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.
But Uwanziga remains skeptical. “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 checkup.”
The idea behind Babyl
Babyl Rwanda is aware of the skepticism. But it has tried 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 democratising healthcare.”
The idea is simple: A registered patient sends an SMS code to arrange an appointment, and a doctor calls the patient’s mobile 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.
‘Not easy to penetrate the market’
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 improve 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.
Digital services help to reduce health costs
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, a German NGO that works to develop new approaches toward fulfilling the UN’s 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.
Africa leading the way in digital health strategies
Hannah Hölscher, project manager for global health at the Global Perspectives Initiative, spoke with DW about how digital technology has helped to develop health services on the continent.
“LifeBank 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 for such programs is still a hurdle, she added, calling for more investment in the sector.
Infrastructure, education key to expanding health services
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, handwritten 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,” he said.
This article was originally written in German