The use of digital health in primary health care in Sub-Saharan Africa has clear potential but challenges.
Imperial College London’s Institute of Global Health Innovation (IGHI) has launched a new report, titled “Digital health in primary health care: Current use and future opportunities in the Sub-Saharan African region”, exploring where digital technologies are being widely used across Sub-Saharan Africa to deliver health services and address long-standing health system challenges. The report, produced in collaboration with Imperial’s Global Digital Health Unit and the African Forum for Primary Health Care (AfroPHC), and launched on 23 May, features key case examples from experts across the region to frame future opportunities, challenges and threats that must be addressed.
Main takeaways
One key finding is the positive impact of mobile health (mHealth) solutions in expanding healthcare access. With the widespread availability of mobile phones in the region, mHealth applications have gained popularity as a means of delivering healthcare services, health information, and supporting remote consultations by connecting patients with healthcare workers. The development and use of mHealth applications has been driven by infrastructure advancements, including the expansion of internet access, with 81% of the sub-Saharan African population living in an area covered by a mobile broadband network in 2020, rising from 53% five years earlier.
Telemedicine use has increased across Sub-Saharan Africa, particularly in response to the COVID-19 pandemic, with current uses covering screening and diagnostics, treatment, long-term management and follow-up. The general consensus of experts interviewed for the report was that telemedicine would continue to be used in primary care, but pointed towards a new trend of hybrid medicine, where patients could use a combination of telemedicine and face-to-face consultations.
Electronic health records (EHRs) are another important and growing technology in improving healthcare quality in Sub-Saharan Africa; by digitising patient data, healthcare providers can enhance care continuity, reduce medical errors, and facilitate efficient healthcare decision-making. EHR systems also enable seamless communication and information exchange between different healthcare facilities, promoting a more integrated and patient-centred approach to healthcare. However, widespread application in Sub-Saharan Africa remains limited.
Niki O’Brien, lead author and Policy Fellow at the Institute of Global Health Innovation said, “The newly launched report outlines the incredible breadth of digital technology use in health care across Africa. By engaging with a range of individuals and organisations driving this work, the report synthesises some of the key challenges and opportunities to enable further scale up and successful implementation that will maximise benefits to patients, providers and health systems in the future. We are so grateful to the contributors who worked with us and intend to continue to work collaboratively in this space to develop further insights and actions.”
Challenges to consider
There are, of course, remaining challenges in the implementation of digital technologies as part of health service delivery. The report highlights the numerous obstacles in providing equitable access to quality healthcare services, including a shortage of healthcare professionals, limited infrastructure and geographic barriers. Patients can benefit significantly from digitally-enabled healthcare; yet ensuring patient buy-in and widespread support for digital health is a challenge, particularly regarding disparities in patients’ socioeconomic status and literacy rates across Sub-Saharan Africa. The use of digital technologies in primary health care must ensure equitable access to care is available for all population groups.
There is also a lack of resources dedicated to supporting the transformation of services, further hindering progress. Financial challenges also pose a barrier, the costs of implementing and operating digital systems are high, and funding for these projects is often unsustainable and short-term. Many institutions work with what is available, which is often out-of-date technologies and legacy systems, leading to challenges in quality of care and data security.
Next steps to embrace the potential of digital health
However, the rapid advancements in digital health present a unique opportunity to bridge these gaps and transform healthcare delivery across the region. The report proposed recommendations to key stakeholder groups to develop programmes and innovations that maximise the benefits of digital health for their citizens. These include:
Government leaders and policymakers
- Ensure basic infrastructure is in place to support digital health innovation in primary healthcare
- Establish minimum regulations, including standards for data protection, digital innovation, and evaluation
Health providers
- Develop a digital health strategy for the sustainable use of technologies by healthcare workers over time
Non-governmental organisations
- Seek meaningful, collaborative partnerships with local stakeholders to maximise programme impact
- Explore long-term and sustainable funding models for digital-focused primary healthcare programmes and innovations
Digitally-enabled primary care has a huge potential to drive improvement, across service delivery, the health workforce, health information systems, and access to care, drugs, and supplies – if developed and implemented strategically and equitably. Early innovators have set the course for technologies to benefit patients, providers, and health systems, which must now be developed at scale.
Dr Nana Kwame Ayisi Boateng, Senior Lecturer, Department of Medicine, Kwame Nkrumah University of Science and Technology and co-author of the report, said, “Primary healthcare in sub-Saharan Africa is bedevilled with a myriad of problems which require digital health innovation to fix. Our report has revealed giant steps made in digital health technology in the past few years around electronic medical records systems, use of mobile phones by community health volunteers to report diseases, e-pharmacy platforms and use of drones to transport essential drugs, vaccines, blood products and COVID-19 samples.
In spite of challenges with their implementation, we should not relent in ensuring their sustainability by investing more resources, continuous advocacy for leadership commitment and undertaking research and training to produce more future innovations”.
Professor the Lord Ara Darzi, Co-Director of the Institute of Global Health Innovation, said: “Our report demonstrates how digital innovation has the potential to bridge gaps in healthcare access, empower patients and healthcare workers, and strengthen healthcare systems across Sub-Saharan Africa, and stakeholders must work collaboratively, alongside patients, families, caregivers, and communities, to sustainably achieve this.”
Overall, digital technology can be a powerful tool to support primary health care delivery, enabling services to reach remote or previously marginalised populations, reducing costs for patients, providers, and payers, and improving the quality and safety of services. There is a clear opportunity for countries within Sub-Saharan Africa, and other low- and middle-income countries, to consider the future of digital primary health care to drive innovation and impact.
