Improving access and sustainability of digital health solutions in Africa

• Startup companies are seeking to use digital solutions to bridge the healthcare access gap in Africa
• Scalable digital solutions focused on specific problems look set to advance healthcare delivery across the continent
• Designers must listen to the needs of local stakeholders and work within the limits of available infrastructure

Africa has already shown it can use digital technology to “leapfrog” in areas such as digital banking and telecommunications. Now, startup companies from across the globe are looking to surf the leapfrog wave in the healthcare sector. Such innovations will play a critical role when it comes to the next steps of economic growth in Africa: to create and retain wealth, diversify its economies and manage resources. 

Despite the buzz around increased access to the internet, millions of people are still without it. Innovations will need to ensure they do not perpetuate the digital divide. Companies will need to navigate important challenges, such as lack of infrastructure, limited access to electricity, and patchy internet connections, but by engaging closely with local stakeholders, there’s a tremendous opportunity to develop and deliver solutions that will take healthcare in Africa to the next level.

We sat down with Enya Seguin – who previously co-founded YAPILI¹, an app that connects people to doctors around the world – to find out why simplicity will be the key to bridging the gaps that exist in healthcare in Africa. She is currently managing BabyChecker at Delft Imaging: a smartphone-based ultrasound that uses Artificial Intelligence to identify risky pregnancies in low-resource settings.²

HT: Tell us a bit about your experience in digital health solutions as well as your time in Africa and how your experiences led you to take an interest in this area.

Enya Seguin:  My experience in digital health started with a focus on underserved communities where there were many opportunities to bridge knowledge gaps through digital platforms.

My first ever experience was with asylum seekers at the Swiss Red Cross. Then, when I was studying political science, I focused on the governance of digital health solutions and how they scale or don’t scale in Sub-Saharan Africa. I took a deep dive into what digital health tools exist, the main actors, and what their biggest challenges were in terms of going from pilots to scalable and sustainable solutions.

That’s when I discovered we have a long way to go in applying digital innovation in the healthcare sector compared to other sectors. The solutions under the umbrella of telemedicine seemed to lack local resource planning, sociocultural and economic understanding of how communities function. Hence, they lacked local adoption.

Our startup, YAPILI, pioneered the concept of connecting doctors from abroad to health-seekers across Africa. As such, doctors from the Nigerian diaspora can be connected to health providers or patients in Nigeria seeking health advice.

A key takeaway from my experience is that simplicity is underrated. We often think that complex and sophisticated approaches are required to generate the best outcomes, but something as simple as using SMS can be highly effective. There have been many remarkable projects using SMS for drug supply management and remote patient monitoring. The complexity will be integrating that solution into local systems, such as a payment scheme, measuring impact, and scaling the solution. I have learned that the only way to address complex challenges is to gain contextual and local knowledge. Innovators need to understand the problem and understand how to leverage local resources. Working with local stakeholders is a necessity.

HT: How do you see the role of digital health solutions influencing access to healthcare in the next five to ten years, for example?

Enya Seguin: In every domain of health access, there’s a space for digitization. From prevention to diagnosis to point of care screening, to treatment, to adherence, to follow-up. Throughout the patient experience, there’s space for digitization.

In the next five to ten years, we will see a lot more solutions driven by AI. This should be embraced especially now that we’re seeing more studies showing the cost efficiency of AI. For example, at Delft Imaging³, we have a study that shows that AI for tuberculosis detection can cut the cost of your tuberculosis program by half. I believe AI will be instrumental when it comes to resource efficiency and health systems strengthening.  From AI chatbots, and remote patient monitoring, to drug supply management and disease detection, when it comes to addressing the shortage of doctors in sub-Saharan Africa, AI will support the processes of triage and task-sharing and shifting. This may mean moving some tasks currently taken up by clinicians, to other healthcare workers, such as nurses and midwives.⁴

AI will be embraced and rolled out by innovators. The challenge will be whether, when, and how healthcare ecosystems, including policies and infrastructure, will be prepared and whether they will be willing to embrace a digitized future for healthcare.

HT: Do you see the digital infrastructure in Africa as an enabler or challenge to the adoption of digital technologies in healthcare solutions in Africa?

Enya Seguin:  When you introduce a digital health tool, let’s say in Switzerland, there are existing infrastructures that are interconnected and institutions to govern the access, delivery, and provision of healthcare. For example, a telehealth app will seek to obtain coverage from insurance providers. In Switzerland, there will be systems and infrastructures for cybersecurity, national registries for doctors and hospitals, and electronic medical records. E-prescriptions are probably coming soon. Those systems, infrastructures, and their interoperability are absent or under-construction in many countries in Africa. This makes it challenging when implementing digital health as a “solution” rather than siloed devices or apps. “Solutions” infer some sort of integration into local systems, whether that is a hospital’s digital information system or insurance payment scheme. When there is no integration, what we get are siloed devices.

However, I also believe that digital health will simply follow a different path in Africa. There is a lot of fast-paced development which could cause the continent to skip or “leapfrog” some conventional healthcare infrastructures and traditional approaches to healthcare delivery, and move directly to more advanced technologies.⁵  For example, in Europe, we went from the fax machine to the landline, to mobile phones, to Apple Watches. Whereas in Africa, telecommunication skipped straight to smartphones. In creating digital health solutions, we need to harness the power of mobile penetration. The adoption of smartphones and connectivity in Africa will drive digitization. At the same time, it is crucial to address the digital gap that is arising.

HT: What are some novel, sustainable business models for digital health that are emerging in Africa and their benefits to the community and economy?

Enya Seguin:  A lot of the booming impactful tech innovations here are also driving innovations in business modeling. It is clear that in many cases replicating business models from other countries or regions won’t work here. The well-known software-as-a-service and subscription models have been applied to goods and services like medical imaging devices and restaurants’ supply purchasing systems.  

With BabyChecker, the possibility for midwives to become micro-entrepreneurs is an exciting prospect. Midwives could scan pregnant women during antenatal care check-ups at their home and charge for that service. Health workers in Africa are severely underpaid. It’s clear that unless considerable changes are made, we can’t solely rely on the current government institutions to allocate the right amounts to pay our health workers. They are a structural pillar of the healthcare ecosystem and communities! 

HT: What advice would you give to healthcare companies wanting to enter the digital health space in Africa to ensure their local adoption?

Enya Seguin:  When it comes to entering the digital space in healthcare in Africa and ensuring the local adoption of digital solutions, companies should:

1. Keep it local. You need local partners to successfully integrate into the local system. Many pilots that lack scalability tend to fall victim to “pilotitis”, which is a term used a lot out here to describe this observed disease-like misfortune. Projects with incredible potential don’t make it because they run out of funding or because they didn’t involve the local stakeholders early enough or offer adequate training to the local health community.
2. Take time to understand the problem. Making sure that your solution is tackling a specific problem is paramount. How is this problem defined and currently addressed locally? Grasping this will have a trickle-down effect on how you manage your resources, form collaborations, and deployment strategy. You need to have local and contextual knowledge and involve local stakeholders, even patients, to create solutions that are fit for purpose and satisfy a local need.
3. Focus on long-term sustainability. It takes a lot of resources locally to run pilots, especially when innovators come from abroad and then have to discontinue the project. Devices need to be maintained, users or community health workers need to be compensated and trained, and a strategy needs to be built for sustained continuity. Without this, we see graveyards of medical devices at facilities. Some are donated, but if there’s no training or maintenance, the devices become redundant.