/ 28 February 2022

Digital health has strong potential to enable universal healthcare access

Operations In A Covid 19 'war Room' As Mumbai Flattens Its Virus Curve
A computer screen displays the available beds of a hospital, in a Covid-19 'war room' set up at a Municipal Corp. of Greater Mumbai (MCGM) building in Mumbai, India, on Wednesday, May 26, 2021. (Dhiraj Singh/Bloomberg via Getty Images)

Digital health has been on the rise globally and is estimated to increase at an 18% compound annual growth rate between 2022 and 2030. Even before the Covid-19 pandemic hit, digital health had gained traction as a tool for innovation to address health problems and accelerate the attainment of universal health coverage under the third World Health Organisation sustainable development goals.  

Digital health is defined as the use of computing platforms, connectivity, software, and sensors for healthcare and related uses. This includes mobile applications (mHealth) that can be used for general consultations, issuing prescriptions, detecting counterfeit drugs, or accessing health financing. Other digital health technologies include wearable devices, telehealth and telemedicine, and personalised medicine platforms for people with chronic illnesses. 

The promise of digital health lies in improving access to healthcare services, particularly for rural areas, where 83% of the population is not covered by essential healthcare services. In addition, these technologies aim to improve quality of healthcare through monitoring, improving knowledge and access to health information, improving efficiencies and reducing the cost of health-service delivery. 

For sub-Saharan Africa, these technologies have yet to prove their claim, because both the digital and healthcare landscapes are riddled with challenges. The challenges include poor infrastructure to support digital-solution usage, poor healthcare systems, and a lack of policies to support further development of the healthcare sector.   

More than 80% of the sub-Saharan Africa population have cellphones, but fewer than 50% have smartphones and only 28% have access to the internet. These low-penetration rates are linked to affordability, digital literacy and skills, and poor connectivity. The median cost of an internet-enabled handset as a percentage of monthly GDP is high at 26.5% in sub-Saharan Africa compared to 19% across other low- and middle-income countries including South Asian countries such as Bangladesh, India and Sri Lanka. 

In addition, one in five people in sub-Saharan Africa lives in an area without broadband coverage, with the rural population 60% less likely to be connected to the internet. Based on this, the penetration of digital health technologies will remain centred in urban areas, with rural areas remaining excluded. It is, therefore, important to note that the rural population is the segment that needs access to these digital health services the most, because more than 50% of the rural population has to travel for more than two hours to access the nearest health facility. 

Despite the above challenges, there have been significant strides taken towards improving access to digital health technologies in some sub-Saharan African countries,  such as Ghana, Cameroon, South Africa, Tanzania, Nigeria, Uganda, and Malawi. These countries have implemented digital health solutions such as mHealth, eLearning and telehealth and electronic health records to improve access to health services and improve efficiencies across their healthcare sectors. 

For example, digital ultrasound using telemedicine solutions has been used in Ghana to allow remote diagnosis and treatment of patients telephonically. Other technologies introduced in sub-Saharan Africa include the cloud-enabled portable electrocardiograph (ECG) used in Cameroon to send a patient’s heart activity to the national healthcare centre for a cardiologist to evaluate and return diagnosis to the patient. 

In South Africa and Nigeria, mHealth solutions such as Hello Doctor and FD-Detector are used for general consultations and the issuing of over-the-counter prescriptions and detection of counterfeit drugs, respectively. However, even with the adoption of these innovations, implementation and deployment remains low.

The road to harnessing the full potential of digital health technologies begins with the creation of an enabling environment. This extends to the development of digital infrastructure and regulatory frameworks that support this development. 

Firstly, governments need to prioritise investment in expansion of digital infrastructure, in particular Wi-Fi and broadband coverage as an enabler for service delivery in digital health. This could be in the form of setting up of public Wi-Fi facilities serving the rural communities in places such as public halls and community centres. 

Beyond that, the government needs to pilot digital health initiatives that are scalable to obtain greater impact for the rural communities. These communities need to be adequately informed on how these solutions could help improve service delivery and improve their access to healthcare services. 

Pilot projects should be kept manageable and centralised in sparsely distributed target areas, such as the Eastern Cape or Northern Cape in South Africa, to avoid poorly coo-rdinated initiatives that result in duplication, over-stretched capacity or redundancy which leads to a waste of resources. In addition, the government should collaborate with medical practitioners in the rural areas to promote and enable fast track adoption. Through these projects, the government can gauge buy-in and scale up for widespread roll-out. 

In conclusion, digital health technologies have tremendous potential in enabling universal access to healthcare for the whole sub-Saharan Africa population. Governments need to take the leading role in deploying these programmes through collaboration with hospitals and clinics to offer and educate communities on the benefits digital health brings. 

Although there has been good progress in deploying digital health across sub-Saharan Africa, the challenges mitigating the successful deployment of its solutions should be addressed. These challenges include affordability, infrastructure and human resource capability, and digital and literacy skills. 

Therefore, political commitment to creating enabling environments, payment plans such as on a month-month or pay-as-you-go basis to ensure affordability, and collaboration and co-operation among health and ICT stakeholders remains crucial to solving these challenges and enabling the successful deployment of digital health in sub-Saharan Africa.