Mobile phones may not be a silver bullet, but across Africa they are going a long way towards addressing long standing deficiencies in the region’s healthcare systems.
These solutions go far beyond simple text messages offering health advice – although these have been used to good effect. E-health solutions are working to combat health problems as diverse as child mortality, countering the spread of contagious diseases and ambulance accessibility.
Kenyan startup Flare has been called the Uber for ambulances, referring to the mobile taxi app. The service is helping to address the lack of an emergency response system in Nairobi, the capital. “Plenty of ambulances are available in Nairobi, yet very few can access high quality, fast and affordable emergency transport,” says Caitlin Dolkart, co-creator of Flare.
“Having the ability to browse emergency transport options by brand, price and quality is a big change in the world of emergency medicine.”
Wazazi Nipendeni, meaning ‘Parents Love Me’ in Swahili, is a SMS-messaging service aimed at reducing the 45,000 newborn deaths registered each year in Tanzania. The service sends free text messages to expectant mothers that provide pregnancy and childhood care advice. Since the initiative was launched four years ago it has reached a total of 500,000 active users and sent more than 5 million text messages.
However, as the number of e-health solutions rise, so do concerns about data protection and cyber security. Even if a device or programme is unprotected for a few moments, the consequences are high as sensitive medical data could be exposed. Many Africans are, unsurprisingly, hesitant to embrace e-health applications that have not been widely tested.
“Our customers have a very keen understanding of data security and privacy, and we found that one of the first things we needed to do to get wide adoption was to put a data use agreement in place with each customer,” says Jessica Vernon, founder of Maisha Meds, which received a $100,000 grant from the Bill & Melinda Gates Foundation last year.
The Kenya-based point of sale application for pharmacies and clinics is compatible with Android smartphones. It also offers patient SMS follow-ups and analytics that help improve business management and patient care.
The proliferation of mobile phones in Africa, alongside falling handset and data costs, are making the widespread usage of e-health solutions increasingly viable.
A recent report by mobile operator trade association GSMA found that 557 million Africans have mobile subscriptions. This figure is expected to reach 735 million by 2020.
Established international healthcare providers, including US drug giant Johnson & Johnson and German science and technology company Merck, are getting involved in the African e-health industry. Merck launched Africa’s first e-health startup accelerator in April, aimed at nascent startups with a broad appeal.
“Digital solutions in healthcare can oftentimes bridge the lack of infrastructure and resources and make good quality healthcare affordable and available to everybody on the continent,” says Karina Fassbender, innovation facilitator at Merck Accelerator Africa.
Merck provides each of the three start-ups it selects with $15,000 in equity free funding and three months working space at Metta, a global entrepreneurship club with a base in Nairobi. Merck experts also provide mentoring and coaching.
E-health is still a nascent industry in Africa, and there are relatively few experts in the field. Capacity building is critical to bridging the skills gap.
“We see a lot of teams who have one main talent, normally in coding and programming. But that is not enough. While it is good to have a coder there must also be a business-minded team member and a medical expert too,” says Ms Fassbender.
The difficulty of scaling health programmes in resource poor settings can partly be overcome by e-health solutions. However highly fragmented health systems and providers across Africa remain a problem.
While more mature markets may have many major pharmacy chains, providing ideal partners to roll-out e-health solutions, Africa has few. Chains like Kenya’s Haltons Pharmacy and South Africa’s Dis-Chem, which each have more than 50 retail outlets, are exceptions rather than the norm.
Health insurance coverage also varies widely country by country. While close to 20 percent of Kenyans have some form of medical insurance, only 1 percent of Zambians do.
“Unlike in the US, where you might scale telemedicine in partnership with an insurance company, there are not frequently insurers here that have the volumes required to make e-health work well at a large scale,” explains Ms Vernon at Maisha Meds.
“It is not always clear who pays or how to get patients or providers to pay for e-health here yet.”
Creating highly interoperable programmes and establishing partnerships can help to move the e-health industry forward. The goal is to move from individual initiatives that act as silos of information to interconnected platforms that proactively monitor health holistically and improve patient care.
FOLUP is one platform working to do this. The South Africa-based initiative now has 20,000 users who can pool all their health data to build their own digital health records, and then securely connect to their healthcare providers to share valuable information about their health.
“We have spent a lot of time focusing on a partner-centric model where we can collaborate with other technology platforms that add more value to the information, and that gives a better end-to-end solution for the patient and provider,” says Simon Spurr, the company’s CEO.
“Until we collaborate effectively to create valuable solutions for our markets, the data remains, to a large extent, meaningless.”