Climate change is accelerating disparities in healthcare access in Africa. Technology can help

although climate change is exacerbating pre-existing gaps in the African health care system and worsening healthcare outcomes across the continent, digital technologies can be used to enable Africa’s healthcare system to leapfrog current gaps

Adebayo Alonge

Africa already battles with widespread disparities in quality healthcare access. It suffers the highest levels of infant and maternal mortality, the highest levels of reported poor quality medicines and limited affordability for common medicines. Sadly, climate change is only going to make things worse.

Although Africa only contributes 2-3% of global emissions, it is bearing the most brunt of change to the global climate ⁽¹⁾. Climate change is leading to erratic weather events such as protracted rainfall that then causes flooding. Recent floods killed thousands of people in South Africa, Central Africa Republic, Ivory Coast, Nigeria – to mention a few impacted countries ⁽²⁾.

On the other hand, temperatures across Africa are 1 Celsius higher than they were in 1901⁽³⁾ and in some regions such as Somalia, Djibouti, Ethiopia and Kenya, rainfall has become infrequent over the last 4 years thereby causing droughts and famine. More than 25 million people across this region are currently experiencing acute food and water shortages ⁽⁴⁾.

These events are causing extensive population displacement, worsening malnutrition, deepening poverty due to loss of livelihoods and increasing the rate of spread of infectious diseases.

Even before the climate emergency, Africa was struggling to enable access to quality healthcare for its citizens. Its healthcare infrastructure is inadequate and its citizens struggle to access quality healthcare as a result. This leads to the region suffering some of the worst healthcare outcomes in the world. Its child mortality rate is 3x that of the world ⁽⁵⁾ and it accounts for 66% of all women who die from pregnancy related causes ⁽⁶⁾. It also has the highest disease burden – 80% of African life years are lost to premature death and disability ⁽⁷⁾, 4x times worse vs. western Europe.

Some progress has been made in many healthcare outcomes across Africa over the past 60 years. For example, child mortality fell by 24% and maternal mortality fell by 44%. Some epidemics such as wild polio virus have been eradicated. However, the pace of progress in many areas compared to rest of the world is insufficient and the added burden of climate change makes the need to have faster progress    more urgent. The adequacy of national healthcare systems across Africa needs to be radically improved and technology can play a significant role in leap frogging the massive changes required

The adequacy of national healthcare systems can be assessed through 6 main components – service delivery, healthcare workforce, healthcare information systems, medicines & technologies, financing, leadership and governance ⁽⁸⁾. All these components can be improved using digital technology.

In public hospitals across Africa, service delivery is often poor as patients experience a high stress environment when seeking care. Healthcare professionals are often rude and do not place priority on the patient experience and health outcomes. In many instances, patients are verbally and even physically abused and, in some cases, some are sexually exploited ⁽⁹⁾.  Mobile based digital technologies can be used to enable AI algorithms autonomously monitor and generate automated reports on in-person appointment visits. Further, healthcare system leaders can provide direct feedback tools via USSD and native apps to patients to enable them provide immediate reviews on healthcare professionals they have just seen. Healthcare leaders must put in place effective processes to analyze the feedback provided and create incentives to reward or punish behavior among health workers. Digital technologies should be provided to customer experience teams to monitor and report on patient experience as well as the outcomes arising from care intervention. The data generated can be used to improve existing processes.

In many African countries, there are extensive disparities in healthcare workforce vs. the number of patients. As a result, the available workforce is often overworked and often stuck doing primary care interventions. Mobile digital tools like AI-powered bots running on smartphones can be used to quickly triage patients for a diagnosis and treatment intervention while relying on a human professional to provide the final prescription. This will greatly expand the scope and reach of Africa’s limited workforce and free up more of them towards the more complex specialized interventions that the continent badly needs.

Further, digital platforms can be used to automate healthcare systems across board. It is inexcusable that Africa’s healthcare workers still mostly rely on pen and paper to run their health systems. This is inefficient and leads to a silo of knowledge across health departments that should be working together. Patients cannot easily move across various health systems as their providers have no way to access their history of care.  Also because of limited automation, many healthcare systems are unable to quickly process health insurance claims, assess the quality of medicines they receive and leverage the data they generate to unlock financing. Digital infrastructure platforms like RxAll, can be easily plugged into the operating model of Africa’s health systems for very low cost. This will enable interoperability across all health systems while enabling value to be unlocked out of the insights generated from the data being generated.

Finally, online and on-demand learning platforms such as the RxAll RxAcademy can be used to cheaply bring advanced management and clinical training to senior leaders of healthcare systems across Africa. This will save on the expensive travel and tuition being paid to international universities to train such leaders and are better suited to tracking learning outcomes. Such learning platforms can also be leveraged to run continuous medical education for health professionals across board, thus helping to narrow gaps in expertise between different health professionals who may be in different cities and practicing at different levels of the health system. It is often the case that professionals working in rural areas and at the primary healthcare facilities are the most disadvantaged when it comes to access to training.              Such online learning platforms can help reduce such gaps. Further, digital technologies can enable the most senior healthcare leaders to directly collect feedback from patients and frontline workers thus improving their visibility into what needs to be done to improve outcomes throughout the system they manage.

In conclusion, although climate change is exacerbating pre-existing gaps in the African health care system and worsening healthcare outcomes across the continent, digital technologies can be used to improve adequacy in all components of Africa’s healthcare system. Such technologies can be used to improve the patient experience, hold healthcare providers accountable, unlock insights out of currently siloed data, enable interoperability of all health systems across multiple countries and improve access to capacity building education for all health workers across grade levels, locations and facilities.

References

1. United Nations Environment Program. Responding to Climate Change, https://www.unep.org/regions/africa/regional-initiatives/responding-climate-change (Accessed August 1, 2022)
2. Flood List. Floods in Africa, https://floodlist.com/africa (Accessed August 1, 2022)
3. United Nations Climate Change. Climate Change is an increasing threat to Africa, https://unfccc.int/news/climate-change-is-an-increasing-threat-to-africa (Accessed August 1, 2022)
4. United Nations Environment Program. On verge of record drought, East Africa grapples with new climate normal, https://www.unep.org/news-and-stories/story/verge-record-drought-east-africa-grapples-new-climate-normal  (Accessed August 1, 2022)
5. Our world in data. Child mortality- share of children, born alive, dying before they are five years old, https://ourworldindata.org/child-mortality (Accessed August 1, 2022)
6. Our world in data. Number of maternal deaths by region, https://ourworldindata.org/maternal-mortality (Accessed August 1, 2022)
7. The global distribution of the disease burden, https://ourworldindata.org/burden-of-disease (Accessed August 1, 2022)
8. National Library of Medicine. Identifying Key Challenges Facing Healthcare Systems in Africa and Potential Solutions, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6844097/ (Accessed August 1, 2022)
9. BBC. WHO horrified over sexual exploitation by aid workers in DR Congo https://www.bbc.com/news/world-africa-58710200  (Accessed August 1, 2022)