Africa Is A Hotspot For Digital Health
Digital health in Africa is booming, and that’s the greatest news since the invention of broadband internet connection. The flourishing of disruptive solutions might go down to the fact that instead of relying on traditional infrastructure and a conventional healthcare system, populations in Africa need cheap, easily accessible and genuinely problem-solving technologies. Why, when and how have they got there? Read on!
Disrupted infrastructure should be …
Africa has the world’s worst health record. The birth-continent of the homo sapiens bears one-quarter of the global disease burden, yet it spends only 1 percent of the worldwide health expenditure and has only 3 percent of the world’s health workers. According to the WHO, there are rarely regions where there is more than one physician for less than 1,000 patients.
There are even extremities that are incomprehensible to anyone living in a luckier part of the world. For example, one of the poorest countries in the world, Mozambique, has just 548 doctors for a population of more than 22 million. One of Africa’s most populous nations, Ethiopia is extremely short of doctors, with fewer than one doctor for every 36,407 people. Niger has just 288 doctors for a population of 14 million and one of the worst health crises in the world. Moreover, almost 90 percent of health workers are in cities – leaving rural areas with 885 medical staff, according to 2008 Health Ministry data; 40 percent of all health workers operate in the capital, Niamey. These ratios are not strange for other parts of the continent either.
As it is painfully visible, the region lacks the infrastructure to provide even basic health care to many of its people. There are hardly any doctors or nurses, only a handful of good hospitals and appropriate hospital beds, a lack of medical devices. It is even more difficult to speak about specialists. The Nigerian Medical Association (NMA) estimates there are about 25 consultant oncologists to approximately 160 million Nigerians, while there is only one pathologist for every 700,000 patient in Sudan. In Uganda, the job is basically non-existent: statistics enumerate 1,555,000 patients per pathologist.
… aided by disruptive technologies
However, as long as many countries even struggle with having electricity or clean water, those who have the means travel abroad for medical treatment, and the brightest doctors leave for good, the improvement of health conditions has to come from unexpected places.
And it does. It comes from disruptive technologies which use the creative mind rather than abundant resources to solve problems. Mobile phones. Apps. Tablets. Telemedicine. 3D printing. Medical drones. Solutions which mostly by-pass traditional infrastructures or national regulations and cost less than the usual medical equipment.
As you cannot go to the doctor because the nearest one is two-hundred miles away, you will gladly use the telemedicinal app on your phone to talk to a physician. As you cannot be sure whether you will receive counterfeit medicine, you will definitely use your mobile phone to figure it out. Although a systemic change in Africa is further down the road, sometimes an average consumer in Germany or the US can feel the era of digital technologies later than in villages in Rwanda or Kenya. What can we discern from all of that?
Real needs spark innovation
Necessity is the mother of invention – and the saying is incredibly valid for Africa. While in the developed world, it is sexy to innovate and bring new ideas to the market to make people’s lives easier, in Africa, innovation might mean the chance to beat everyday challenges and to ensure basic conditions for the life of large populations. Digital technologies are spreading like wildfire especially because they allow the jump from no infrastructure to the fourth industrial revolution without investment in traditional infrastructures and the need for conventional social circuits – which are often disrupted in many places of the continent.
Over the last 15 years, African economies have enjoyed growth above the global average, which comes down to mineral agriculture linked to China’s demand for raw materials in as much as to a technological revolution. Disrupt Africa reports that in 2015, African technology startups received over $185 million in funding, and pharma companies see a growing potential in the continent as they are supporting more and more digital health start-up incubators.
By 2020, there will be more than 700m smartphone connections in Africa – more than twice the projected number in North America and not far from the total in Europe, according to GSMA, an association of mobile phone operators. In Nigeria alone, 16 smartphones are sold every minute, while mobile data traffic across Africa is set to increase 15-fold by 2020.
SMS for Africa
Smartphones and access to broadband internet connection are potent tools for innovation, and due to the undersea internet cables encircling Africa, the continent gets more and more connected. Mobile phone solutions popped up for almost everything ranging from the iCow app to help farmers get advice until one of the biggest long-term experiment with universal basic income. More than 21 thousand people in Kenya receive 2,250 Kenyan shillings, one-quarter to half of the average salary in Bomet County, one of the poorest in Kenya, every month for the next 12 years. It’s courtesy of the US-based charity GiveDirectly, which is studying the effects of handing people lumps of cash with no strings attached.
Regarding healthcare, mobile phones and smartphone apps mean basic access to care and better management of scarce resources. Around 27,000 government health workers in Uganda use a mobile health system called mTRAC to report on medicine stocks across the country. Novartis is also working on an mHealth pilot in Nairobi and Mombasa to understand the supply chain cycle better and build capabilities to ensure medicines reach patients in need. Through this initiative, pharmacists register their patients for surveys via SMS. The survey results then help map out where patients are located to redistribute medicines to areas in need. Mobile healthcare solutions such as Kenya’s Miti Health and Ghana’s mPedigree are helping to improve the drug supply chain by validating prescriptions and over-the-counter drugs.
Smartphones could also aid diagnostics. Nigerian start-up, Ubenwa has developed an A.I. algorithm able to diagnose childbirth asphyxia based on an infant’s cry. The smartphone application analyses the amplitude and frequency patterns of the cry and provides an instant diagnosis. As, according to WHO, birth asphyxia is the third highest cause of under-five child deaths and is responsible for almost one million neonatal deaths annually, the solution comes as a real life-saver.
Solar power and discarded electronics – lack of resources call for creativity
In many cases, it does not even go down to financial resources, but necessary infrastructure. You could have a state-of-the-art MRI machine, but if you cannot turn the lights on due to the lack of electricity, you can only use it as a flower pot holder. While accessibility is a massive problem for smartphones and the internet in Africa, too, statistics show that mobile phone penetration is surpassing electricity penetration in many countries – and it will be even more so in the future.
And what if you search for different resources such as solar power or discarded electronics? Botswana-based Deaftronics manufactured the first solar-powered hearing aid unit, Solar Ear. This technology is game-changing in a country where there are only 12 audiologists and five audiology centers for a population of over two million. The 22-year-old Sanga Kathema from Malawi uses discarded electronics to build low-cost wireless heart diagnostic systems. The device applies two methodologies for measuring and monitoring the heart; electrograph and digital stethoscope. Both solutions are great for helping people in remote areas not having access to doctors.
Smart jackets for portable diagnostics, e-waste as material for 3D-printers
In Tanzania, GE is working with the Ifakara Health Institute to provide health workers with portable ultrasound devices that will be used by midwives and nurses to assess the wellbeing of pregnant women in rural areas. And cutting-edge research is testing how to extract the data necessary to perform blood analysis with only a smartphone attachment, useful to telemedicine or rural treatment. A Ugandan engineering student, Brian Turyabagye, who had to witness how his friend’s grandmother was misdiagnosed with malaria instead of pneumonia, built a smart jacket, Mama-Ope, to help doctors identify pneumonia faster and more accurately. Mama-Ope or “mother’s hope” measures temperature, breathing rate, and compares it to a database of parameters. The team wants to reduce the alarming statistics with 27,000 Ugandan children dying annually from pneumonia.
The endless creativity of African entrepreneurs also facilitates the development of 3D printing – and it’s easier use for printing out finger splints, medical devices or prosthetics. While the e-NABLING the Future project allows anyone to download 3D printing designs, video tutorials and other information about building prosthetic hands to enable volunteers, doctors or anyone on the field to create the actual prosthetics; an innovative lab in Lomé, the capital city of Togo in West Africa, built the first “Made in Africa” 3D printer using e-waste. Now, that’s what I call innovation!
Less regulation and targeted policies: governments have a huge role in facilitating digital health for Africa
In 2016, the Rwandan government teamed up with Zipline, a medical drone manufacturing company to deliver medical supplies to five of its hospitals. The American start-up appeared earlier on the African market than in the US – as the government supported it and looser regulations allowed it. Within a year, Zipline plans to expand the program to nearly half of Rwanda’s 45 hospitals. After its Rwandan success, the White House reached out to Zipline. They expressed interest in delivering medicine and blood to rural parts of the US. Thus, the start-up announced in August 2017 that it brings its system to rural and remote communities in Maryland, Nevada, and Washington, including some Native American reservations.
Something similar has been happening with telemedicine in Ghana. While some progress has been made in South Africa, Ethiopia and Mali, Ghana’s health service and ministry have committed to scaling up a telemedicine pilot project that has proven successful in one of its regions in increasing access to healthcare. While Novartis Foundation funded the set up of the pilot project, the government will have to ensure sustainability of the project.
African governments seem to be aware of the fact how important digital health might be for their communities in spite of the limitations of authoritarian leadership or rouge state-like lack of regulations in certain places. For example, African leaders gathered at the African Ministerial Dialogue on Digital Health Leadership at the 2017 World Health Assembly to affirm their commitment to digital health and identify the pathway to achieving robust digital health systems in their countries. A coordinated intra-national dialogue? Have you seen anything like it in Europe or the US?
The Medical Futurist is amazed by the creativity and innovative energy of the overall African tech scene and the sensitivity with which they are aiming to solve the acutest healthcare problems. African countries could be held before us as examples how out-of-the-box attitudes, smart usage of scarce resources and government flexibility could boost cheap, creative and straightforward healthcare solutions.