When it comes to the influence of technology in health care on the African continent, seemingly small victories can lead to vast improvements.
The problem, said participants on a panel entitled “Can Technology Enable Health Care for All?”at the recent Wharton Africa Business Forum, is that African nations often lack the ability, or home-grown advocates with both passion and resources, to cash in on those advances.
“What we need are more smart rich people who are passionate about health care in Africa,”said Dr. Felix Olale, CEO of Excelsior Ventures, which invests in the health sector in Africa, with headquarters in Nairobi and New York.
“What Bill Clinton and Bill Gates have done, what USAID and George Bush’s programs did, what the U.K. government has contributed, those have had massive impact,”Olale noted. “But it comes down to smart people with a little bit of money and passion. We don’t have enough of those people —African people and those in government —among Africans themselves.”
There have been some successes, mostly where government officials have made health care a priority. Ladi Awosika, CEO of Total Health Trust, based in Nigeria, said that in his home country, only five million of 170 million citizens have even a modicum of health care insurance. In nearby Ghana, however, 68% of residents have such coverage.
“What we need are more smart rich people who are passionate about health care in Africa.” –Felix Olale
“We have a lot of smart people hanging around there, but there is no passion,”said Awosika. “We’ve gone from two or three private jets to 200 private jets in a few years, but no passion for health care. If [well-off people] get sick, they fly off to Sweden, or wherever, to get their operation. But they don’t bring to Africa what it needs, which may not cost all that much.”
Change will not come, Awosika added, “until the richest guy in Nigeria gets in a car crash and doesn’t get the attention he needs at the scene, like he would in America. Your six-hour flight to Sweden isn’t going to make any difference then, and maybe people will notice.”
Improving a Desperate Situation
Awosika noted that recent developments in technology could vastly improve what might seem like a desperate situation on the surface.
Complications from maternity-related afflictions kill the equivalent of crashing three full 747 jets every day, he noted, adding that one state governor got the idea of giving expectant mothers cell phones so they could call experienced midwives and other health professionals when they had a health issue, and also receive calls to remind them to take their medicines or get their check-ups.
In this case as in others, “you can see a simple technology innovation being applied to address a specific problem,”said Awosika. “Something so small can be so important.”
Anna Thompson-Quaye, deputy director of innovative finance and private sector partnerships at the GAVI Alliance, which concentrates on vaccinations and related services, said similar small innovations in technology are aiding her African initiatives.
“We often deal in individual vials and need to find storage for them, which creates incredible wastage,”noted Thompson-Quaye, adding that simple technology like a machine that can monitor the temperature of the vials or barcoding machines that track the transport and storage of the vaccines have significantly advanced GAVI’s programs.
“We have experimented with vials that have their own syringe attached,”she said. “It is small technology, but that, for us, is exciting technology.”
The Impact of Ebola
Olale said that he saw a certain irony when he appeared on CNBC’s African channel and a headline came up reading, “Ebola Unlocks Investment Opportunities in Africa.”It has been true, at least in part, he said.
“The panic is unwarranted, but Ebola is a big deal,”said Olale. Kenya Airways, which is headquartered in his home city of Nairobi, flies to more African destinations than any other airline. The carrier started using its technology to lay the groundwork for protocols to limit the spread of the disease and also for treatment. The health ministry got involved and provided clinics with the funds to buy the technology they needed. “So Ebola is actually more feared in New York than Nairobi.”
“You can see a simple technology innovation being applied to address a specific problem. Something so small can be so important.” –Ladi Awosika
Awosika said Nigeria was well-prepared for the outbreak, since urban clinics in Lagos and other major cities have long been prepared for infectious disease treatment.
“The problems in Sierra Leone and Guinea and Liberia are, first, that they are underfunded and, second, that their outbreaks took place in rural areas, where the situation was even worse. Nigerian officials apparently fear death so much they are willing to at least fund these clinics.”
Awosika added that there has also been a vast deployment of people and technology to dispel fears surrounding the disease. For instance, many Nigerian tribes hunt and eat wild game. Rumors spread that Ebola festered in wild game.
“The reality is that no matter what, Ebola is spread by fluids, so the word went out that if you are bringing your game to market, make certain it is dried,”said Awosika. “It wasn’t just, ‘don’t eat game meat.’You can’t leave out any segment of society when you treat a disease. You don’t want rumors to overtake reality.”
A Cell Phone Revolution
A growing amount of information about Ebola is being spread through social media, which has picked up in Africa due to the rapid increase in cell phone use. Still, a lack of information, the panelists said, echoing what is even true in the most sophisticated segments of world society, is perhaps the worst problem in health care.
“There has been a strong social mobilization to use cell phones, television and whatever technology the government and private health care sector can to disseminate public health messages,”said Awosika. “All over Nigeria, every institution you go to, you get a temperature check and are asked to wash your hands. All over social media you see things about hand sanitization. Modern technology is vital here, and it can be this simple.”
“The panic is unwarranted, but Ebola is a big deal.” –Felix Olale
The cell phone revolution has helped maternal care, too, noted Thompson-Quaye. In several of the areas in which she works, GAVI has made the connection between taxi drivers and maternity patients, using cell technology to get the expectant mothers quickly to clinics and gaining new fares for the drivers at the same time.
“This is how we have to use technology,”she said. “From our perspective, we have to think about private projects and address real challenges. Then we can move that pilot project into something that is scalable.”
East Africa is currently “obsessed” with medical mobile applications, said Olale, who has been told that Uganda has 3,400 medical apps alone, more than any developing country save for India. Two or three years ago, the major health care impediment in East Africa seemed to be diagnostic errors, which even in national hospitals occurred in 36% of cases.
“First, the fact was that the technological equipment was not there. Second, the people weren’t property trained in using it. Third, there were no proper guidelines for using the technology,”said Olale. Fortunately, government wanted to do something about the problem, so it started working with multinational companies like GE and Phillips. Health care providers gained access to more sophisticated diagnostic instruments, so even simple errors are now being corrected, he added.
The Cooperation Factor
The panelists said that government cooperation is the key to large-scale improvements.
“In the private sector in health care, 80% of the technology is funded through grants, and you never know whether that will be sustainable,”said Olale. “We have gotten used to thinking the answer is to have a whole bunch of rich foreigners who have passion for health care. I don’t want to demean the progress that, say, Melinda Gates and the Gates Foundation have made, but we need to get governments to know that technology is available and that connecting it to funding will make health care more available to everyone.”
Awosika said that a little more than a decade ago, government policies were moving in that direction, but then the September 11, 2001, terrorist attacks shifted funding to bio-terrorism rather than basic health care, at least in technology. The response to Ebola is an outgrowth of that, but there are still 150,000 deaths a year at least from malaria, not to mention other easily treated diseases, Awosika added.
“Politicians deal in concrete things. They can see a hospital when it is built,”said Awosika. “They have to understand that ‘health is wealth,’and that even small investments in technology will make a big, long-term difference in Africa.”