Due to social distancing imposed over the last couple of years, the cyber industry has accelerated in all areas of life across Africa, especially in health in a relentless quest for solutions for the Covid-19 crisis. Africa has advanced with entrepreneurs who have tried to make the most of digital opportunities in a sector that has major shortcomings. Most notably, the chronic shortage of skilled personnel on the continent, which the WHO detailed in a June 2022 report predicting a shortage of millions of health professionals in Africa by 2030, an increase of 45% since 2013, when last estimates were made. Yet the report also envisaged a “promising future” for e-health on the continent, noting that a new wave of mobile technology is radically changing the way health care is delivered in urban and rural communities.
However, numbers and opinions of the overall situation aren’t encouraging.
As of November 2020, 34 member states in the WHO African region have developed digital health strategies, but these have so far only been implemented in 12 countries.
Africa has low maturity, is the least advanced in infrastructure, and lags behind the global average in legislation, policy and compliance, standards and operability, and infrastructure according to the Global Digital Health Index Indicator 2019.
Between telemedicine, awareness and prevention through mobile health promotion applications, monitoring of patients and epidemics via electronic medical records, the scope of e-health is wide and there are many levels of difficulty to overcome so called “medical deserts” in Africa, according to Hadi Zarzour, manager of Africa and the Middle East at Evolucare, a French company that publishes health software and an expert in health information systems.
“Today in Africa, there’s a growing ambition to go digital because it allows us to secure data,” says Zarzour. “We no longer lose the patient’s data as we used to do with paper. The information is preserved and digital allows us to store, trace and archive this data for better medical follow-up and to avoid bad communication of medical information.”
To improve on these priorities, Zarzour says that hospitals must be sufficiently and thoroughly equipped and interconnected with digital technology. “This is what some governments are trying to put in place in order to make up for the lack of doctors,” he says. “State projects emphasise more inter-connectivity between different institutions.”
Telemedicine is another challenge he highlights to illustrate how digital technology can help bridge the medical gap by considerably reducing the distances between patients and practitioners.
Cameroonian machinist Emmanuel Assom Neyeng, CEO of healthtech OuiCare, also found access to a doctor online very useful.
“Even if we are aware that not everything can be treated remotely with digital technology, a doctor is able to determine whether a patient can be treated remotely and thus avoid him or her spending hours in the hospital before being seen,” he says. “The first positive point would be to reduce the flow in the waiting rooms but also allow everyone to have access to a doctor and thus limit self-medication.”
However, telemedicine goes far beyond teleconsultations, and among many other solutions, there’s teleradiology in a continent where there are only a few dozen radiologists in countries with millions of inhabitants. This is a real handicap according to several health personnel.
“When a radiologist is not on site in Africa, the patient can have access to the same specialist who connects from a foreign country to do image interpretation, for example,” says Zarzour. “An external opinion and images can be shared with these colleagues at a distance in a very fast, reliable and secure way. This makes it possible to compensate for a lack of radiologists.” It also preserves or betters the customer experience.
“In Morocco, for example, we have a project that allows us to equip first-level centres and dispensaries in rural areas connected via the Ministry of Health,” he says. “These solutions make it possible to follow the patient’s health path even when moving from one place to another.”
Digital technology, he added, is a very effective way to make reliable and accurate care available to patients. “The use of paper medical records should be reduced as much as possible because it constitutes a risk of loss of medical information and, therefore, a hindrance to the patient’s medical follow-up,” Zarzour says.
Aymard Djadchin understands this very well since he runs Universal Software, a startup in Cameroon providing IT services. In 2017, he launched Hospisoft, a digital solution that optimises the management of patient information in order to avoid medical treatment errors.
The special feature of his invention, he says, is the possibility of accessing medical records via a mobile phone and therefore transporting them from one point to another easily without the risk of misplacement.
But to implement more rational technologies to facilitate the adoption of better digital health in Africa, there are several prerequisites.
Focus on human skills
There is a need for consistent support from governments and various health stakeholders, according to Neyeng, whose startup has a platform that collects medical information through an electronic notebook and analyses it with artificial intelligence (AI).
“Digital solutions in e-health must be the result of a long reflection between all the actors in the field,” he says. “Since the natural beneficiary of health services is the patient, they shouldn’t experience inconveniences when going from one hospital to another.” Emphasising that the human element has to be central in the development of all solutions, the platform stores and facilitates access to medical information coupled with telemedicine.
“This will make the shortage of doctors less acute when we know that in a country like Cameroon, with more than 26 million inhabitants, there are two doctors for every 10,000 people,” he says.
Putting humans back at the centre of solutions, however, raises another crucial issue: the skills gap. To counter this challenge, according to Zarzour, it’s necessary to focus on the development of local skills.
“Africa is a territory full of potential,” he says. “We’re working on transferring the skills of the teams to hospitals so they can familiarise themselves with the medical environment, because health professions straddle functional expertise. They need to know how to decipher the demands of the medical profession. The skills exist and it’s up to manufacturers like us to make this expertise available via programs and partnerships. It’s the same for security experts. They have to rely on local expertise to develop this transfer of skills.”
Neyeng shares this opinion. For him, it’s already necessary to focus on supporting startups by implementing support programs and funding.
The young entrepreneur believes that the government can’t do everything and a single startup can’t cover the entire market. So policies will have to rely on numerous startups to foster digital change while allowing them to train doctors and health sector workers in digital tools while relying on the interoperability of all these startups.
“In addition, training programs for medical staff in the use of digital solutions will certainly be of great benefit to the population,” says Neyeng.
Digital health evolution in Africa goes hand in hand with reliable internet access, awareness campaigns on the merits of digitisation of medical data, the popularisation of connected medical devices, and training of health personnel, according to Leonel Ottou, independent CIO and CTO at ASTA Cameroon, a company specializing in ICT design.
“Technically, it will be necessary to focus on training in computer security, which is a very important part of the establishment of digital health ecosystems, and to encourage African computer scientists to take an interest in everything that concerns AI and big data, which are also very important tools in e-health,” Ottou says, adding that public authorities should think of popularising the construction of datacentres on African soil and facilitate access to young startup companies working in digital health so they can retain sovereignty over the medical information of Africans.