Can technology help transform healthcare in developing countries?
The Health and Quality Index (HAQ) ranks the Nigerian Health system 187th out of 195 member states. The HAQ measures the quality and accessibility of healthcare based on 32 causes, which are preventable with effective medical care. This defines a healthcare system that is struggling to meet the needs of Nigerians. Those that can afford to travel vote with their feet and spend over $1 billion on medical tourism every year. According to Molly Fosco's writing on ozy.com, “approximately 20,000 Nigerian medical doctors are currently working outside the country. A survey by NOIPolls found that about eight out of 10 doctors who remained in Nigeria were looking for jobs overseas, with the U.S. and U.K. as leading destinations.” The Nigerian economy is predicted to contract by 3.2% in 2020 with significant implications on the healthcare spend.
We have to reimagine healthcare in developing countries to make real gains with our limited budget.
The Canadian ice hockey player Wayne Gretsky quipped once that “I skate to where the puck is going to be, not where it has been” to explain his domination of the Canadian ice hockey league between 1979 to 1999. Can we do the same with healthcare provision in Nigeria, applying technology to create a healthcare system that will meet the demands of the country?
Let’s look at some examples of how this might work. Sherpaa is an on-demand doctors’ practice without brick-and-mortar clinics and is designed as a primary care system in the cloud. Sherpaa’s mission is to constantly streamline the doctor’s time to make healthcare as affordable as possible. Primary care activities are about 80% of healthcare engagements and any strategy that effectively drives down the costs of primary care will potentially have significant utility in developing countries.
Indeed, Telemedicine is already in use in Nigeria and increased adoption was facilitated by the lockdown enforced by the COVID-19 pandemic because people were concerned with the risk of infection at health facilities. We need to look at the solution beyond video consultations and integrate the technology to make the customer journey more patient-centric and bring healthcare to the patient. This is what Sherpaa has been able to do and solutions like this will play a significant role in the acceleration of primary care access across the country. Technology will not only improve access to the healthcare system but patients may also receive better care because follow-up will be easier, especially for people with chronic conditions.
The drawback for the application of telemedicine in developing countries is the cost of technology and the availability and cost of internet access. There are also issues with user adoption, as the very important emotional component of the patient–doctor relationship will be difficult to reproduce. Furthermore, there is still a lot of work to do to surmount the challenges of examination of the patient, although linking digital camera technology and internet-enabled wearable devices to monitor heart rate and blood pressure hold promise for the future. There is also a lot of discussion about data security and the need to encrypt information. Blockchain technology is a distributed, decentralised public ledger. The digital information (the “block”) is stored in a public database (the “chain”) and holds promise as a secure repository of medical information for the future.
A significant contribution to healthcare costs are back-office administrative functions such as invoicing, payment management, procurement, contact and facility management; most of these can be managed with technology. The cost of implementing an enterprise resource management system may be prohibitive for an individual clinic and we need to look into ways of developing shared services platforms where multiple facilities can be linked to the same platform.
There are many technological innovations that hold promise for the future and some of them will find application in the transformation of health systems in developing countries. Internet-enabled wearable devices such as an Apple watch or Fitbit already allow the monitoring of health data for risk assessment for health insurance premiums. The healthier you are, the less your requirements for hospital care and the lower your premiums. These predictive analytics could be extended beyond insurance to the prediction of ill health and the implementation of preventative measures.
Big data analytics is the use of computer analysis to sort through large data sets to reveal patterns, trends and associations. This has found application in disease surveillance. For example, the Nigeria Centre for Disease Control (NCDC) has commenced the use of digital tools to track the spread of disease in the country. The agency is making use of SORMAS, a digital surveillance device that facilitates real-time reporting of cases of epidemic-prone diseases such as COVID-19 by health workers across the country.
Big data and artificial intelligence (AI) will play an increasing role in the analysis of relationships between prevention or treatment techniques and patient outcome as well as the management of the back office to improve resource utilization and optimisation of staff levels. Robots using AI are playing an increasing role with remote patient monitoring such as patients with contagious infections such as COVID-19.
The Da Vinci and other robotic surgical systems allow surgeons to perform delicate and complex operations through a few small incisions with robotic-assisted surgery. The first telesurgery operation where the surgeon and the patient were geographically separate was carried out in 2001 and the procedure has received significant refinement and improvement since then. This will find significant application in developing countries at a conceptual level but practical issues such as the cost of the applications will need to be managed.
The ideal of universal healthcare is far from being realised in Nigeria. More than 60% of healthcare purchases are made out of pocket and the people in most need for insurance cover and protection from the risk of catastrophic financial hazards are the least covered. Innovative solutions linking mobile phone recharge card activity to a payout to support hospital bills and life insurance is recruiting a large group of the previously unserved to the insurance risk pool and millions of people are now receiving an opportunity to pay for health expenses in countries such as Uganda, Ghana and Zambia. This is an important step in making the dream of universal health coverage a reality.
There are many technological innovations defining the future of healthcare such as the study of the gut bacteria (Microbiome) and using that information to predict health and how the patient will respond to different pharmaceutical agents. Synthetic biology and 3D printing hold promise for organ replacement in the future. Virtual reality is being used for desensitisation therapy with graded exposure to the offending stimuli in a virtual and controlled setting for the treatment of phobia. Immuno-oncology, where the body’s immune system is programmed to fight cancer cells, gene therapy where deficient or absent genes are replaced to restore organ function and nanotechnology which is the manipulation of matter at an atomic and molecular level which can be used to deliver drugs to cancer cells by coating the blood cells with the drug and sparing other cells of the side effects, all hold promise for the future.
I am optimistic about the potential technology holds to help developing countries leapfrog into accessible, high-quality, and affordable healthcare for all. This will not happen overnight, we need to build a healthcare system that will meet the needs of the people. We need hospitals, clinics, qualified doctors and nurses, universal health coverage as well as enabling government policies and regulation, — and only then will technology enable us to enhance and scale our healthcare offerings. In addition, for technology to reach its transformative potential, we need the manpower that can support this strategy to help us shape the way forward. Technological enabling is where the “puck” is going in the trajectory of healthcare development in the developed world and we need to approach the desired improvements in our health system with this in mind. We need to tackle these challenges head-on.
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