Imagine a world where healthcare is less about the treatment of disease and more about health promotion, disease prediction and prevention. We would see innovation in medicine as well as a change in mindsets, in science and health systems, in technology as well as our overall approach to healthcare.
We believe data driven, digital technologies such as artificial intelligence (AI) and machine learning can enable this transformation to achieve universal health coverage (UHC) by 2030. Fortunately, many African countries are well-placed to harness these benefits for UHC, and the Sustainable Development Goals more broadly, especially as internet connected devices (internet of things, IoT) continue to surge and improve exponentially.
AI and IoT combined with 5G, the fifth generation of cellular wireless technology, could dramatically change how healthcare is delivered today in African countries, particularly for people living in hard to reach areas.(1) Digital technologies can contribute to improvements in point of care diagnostics,(2) real-time patient remote monitoring and increase access to more affordable and appropriate care. (3, 4) With the analysis of big data, AI and machine learning can even help to predict certain health problems based on probabilities derived by algorithm. This type of data can empower patients, healthcare providers and health systems to predict disease, intervene and provide preventive measures in a timely manner.
We must take advantage of available and emerging digital enablers if UHC2030 is to be achieved. However, it is not only about the development and implementation of technology. New policies are needed, and a digital mindset must be adopted in policy making to encourage a cultural change in the way innovation is seen and understood. It will also mean developing new partnership models with non-traditional health actors such as with retailers, consumer companies, and the entertainment and gaming industry. For example, preventative healthcare games can make services more accessible, fun and empowering for users.(5)
Currently, such political efforts are being made by The African Union and leaders like former President H.E. Kikwete of Tanzania who are actively advocating for strong country leadership on UHC through inter-ministerial and governmental collaboration. Through the One By One: Target 2030 Campaign, President Kikwete is encouraging African Heads of State to create an enabling policy environment for coordinated UHC with the development of a UHC Resolution at the Pan-African level.(6) When governments become digital enablers, and strong UHC is defined by African leaders, policy reflective of this innovative approach to inclusive digital health is possible. We acknowledge a lack of coordination around health policies in Africa, but also a great potential and interest in digital uptake for better health. (7)
We also recognize African governments face other challenges to integrating digital technologies, such as a lack of human resources for digital health and ethical issues related to the collecting, storing and sharing data and specimens. (8) Moreover, most healthcare data generated in Western nations lack adequate representation of females and African populations, which in turn creates inadequate datasets with the potential of bias. An issue that we are also seeing worldwide is that many datasets are not publicly available, despite being publicly funded.
A current lack of regulation of data ownership is a real challenge to the social benefits that big data could bring. Coalitions such as that formed by Fondation Botnar, PATH, Women Deliver, the Partnership for Maternal, Newborn & Child Health (PMNCH) among others, are an important effort towards increasing collective action, harmonising approaches to the pooling and sharing of data, and tackling these biases so benefits can be experienced by everyone, regardless of gender, race, ethnicity or geography. (9)
Despite these challenges, solutions to some of the most pressing problems facing countries in Africa are being designed to take advantage of what digital technology has to offer. For example, the introduction of mobile phones to remote areas of Africa has enabled the social and economic benefits of telephone networks while 'leapfrogging' the need for intensive landline infrastructure.(10) Digital technologies including predictive analytics and biometric identification, are being used to improve the flow of information and increase coordination between community health workers, health facilities, and private drug dispensers in Tanzania. (11)
In other cases, electronic medical records are used to gather comprehensive health data sets and provide clinical decision support to improve care in response in low-resource settings. (2, 11) These examples of innovative practice show the potential of digital technology to not only improve efficiency, lower overall costs, and streamline workload, but to also enable more responsive, people-centered care.
Many African countries are in a strong position to harness digital technology for UHC, as well as other social and economic advantages. The next generation of digital natives, the growing adolescent and youth population across the continent, must also be supported in driving this change. Digital health solutions must address health disparities otherwise the most vulnerable groups in society will reap little or no benefits from the digital age. Working in partnership we must do all we can to ensure digital technology is used to democratize health and to transform the delivery and accountability of health services, so no one is left behind.
This guest column was written by:
Stefan Germann, CEO, Fondation Botnar, Switzerland
Emmanuel Fombu, physician, entrepreneur and author of ''The Future of Healthcare - Humans and Machines Partnering for Better Outcomes"
Dr. Githinji Gitahi, Group CEO, Amref Health Africa; co-chair of the UHC2030 Steering Committee
Kate Campana, CEO, The Access Challenge
References
1. Broadband Commission for Sustainable Development. Digital Health: A Call for Government Leadership and Cooperation between ICT and Health. 2017. [available at: [ https://www.broadbandcommission.org/Documents/publications/WorkingGroupHealthReport-2017.pdf ].
2. Keitel K, D'Acremont V. Electronic clinical decision algorithms for the integrated primary care management of febrile children in low-resource settings: review of existing tools. Clin Microbiol Infect. 2018;24(8):845-55.
4. World Health Organization. Compendium of innovative health technologies for low-resource settings. Geneva: World Health Organization; 2015.
4. Fombo E. 5 ways 5G will transform healthcare: Data Driven Investor; 2014 [available at: https://medium.com/datadriveninvestor/5-ways-5g-will-transform-healthcare-9187493ae898 .
5. Deweerdt S. Can science-based video games help kids with autism? 2018 [available at: https://www.sciencemag.org/news/2018/06/can-science-based-video-games-help-kids-autism .
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6. The Access Challenge. UHC Briefing and Communications Guide for African Member States. 2019 [available at: https://www.onebyone2030.org/uhc-newsroom ]
7. African Union, Department of Social Affairs. Africa Health Strategy 2016-2030. [available at: https://au.int/sites/default/files/documents/24098-au_ahs_strategy_clean.pdf ]
8. Nordling L. Africa's science academy leads push for ethical data use: Nature; 2019 [ a vailable at : https://www.nature.com/articles/d41586-019-01894-0 .
9. Fondation Botnar. Leveraging artificial intelligence, digital and frontier technologies to achieve Universal Health Coverage by 2030: "Fueling a movement towards action and leaving no one behind" [available at: https://www.fondationbotnar.org/fuelling-a-movement-towards-action-and-leaving-no-one-behind/
10 . Lamiaux M, Woods W. Health in Africa: Leapfrogging to success 2014 [available at: https://www.bcg.com/en-ch/publications/2014/global-health-community-economic-devlopment-health-africa-leapfrogging-success.aspx .
11 . Fondation Botnar. Media Release: Fondation Botnar, Apotheker, D-tree International, and partners launch first digitally-enabled responsive health initiative at the community level in Tanzania 2019 [available at: https://www.fondationbotnar.org/fondation-botnar-and-partners-launch-afya-tek/ .
12 . Bustreo F, Mshinda H, Hinton R, S H-M, Tanner M. Commentary: Primary health care in Tanzania – Leading the way through innovation. EClinicalMedicine. 2019;13:12-3.
