Story by Martina Schwikowski, Alex Ngarambe
With rising internet connectivity, African governments are turning to digital health services to handle a shortage of health workers — and to better connect rural communities. But not everyone is quick on the uptake.
Harriet Uwanziga is one of a several million Rwandans who have tried the services of digital health service provider Babyl, which supports a global patient network across 15 countries.
Only three years ago, Babyl partnered with the Rwandan government to build Africa’s first digital universal primary care service, which aims to make health care more widely accessible across the small East African country.
Babyl relies on the rapid spread of internet and phone services throughout Rwanda. Its services include health consultations, doctors’ appointments and more. Prescriptions, referrals and payment can all be arranged over SMS messages.
Patients can use SMS and messaging apps to communicate with their health care providers© ISAAC KASAMANI/AFP/Getty Images
But Uwanziga remains sceptical. “I don’t trust this digital system,” she told DW. “There might be a misdiagnosis, a patient may experience certain symptoms identical for different illnesses. It’s better to see a doctor for a comprehensive check-up.”
Babyl Rwanda is aware of the skepticism. But it tries to allay any doubts with an elaborate philosophy that it traces back 2,500 years to the ancient city of Babylon.
“Citizens needing medical advice often gathered in the town square to share thoughts on treatments for common illnesses,” the company points out on its website. “This is one of the earliest examples of democratizing healthcare.”
The idea is simple: A registered patient sends an SMS code to arrange an appointment. A doctor calls the patient’s cell phone at the arranged time. The patient’s local pharmacy or health care facility will dispense the prescribed medicine or conduct laboratory tests in line with further SMS codes sent via Babyl.
Patients can collect their medication at a local pharmacy after showing an SMS code© BARBARA DEBOUT/AFP/Getty Images
Calliope Simba is Babyl Rwanda’s medical director and described the company’s rocky road to success.
“It was not easy to penetrate the market because of low levels of literacy in digital health care services,” Simba told DW. “We have another milestone to reach in making sure that everyone in the country understands that doing consultations online is possible.”
Simba hopes that in the long run his services will help alleviate access to medical services and mitigate a number of problems caused by the sector’s many deficits.
“There is a shortage of human resources in health and we have a doctor-patient ratio of 1-to-80,000,” he said. Furthermore, many physicians or nurses would prefer to work in cities, he said. Digital consultations would therefore make it easier to access services in rural areas.
Prescriptions, referrals and payments can all be arranged through SMS messages© SolidarMed
Ensuring accessibility of health services remains a huge challenge for many African countries. According to the World Health Organization, Africa has an average of three doctors per 10,000 people — compared with Germany which has 84 doctors per 10,000 people.
In African countries, health centers are often far away, equipment is insufficient and services are expensive, according to the Global Perspectives Initiative (GPI), a German NGO that works to develop new approaches towards fulfilling the Sustainable Development Goals.
Health insurance is rare in Africa where many people have to pay for medical services themselves. In this context, digital services help to further reduce costs, such as traveling long distances to visit doctors.
Smartphones and mobile devices have long been a part of daily life across Africa© Blend Images/Hello Lovely/picture alliance
Hannah Hölscher, project manager for global health at GPI, spoke to DW about how digital technology helps develop health services on the continent.
“Life Bank in Nigeria offers a 24/7 service that delivers blood and oxygen straight to your door,” she said. “In Kenya, Suri Health runs a virtual hospital that allows for doctors’ appointments.”
“Africa has a young population, many of these young people are well-educated and well-acquainted with digital technologies,” Hölscher said.” Forty-one countries have laid out digital health strategies. There is no such thing in European countries.”
However, financing of such programs was still a hurdle, she added, calling for more investment in the sector.
Michael Hobbins from Swiss NGO SolidarMed also highlighted Africa’s innovative potential. In the health sector, however, he sees enormous variation between countries and regions.
“You will find hospitals where there is no computer or internet connection and documentation is kept in large, hand-written books,” Hobbins told DW.
“At times, papers holding data are transported several kilometers for digitization.” Other, mainly private hospitals in big cities, had switched to digital-only, he pointed out.
Hobbins called for investment in infrastructure and education, pointing out the danger of relying on digital services in areas with digital illiterates. In such areas, he said, patients would still depend on face-to-face contact.
Hobbins also pointed to a number of legal issues still to be clarified: Who holds the right to patients’ data, who can access them, how are they safeguarded?
“Digitalization is important in developing health services, but it is not key,” Hobbins said.
This article was originally written in German
Author: Martina Schwikowski, Alex Ngarambe