Across the continent, innovative digital solutions to healthcare challenges are developing. They are not a golden bullet, and implementation difficulties remain, but some websites, phone applications, and SMS-based services are already filling gaps, saving time and improving lives, as Gabriella Mulligan reports.
Africa is witnessing a rise in online and mobile-based health services. Some of the continent’s tech innovators are seeking to address the healthcare challenges posed by a shortage of healthcare staff and facilities across Africa. From online doctoring, to SMS-based midwifery, to health information apps, a new wave of African tech innovation is turning healthcare upside down.
South African company Folup is one example of how technology can fill the gaps created by distant healthcare facilities and staff shortages. Folup is an online platform that allows patients to communicate with their healthcare practitioner without having to do so in person. Patients upload information like what medicine they have taken or the results from home-based medical measurements, such as a blood pressure reading. Healthcare practitioners can then monitor a patient’s health in real time, easing pressure on limited healthcare facilities.
According to Folup’s chief executive officer Simon Spurr, the software – available for free via desktop or mobile internet – is a way to enable quality healthcare to overcome particular challenges.
“The vision behind our technology is to help patients understand their health better, get better faster, connect with other patients, share experiences, and to help doctors track and monitor them better,” Spurr said.
“Mobile technology removes obstacles such as geographic distances and time barriers. Doctors can monitor constantly – remotely – and not periodically. We have severe challenges in South Africa and throughout the continent, especially regarding a lack of skills, a shortage of doctors and nurses, a lack of facilities, and the rising cost of healthcare services,” he said.
“We also know that the majority of African families have a mobile phone. Hardware is becoming cheaper and more readily available. Connectivity through network operators is constantly improving. Mobile phones are the delivery channel for a number of services in Africa, and will become more and more important in the future. Technology, particularly mobile, has to be the next great ‘enabler’ in healthcare. Folup’s technology has the potential fundamentally to alter the economics of patient care.”
With over 30,000 active users in South Africa, Folup is going from strength to strength. It recently concluded a deal with a Medical Aid administrator and is taking its African solution global, with a new office in Paris already open, and a London base planned for this year.
Text H for health
In Tanzania, SMS messaging is being used to address the high rates of maternal and infant mortality in the country. It is estimated that over 21 women die daily while pregnant or during delivery in Tanzania, while approximately 23,000 babies die during childbirth each year.
Tanzania has 7,000 healthcare facilities to provide for a population estimated by the National Bureau of Statistics (NBS) at 47.4 million. Half of all deliveries occur in healthcare facilities, but this figure masks significant rural-urban inequalities in service provision. The rate falls as low as 24% in the rural Pemba North and rises as high as 90% in the largest city of Dar es Salaam, according to an NBS survey from 2010.
Providing sufficient pregnancy information is also a challenge, with less than 43 per cent of women attending four or more antenatal visits, and only 15 per cent receiving antenatal care in the first trimester.
The mHealth Tanzania programme seeks to provide pregnant women, new mothers and their supporters with a potent solution to these information and access issues, through the Healthy Pregnancy, Healthy Baby text messaging service, also known as Wazazi Nipendeni.
According to Janita Ferentinos, partnership director of the mHealth Tanzania Partnership, mobile holds the key to turning around maternal and infant mortality rates in the country.
“Early promotion of healthy behaviours during pregnancy is key. The mobile phone offers an opportunity to provide these women and their ‘supporters’ with information at any time. Recent studies show that at least 85 per cent of the Tanzanians [surveyed] used a mobile phone within a 7-day span,” she said.
“Information dissemination to patients is crucial. However, this depends on the time health personnel have available. The Healthy Pregnancy, Healthy Baby Text Messaging Service […] offers men and women – located in every corner of the country and from any income level – with healthy pregnancy advice and early childhood care information via text messages, directly on their phone for free.”
According to Ferentinos, while technology can never replace healthcare staff and facilities, it can have a substantial impact in terms of supporting personnel and improving healthcare provision in rural areas.
“Mobile phone services can support – but never replace – healthcare personnel in performing their duties. It supports the community health workers (who support the health facilities and health programmes) in performing their duties. We heard from several healthcare workers that their efforts are supported by the SMS messaging service,” Ferentinos said.
“In short, technology is a means to support a heightened healthcare effort in rural areas. [However…] it is not a standalone solution.”
Through the efforts of the mHealth programme and partnering initiatives, the Tanzanian government projects the under-five mortality rate will fall from 81 deaths per 1,000 live births in 2011 to 46 per 1,000 in 2015, while the maternal mortality rate will fall from 454 deaths per 100,000 live births in 2011 to 382 per 100,000 in 2015.
Knowledge for health
In Kenya, local company MedAfrica is tapping into high levels of mobile adoption to increase health-related awareness, and cut down on bogus “doctors”. The MedAfrica health information app provides healthcare information ranging from first aid advice to a step-by-step diagnosis tool. Users are also able to view listings of qualified healthcare practitioners and facilities. Since launching in 2011, MedAfrica has seen over 200,000 downloads of the app – 60 per cent of these by regularly active users.
It is not just patients who are empowered by the technology. MedAfrica says that practitioners’ ability to gather information, second opinions, and advice over the internet – often through mobile devices – is improving the quality of healthcare.
“Technology has made it easy to conduct online research. With an internet connection, one can browse through the various websites and carry out research in regards to a certain area in the health sector. It only takes a touch of a smartphone for doctors to access pages of medical books to do research. They are also able to reach medical databases to access information,” Mary Njuguna of MedAfrica said.
Given that e- and m-health are relatively new, implementation obstacles remain. Key to launching a successful tech-based health service is ensuring seamless and secure technology, says Spurr. Health technology must create a closed loop between a patient and healthcare provider as well as any insurers involved, and each party must be able to upload the data to the platform securely.
Most players also concede increased collaboration is necessary to unlock the real value of tech in healthcare. This collaboration should be systemic, ranging from technical standardisation and interoperability, to an increased willingness of the various players to share content in order to prevent a fragmented market of varying services.
If Africa’s medical tech innovators can meet these challenges, they will continue to reshape healthcare across the continent. Perhaps the scope could go beyond this, with models and practices developed in Africa being exported to the rest of the world. E-health could become an African solution to a global problem.