June 4, 2019 Source: drugdu 146
With billions of dollars pouring into the biggest tech hubs in the world like Silicon Valley, New York and Beijing, it can be easy to forget about other health technologies under development in regions without the same resources.
However, digital health has already started changing care around the world, especially in developing regions, making care more accessible and cost effective. In particular, health tech in central and east African countries have started to turn heads. From blood delivery by drone to open-source EHRs, innovators are starting to address the needs and special challenges of the region with digital health technologies.
“I think the opportunities and possibilities are endless and that is what makes it really exciting,” Tracey McNeill, CEO of Babyl Rwanda, said. “We all know technology can transform our lives and has already done so [for] all of us by using mobile phones for everyday living. In the context of the developing world and healthcare, we know that from the work that we have done we can make it more accessible and much more affordable.”
Rwanda is a key example of this latest technology revolution. Teaming up with big names like Babylon Health, the government has rolled out a slew of digital health initiatives that are employing some of the most advanced tools to address country-specific needs.
“Rwanda is to the point where everybody has got an EHR. Does everybody in Europe or US have that, does everyone have access to it?” Brian O’Connor, chair of the European Connected Health Alliance, said at the Connected Health Conference in Boston in October. “Secondly, every village has a clinic. Sometimes it’s an actual clinic, sometimes it’s an iPad. Those iPads have allowed people, instead of going four hours to see a doctor, to communicate through the iPad. And when they need drugs and so on, they are …sent by drone, parachuted down.”
In 2016 the Rwandan government teamed up with Babylon Health on a program called Babyl Rwanda. As part of the service people in the country have access to virtual consultations with doctors and experts, as well as monitoring and diagnostic tools. The system can also enable prescription delivery and access to secure clinical records.
“We launched Babylon in Rwanda about two years ago at the request of the Rwandan government,” McNeill said. “The government is very forward thinking and digitally savvy so they are looking at options for digitizing healthcare education, finance and agriculture. So they were very keen to get us to launch a digital health service for the population of Rwanda.”
In 2018 the partnership between the country and the digital health company kicked off an artificial intelligence pilot program.
“We have triage nurses at the call center, and alongside the nurses doing their normal triage flows they are now using AI,” McNeill said. “The symptoms a patient describes, we are putting in our AI and we comparing the results of our AI with our own nurse triage. What we are doing is developing the AI and teaching the AI.
Eventually the plan is to put the AI into the hands of community health workers in order to give them access to “a doctor’s brain on a smartphone.”
“Rwanda was the first country in the world to see drones take flight to deliver blood products supplies to health facilities,” Dr. Diane Gashumba, the minister of health for Rwanda, said in a statement at the time of the 2018 announcement. “Now the Government of Rwanda is embracing cutting edge technology by partnering with Babyl to ensure that every Rwandan who needs healthcare can access it.”
Looking to speed up the delivery of vital medications and blood products the Rwandan government turned to drones, teaming up with Zipline, a medical specific drone delivery service, in 2016. The way it works is health clinicians in remote areas can text orders to Zipline. The supplies are then packed up at a distribution center and prepared for delivery. The products are sent off in drones that fly at 100 km/h. Currently there is one distribution center in the Muhanga district of Rwanda but a second is slated for this year, according to the Zipline’s website.
Addressing the gaps in care
While Rwanda may be an exemplar, the region as a whole is starting to implement new programs that are addressing specific health gaps. As with many parts of the world, EHRs are a vital source of information but often not fully available.
However, for more than a decade the OpenMRS network, an open-source medical record platform aimed at developing countries, has been set up to tackle this issue. So far the system has been involved with dozens of countries including Uganda, Rwanda and Zimbabwe. Its reach also extends to the Americas and Asia. The network was designed to help aggregate data and address population health.
“The opportunities are in appropriate technology,” Dr. Theresa Cullen, associate director of global informatics at Regenstrief Institute, the lead organization behind the service, said.
While the major goal in many low- and middle-income countries is population health, conditions like cancer have often been underfunded and not the main focus, according Dr. Johnblack Kabukye, a medical doctor and health information specialist at Uganda Cancer Institute.
Where there are challenges, some are also seeing opportunities. For example, Kabukye referenced a teleoncology trial, which linked the Fred Hutchinson Cancer Research Center in Seattle, WA to the Uganda Cancer Institute for a monthly conference. The centers were able to teleconference 36 times to discuss leukemia, lymphoma, breast cancer, head/neck/lung cancer and other various types of cancer. Eventually the two centers were able to publish two locally relevant treatment guidelines co-authored by specialists at both publications.
Some large companies are also starting to take notice of the gap in cancer care in the region. Kabukye said that in Uganda IBM has already been involved in cancer care. According to a statement from the American Cancer Society, IBM Health Corps teamed up with the ACS and Clinton Health Access Initiative to develop ChemoQuant, a chemotherapy forecasting software that is designed to help countries quantify their cancer medicine needs and then plan budgets. The system is already being used in Uganda, and will be deployed in Ethiopia, Kenya Nigeria, Rwanda and Tanzania.
While there are a myriad of uses for digital health in the future, the technologies have already had an important impact on care. McNeill said that digitizing care allows doctors to see 80% more patients. The technology has also helped make care easier and more accessible for patients, so instead of a mother having to walk miles to a health center with her baby she can get care virtually.
“The opportunity is enormous but what you need is strong partnerships with key stakeholders,” McNeill said. “As a provider, we couldn’t do this alone.”
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