The Rise of New Technology in Reshaping Africa’s Healthcare System — Where do Pharmacists Come In?
By: Ètashè Okpola
Rwanda is a landlocked country in East-Central Africa. Dominated by highlands and mountainous geography, the country is densely populated with 12.5 million residents on 26,338 km2 of land (CIA, n.d. & World Bank, n.d.).
One evening, on April 6 1994, a jet approached the Kigali International Airport. It was occupied by three French crew and nine passengers, including Rwandan president Juvénal Habyarimana and Burundian president Cyprien Ntaryamira (BBC, 2019). A few moments into its landing, the Dassault Falcon crashed into the garden of the presidential palace and burst into flames on impact. Its wing and tail had been hit by a surface-to-air missile. The crash claimed the lives of all twelve occupants and served as a motive for the massacre of 800,000 people in the Rwanda genocide. As a result, Rwanda suffered an impoverished economy, with a major hit on its service and housing sectors, as well as a prevalent rise in malaria cases within the nation (Suveshnee et al., 2010).
By 2000, a new vision had been designed to reshape this economic decline. And by 2014, the mutuelles de santé, a system of health insurance providers, provided coverage for up to 90% of the population (Twahirwa, 2008). This system, alongside the strengthening of the Kigali Health Institute (KHI) and the President’s Malaria Initiative of 2005, has improved a number of key health indicators. By 2013, Rwanda recorded impressive economic growth, with the GDP tripling to $580 per person (Emery, 2013). The upward turn was a direct outcome of decreased death rates from manageable diseases — the percentage of deaths resulting from HIV, TB, and malaria had plummeted by about 80 percent, and both the maternal mortality ratio and the number of annual child deaths declined by 60 and 63 percent respectively (Emery, 2013).
This was greatly influenced by the Vision 2020 Plan that was aimed at the economic development of Rwanda into a middle-income country (Uwizeyimana, 2019). Today, Rwanda is veneered for having established the world’s first health drone-delivery system. This victory, however, cannot be attributed to a majority of low-income African countries.
The World Health Organisation (WHO) reports that populations in low-income countries generally have less access to essential health services. It shows life expectancy at birth to be 18.1 years lower in these climes than in high-income countries, with one-in-41 women dying from maternal causes. It also reveals data on the greater shortages of healthcare professionals within these regions. Of the ten countries with the poorest healthcare in the world, Africa bears the highest number of eight, with Sierra Leone and Nigeria as the 3rd and 5th countries on the list respectively (WHO, 2019).
There are two core thematic factors that influence quality healthcare, namely access and availability. A large number of residents within low-income countries reside in rural areas that are riddled by bad roads and minimal to no access to quality healthcare. In the last decade, sub-Saharan Africa has witnessed a massive exodus of health care professionals to countries equipped with the necessary tools and finance for providing better healthcare services to its population. This is largely fueled by de-motivation of migrating health care professionals within economies dominated by fractured healthcare systems that exist below the required standards (Ogilvie et al., 2007).
This brain drain of health professionals in low-income African countries, coupled with the persistent strikes that occur as a result of poor remuneration and lack of basic infrastructure, has seen higher death rates from avoidable health cases and threatened the effective response of health systems in times of global health crisis. This threat calls for a balance between the social needs of health professionals and the provision of quality health care services. Its cure requires a redirection in an economy’s health systems structure and health-fund allocation.
In 2016, the Rwanda government collaborated with Zipline, a product delivery company that develops and operates drone aircraft, to provide drone delivery services for its healthcare sector. Like many African nations, Rwanda’s healthcare system lacked the capacity for storing and maintaining vital cold-chain products such as platelets, antivenin, oxytocin, and blood products (World Economic Forum, 2018). Another notable obstacle is its mountainous topography, which affects the transportation of goods and movement of people. This partnership tackles these issues by ensuring the timely delivery of health products to underserved regions in Rwanda.
Rwanda identified the core challenges in providing quality healthcare for a low-income population and sought out an effective solution to these issues. This is the key to strengthening a healthcare system — recognizing the core challenges and addressing them with a cost-effective approach.
Another key concern in the healthcare system of low-income economies is the lack of data. Governments and institutions require quality data for accurate planning, funding, and evaluation of developmental projects. Data is an essential tool that perpetuates objective analysis in decision making, budgeting, and enactment of practical policies. This can be achieved with new technologies — such as artificial intelligence, blockchain, data science — which seamlessly store and provide data, creating room for healthcare professionals to focus on accurate diagnosis, provide quality solutions in emergency cases and the best treatment approaches for patients.
One study found that the availability of data in a healthcare system enables the development of clinical rules that save time and enhance treatment outcomes. A notable example of the smart use of data is Care.ai, which solves the problem of staff operating over-capacity. Care.ai is an AI-powered autonomous monitoring platform that provides around-the-clock monitoring of patients, real-time tracking of health, and context-aware alerts to healthcare providers. Using AI-accelerated edge sensors to generate millions of data points, Care.ai provides actionable staff performance and care management insights to enable data-driven decision making across a health facility.
AI reduces and prevents risks, enabling caregivers to deliver care more efficiently and accurately. Effective data usage is also practised with Care AI doctor, a European Commission project which anonymously correlates patient medical data with libraries of academic data/journals. Using a statistical analysis, this data is further utilized by the system in the diagnosis of a disease. CareAI targets refugee camps in Europe and provides medical services to minority groups including migrants, ethnic minorities, and those unregistered within traditional healthcare systems (Ekekwe, 2018).
In light of healthcare workers’ migration, lack of adequate infrastructure, and limited access to quality healthcare in Africa, the model of these CareAi systems could improve health outcomes in underserved African regions. Data provides access to patients’ medical history, including past and current drug use information. And by dealing with the minor issues, systems powered by artificial intelligence could realign the focus of the few available healthcare professionals toward more difficult health issues.
It is also worth noting that smart solutions need not be simply tech-based. The Arogya Parivar (“healthy family” in Hindi) program created by Novartis is a clear exemplification of this. The program transitions locals in remote villages into “health educators” via intentional recruiting and training who collaborate with doctors to organize health camps and independently educate community members on good health and disease prevention. In addition to this, mobile clinics have been curated to provide access to patient screening, diagnosis, and treatment. The Arogya Parivar program also seeks to connect villagers with physicians in primary healthcare facilities, to provide quality healthcare services near remote communities (Novartis, n.d.).
Also, the Rwanda government implemented a monthly car-free day in the nation’s capital Kigali. This is aimed at utilizing bodily activities that improve and maintain physical fitness — such as walking and cycling — to promote wellness amongst its citizens (Mbabazi, 2018). Driving the use of high-tech — as well as low-tech — in medical intervention is not dependent on a section of the healthcare community. The act calls for the contribution of all healthcare workers. Pharmacists can play key roles in improving the provision of healthcare by collaborating with researchers, scientists, tech-engineers, and other stakeholders to curate smart solutions to the care needs of patients. Community pharmacies in African countries should work with a data collection system to provide other healthcare professionals with a clear view of patients’ medication history. Learning should also be accelerated to improve the capacity of young pharmacists in identifying and evaluating appropriate data, as well as creating sustainable health solutions.
Also, African economies can combat the loss of healthcare professionals and ensure the availability of data by providing appropriate remuneration for healthcare workers, equipping the education sector to train more healthcare providers, and enacting favourable policies for the provision and protection of patient data. With easy access to basic health care and qualified health professionals, as well as the availability of quality infrastructure, patient data, and qualified health professionals, the health sector of any economy can be bolstered for effective functioning.
References
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