An E-enabled Continent: Transformative Innovations for Healthcare Administration in Africa

Introduction

Dubbed “A hopeful continent” by the Economist, Africa’s transformation over the last decade since its decolonization in the 1960’s has been quite remarkable.[1] There have been substantial advancements in improving the social welfare of its population, particularly health outcomes over the past two decades; however, its indicators continue to fall behind those of other regions. While Africa’s under-5 child mortality rate has declined considerably, it still remains larger than the rates for Asia or the Americas.[2] The HIV/AIDS pandemic, malaria and tuberculosis continue to pose severe challenges, despite intensive measures to fight them. In many parts, there is an acute shortage of medical doctors and other health professionals. Several millions still lack access to medical care either because they are unable to afford payment for services or due to the long distances to a health facility. Despite the growing optimism about Africa’s economic, social and political prospects, the continent continues to be marginalized from public debates and academia probably due to the overall dissatisfaction about the lack of development. The African story is also reinforced by negative images portrayed by the media. Nevertheless, the hope of Africa still remains an illusion not only for the Africans themselves, but also for policymakers and the numerous international partnerships which promote investment in African prosperity. Hence, there is an urgent need for robust health policy for Africa.

Policy Option: An E-enabled Healthcare administration system to provide tangible solutions to challenges by enabling greater use of remote diagnosis, treatment and education.

Problem it solves and Explanation

There are huge opportunities for progress of healthcare in at least three key areas, where interesting innovations are evolving throughout continent. First, is telemedicine. This technology enables doctors to diagnose, advice and treat health education. It is estimated that in Africa up to 80 percent of health issues would be addressed, especially in rural clinics, which usually have the most poorly staffed medical personnel. This would improve the efficiency of health expenditure and reduce the cost of treating chronic illnesses by about 10 to 20 percent and saving an hour a day of nurses’ time.[3] This revolutionized technology is not new to Africa as initiatives are already taking place from simple to complex-based solutions to demonstrate its potential. For example, Senegal have partnered with Cisco and Sonatel to integrate high-definition video, advanced audio and third-party medical equipment (e.g. blood pressure monitors) to patient diagnosis. So doctors are now able to examine patients remotely, diagnose and prescribe drugs in remote areas. Telemedicine also enables health professionals to properly educate patients on completing their treatment after diagnosis. For instance, Uganda have instituted a campaign to raise awareness of HIV/AIDS prevention through SMS text messaging, mini quizzes for Celtel mobile subscribers in rural Mbarara and providing free talk time as incentive for participation. At the end of the quiz, text messages are dispatched to all participants to encourage them to go for voluntary testing and counseling at their local health centers. This initiative saw a rise of about 40 percent in the number of patients going to clinics for free HIV/AIDS screening.[4] Similar projects with text-messaging have been conducted in Mozambique for tuberculosis screening.

Second is treatment of patients. Due to poor management of patient medical records, it is often difficult to update patient folders after diagnosis to ensure quality treatment and recovery. A serious problem facing Africa’s healthcare administration (both public and private) is the laborious manual or handwritten folders of patient’s medical records in health facilities. This reduces the efficiency and effectiveness of medical staff to retrieve patient information as they have to search through a long pile. The internet is now available to update patient admissions, health records, supply chains, and database management. South Africa’s HealthID initiative is a very good example of this where the system collects patient’s medical history, and with the consent of the patient grants his or her doctor online access to a full health record. Kenya also uses 3G connectivity to streamline reporting for the supply of antiretroviral to treat HIV/AIDS. Nigeria have also adopted technology in one of its states, Ogun, to establish an online payment system for a hospital. Within two months, the new system of payment had collected payments equal to the amount the hospital had manually managed to collect within the previous year.[5] Online resources can be employed by health system managers to observe disease trends, performance and readiness across facilities in a timely and accurate manner. In Ghana, the Ministry of Health and Interior have partnered innovation in mPedigree technology to detect counterfeit drugs by allowing clinicians to communicate via text messaging with a drug identification information and instantly receive verification of a drug’s authenticity. Mobile technology can also revolutionize medical record keeping by containing disease outbreaks and preventing their spread. A key example is Nigeria’s Maliafiya program which gathers and dispatches patient medical information through a database, where it analyzes disease spread rate and responses. The availability of this tool in real time has significantly improved the spread of epidemics and ensured the proper allocation of health personnel.

Third is online education for health practitioners. This includes innovative provision of initial medical training to health workers or professionals, and timely information on vaccination, disease outbreaks and preventative initiatives. For example, in Ghana, text messaging is used as a communication tool by midwives to refer pregnant women to regional hospitals. The provision of training is not only important for health workers but also for the patients who have to adapt to the new technology.

Why should we care about this policy?

To discover the full potential of an E-enabled health care administration system, it is important to mitigate the challenges they tend to pose. First, there is the issue of complexity. Revolutionizing the health systems of all sub-Saharan countries is discouraging since it is complex and fragmented. Therefore, it will be difficult to impose high-tech solutions because more often sponsors do not always share similar objectives. Governments, private non-governmental organizations (NGOs) and donor organizations which provide the investment may not benefit directly from such projects; however, telecommunications companies are the well placed beneficiaries of such ventures to provide innovative solutions to healthcare administration. Second, there is the issue of the source of funding. Many existing digital technologies in Africa are either specific to a particular donor or project; hence, it cannot be replicated across countries. To mitigate this problem, the private sector can develop commercial models to provide flexibility for different markets to enable consumers of all income levels to benefit. Investment in Africa is a long-term partnership with the continent hence both public and private sector associations should be strongly encouraged. Third, there is also the issue of access to technology. Despite fluctuating data on mobile access in Africa, there are still many people who lack access to computers and smartphones. To address this concern in the short-term, mobile service providers should adopt a multidimensional approach which uses SMS text messaging to promote initiatives that connects patients to health facilities. A long-term approach will be for telecommunication companies to develop applications for handheld devices (smartphones, tablets) which will have greater penetration in the future. Finally, there is the issue of ensuring the privacy patient’s information. The use of new technology is likely to expose confidential information about patient illness or disease since families that live in remote areas may only have access to a single smart phone to access their information. The way to solve this problem is for telecommunication companies to introduce privacy and authentication settings for each patient’s usage.

The adoption of an E-enabled healthcare administration system presents new prospects for Africa, and although it is not an end in itself, it is a good step in the right direction. Integrating technology into Africa’s health care cannot not happen overnight as there are variations in health care administration; however, various initiatives are already being implemented in some African countries as shown, hence there is hope of providing efficient healthcare for many Africans in the near future. It is a change that needs to occur and one that African governments need to learn to adapt and reach out to investors, companies and philanthropists to invest in African prosperity.

[1] The Economist Special Report Emerging Africa, March 2, 2013.

[2] World Bank; World Health Organization; McKinsey Global Institute analysis.

[3] Ibid.

[4] Ibid.

[5] Xan Rice, “Nigerians begin to embrace mobile and Internet,” Financial Times, October 10, 2013.