who donated DNA.10 African countries must now build regulations that protect the rights of their populations and equip themselves with the tools and know-how to exploit their data themselves.

CONCLUSION

In conclusion, in Africa, technology is making it possible to meet the challenge of making health accessible to all. However, although many solutions exist and continue to be developed, there is still no unification of African countries’ digital strategies or regulatory framework. Such a common strategy would help to effectively guide health investments ($25bn to $30bn needed to meet health care demands11), a significant part of which must be dedicated to technology. However, no technology can replace a doctor or a health care worker today. It is therefore essential to continue training doctors and building hospitals. 

REFERENCES

  1. How to start a digital healthcare revolution in Africa in 6 steps – Patrice Matchaba – 26 Aug 2019 
  2. Drones, apps and smart lockers: The technology transforming healthcare in Africa – By Nell Lewis, CNN Business
  3. Temperature tracker offers sea change for vaccines – Financial Times – 05/2020
  4. AI set to transform healthcare in world’s poorer regions – Financial Times – 15/05/2020
  5. MomConnect lets expectant mothers know what to expect – Financial Times – 05/2020
  6. Tanzania’s digital doctor learns to speak Swahili – Financial Times – 05/2020
  7. How New Technologies Could Transform Africa’s Health Care System by Ndubuisi Ekekwe – August 06, 2018 – Harvard Business School 
  8. AI set to transform healthcare in world’s poorer regions – Financial Times – 15/05/2020
  9. How data analysis helped Mozambique stem a cholera outbreak – Financial Times – 05/2020
  10. AI in Africa healthcare falls short of potential – Financial Times – 05/2020
  11. International Finance Corporation