Health and Healthcare Systems

It's time for a great reset of Africa's e-health systems. Here’s how

A soccer fan uses his mobile phone for betting during a television broadcast at a soccer theatre called the San Siro Stadium as the English Premier League season resumes after a three-month stoppage due to the coronavirus disease (COVID-19) spread, in Kibera district of Nairobi, Kenya June 17, 2020.

Mobile technology and broadband can unlock e-health services across the African continent Image: REUTERS/Thomas Mukoya

Cornelius Kalenzi
Postdoctoral Researcher, KAIST-Korea Policy Center for the Fourth Industrial Revolution
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Healthcare Delivery

  • COVID-19 has highlighted the often parlous state of Africa's healthcare infrastructure.
  • It is time to reset and reform healthcare systems across the continent, using mobile technology and broadband as the building blocks.
  • Here are four areas where politicians and policy-makers can start to unlock e-health in Africa.

As COVID-19 rages on, it gives Africa multiple reasons to turn to mobile innovations in order to leapfrog the continent's e-health services. Externally, the overwhelming of healthcare systems in G7 countries suggests a catastrophe is simmering in Africa, while the resurgence of the pandemic across the world suggests that we are in for a long fight. Lastly, COVID-19 is proving to be a ‘mother of inventions’ for healthcare, and Africa should not be left behind.

Across Africa, the pandemic has awakened everyone to the continent's sad state of healthcare infrastructure which, having been underfunded for a long time, is unprepared for COVID-19. In the majority of its countries, there is one hospital per 1 million people, one doctor per 10,000, and one hospital bed for 10,000, according to the World Health Organization (WHO).

The percentage of people with universal healthcare coverage in Africa, by country
The percentage of people with universal healthcare coverage in Africa, by country Image: Authors' compilation based on WHO data

The message to our leaders is simple. This is a time to revamp our healthcare delivery systems – to enable equitable and high-quality delivery of healthcare to households to combat the pandemic, and to reinvent healthcare systems for the post-pandemic era. We can achieve this by complementing old systems with new digital innovations.

Thankfully, some building blocks are in place. For example, Africa is home to the fastest-growing mobile ecosystems, as over 70% of the continent has mobile coverage with 3G connections and 30% with 4G networks. Additionally, Facebook and Google are installing high-speed broadband networks within and across the continent. This communication infrastructure, coupled with growing healthcare innovations including home testing and AI chatbots that enable self-diagnosis, AI-powered call centres, disease surveillance, contact tracing, and telemedicine applications that revolutionize healthcare delivery – beyond COVID-19 – are all within reach of every country on the continent.

Nearly 80% of Africans have at least 3G coverage
Nearly 80% of Africans have at least 3G coverage Image: Authors’ compilation based on ITU data

Some countries are already using mobile innovations in their healthcare delivery. For example, through Babyl, Rwanda has enabled access for over 2 million citizens to healthcare through Telehealth. Related innovations are mushrooming on the continent – for example, Medical Concierge and Mobihealth in Uganda and Nigeria, respectively. However, the growing number of innovations masks the widespread inequality within access to quality healthcare services across the continent. Therefore, more efforts are required to unlock digital health innovations for all in Africa. Below, we highlight four areas that governments and stakeholders can explore to unlock e-health in the continent.

1. Unlock e-health and digital platforms

With a rising middle class and improving broadband coverage, cities across the continent are ready for quality healthcare systems powered by digital innovations. It is, therefore, the responsibility of both public and private players to seize this moment to reset the continent's healthcare system. Some starting points include encouraging market-driven innovations, such as scaling the WHO's healthcare start-up challenge across the continent, actively promoting digital innovations, and agile policy-making for people-centred healthcare. Many countries, including the United States, the United Kingdom, Germany and Korea, among others, are also moving in this direction. Africa can also ride this tide to unlock healthcare 4.0 on the continent. However, what about the majority of rural Africans? From the data, we learn that network coverage is available, but people are not using it. Therefore, market-creating interventions, including reducing the cost of connectivity, smartphone subsidy programmes, rural education programmes and suitable applications will enable the design of healthcare delivery systems for all.

Cheaper mobile data means better access to universal healthcare
Cheaper mobile data means better access to universal healthcare Image: Authors' compilation based on WHO data

2. Unlock the insurance market through mobile innovations and micro-insurance

How an average patient can sustainably pay for healthcare is a question that has been dodged by the continent for decades. The majority of patients are still paying-out-of-pocket, with precarious effects on their income and wellbeing. As countries move towards universal health coverage (UHC), it is critical to ask what will work or fail in Africa. Many models of community-based insurance schemes (CBHI) have been attempted with dismal results, but recent success stories in Rwanda and Ethiopia suggest ways to negotiate to this challenge. In Rwanda, more than 80% of the population has insurance coverage, while in Ethiopia, the model has been successfully adopted in 512 districts. Through benchmarking these success stories, other countries may be able to identify why they failed to scale similar models in the past. In addition, the modernization of CBHIs through digital innovations will increase efficiency and convenience, and will drive adoption, especially in countries where service users have to walk long distances to pay their premiums in traditional banks. Similarly, market-driven micro-insurance schemes such as M-TIBA in Kenya, Tanzania and Nigeria, and other similar models in South Africa, are promising to provide access to insurance for Africa's informal workforce. Governments, the private sector and other stakeholders need to work together to scale these proven models as channels for sustainable health coverage that works for all.

3. Providing identification to unlock the use of healthcare data

An ID is central to unlocking data in healthcare, from routine visits to a hospital to patient records management, insurance, benefits disbursement, and data collection for policy development – it is a must-have. However, only 40% of Africans have access to an ID, and when they have it, the system is fragmented and not interoperable with other services. There is an urgent need for political prioritization to accelerate foundational ID projects, support interoperable IT infrastructure, and appropriate privacy frameworks, if Africa is going to make headway in unlocking digital innovations in healthcare.

4. National informatization and training

Unlocking successful e-health in Africa is dependent on ICT literacy campaigns to drive the adoption of innovations by healthcare workers and citizens. Africa's young population, which is quick to learn and adopt technologies, offers a natural advantage, but governments have to step in and proactively provide targeted education programmes to all its citizens. Examples from Rwanda, Estonia and the Korea National Informatization initiatives provide solid case studies of how to achieve this.


What is the World Economic Forum on Africa?

In conclusion, the pandemic provides ample opportunities for a great reset of Africa’s healthcare through digital innovations. This requires political commitments and concerted efforts by governments, the private sector, and international stakeholders to translate shared visions of digitizing Africa’s healthcare to actions.

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