A West African Perspective on Digital Transformation in Healthcare
In Ghana, mobile technology is widely available with more mobile connections than people in the country. At the end of 2015 in Ghana, GSMA reports the SIM penetration of 124% although mobile broadband was lower at 31% with large variation between urban and rural locations. With the number of phones and growing broadband infrastructure, mobile technologies have tremendous potential to drive transformation.
Mobile solutions are becoming common, transforming businesses and sectors across Ghana. For example, farmers review prices, fishermen check weather patterns, teachers share slides, and even churches are now using applications to manage membership, collect funds, and send messages. The financial sector has been adept at using new technologies and mobile money solutions are gaining popularity in Ghana. Even the government is tapping into new mobile technology leveraging it for election campaigns as well as for releasing news and speeches.
One area of mobile innovation in Ghana is mobile health, commonly called mHealth, with potential to create real changes in health services and disease management. Technologies available through phones can increase access to information, improve service delivery, and lower response time in emergencies. To learn more about the mHealth landscape in Ghana, we caught up with Mr. Hammond who has over 20 years of experience in Ghana’s health sector. Currently, Mr. Hammond serves as the Deputy Director of the Ghana Health Service (GHS) in charge of Transport Management Department, and in 2016, he was elected President of the Chartered Institute of Logistics and Transport (CILT-Ghana). He has participated in a number of mHealth projects with the Ghana Health Service and is currently doing research on mHealth in the Greater Accra Region of Ghana.
mHealth Landscape in Ghana
mhealth has great potential to improve health services throughout Ghana. Mr. Hammond describes the landscape in Ghana as donor-driven, largely initiated and supported by independent organizations. Similarly, telecom companies are piloting their own health solutions for customers to call for additional health information. Mr. Hammond says “the general populace is open to receiving health information via mobile phone but awareness and adoption of mHealth is not yet widespread.” As he reaches out to individuals, they appreciate the potential of mHealth and are “very positive” but there is still a fair amount of work to be done to build understanding and engagement.
While mHealth is not yet widespread in Ghana, there have been a few very successful mHealth projects and innovations. One of the flagship mHealth projects in Ghana was a telemedicine project lead by the Novartis Foundation along with the Ministry of Health and many partners. The partners piloted a teleconsultation center at the District Hospital in Agroyesum to serve about 7,500 households fielding a range of calls on topics from malaria to labor, diarrhea to diabetes. Mr. Hammond says “the project reduced the need for referrals by about 30%” and it is scaling across other regions of the country.”
The Grameen Foundation also had a key mHealth initiative in collaboration with GHS called Mobile Technology for Community Health (MOTECH) which was piloted in the Upper East region of Ghana supporting pregnant women from conception through delivery. Mr. Hammond says, “When we tested MOTECH, we saw more supervised deliveries and antenatal visits, helping to attain the goal of lower maternal and child mortality.”
There are also a number of exciting innovations being developed in Ghana, for example MedRX is an application which allows patients to order their prescriptions online to a nearby pharmacy. These projects and technologies are only the beginning of mHealth innovations but confirm the potential for mHealth in Ghana.
Public health services stand to greatly benefit from digital solutions. From patient engagement to service delivery to logistics and stocks management, Mr. Hammond indicates that “the potential is massive, especially when viewed from a consolidated or national level.” While there are significant and important opportunities for mHealth throughout Ghana, it is important to understand the specific market challenges.
Challenges for mHealth Innovation and Uptake
As in any market, innovation, uptake and scaling come with challenges. For mHealth and mobile solutions more broadly, the landscape is shaped by national policies, funding, telecom infrastructure, language, literacy and more. How do these issues shape the digital transformation in Ghana?
The mobile economy in terms of SIM penetration is thriving in Ghana, but Mr. Hammond believes more infrastructure and institutional support is needed to scale mobile innovations throughout the country. For instance, Mr. Hammond says, “the government has yet to review policies to accommodate online interventions and will need to formulate a framework for online intervention to give credence to the national e-health policy.” Sustainable funding arose as another ongoing challenge, particularly in donor-driven projects; Mr. Hammond asks, “What happens in future to great programs like the telemedicine project whose initial costs were covered by Novartis Foundation?”
There are also a number of issues to consider on an individual or consumer level from communication to cost and more. The first item Mr. Hammond notes – illiteracy, both the inability to read or write but also digital illiteracy. He says, “There are two types of illiteracy that pose a challenge for the general population in Ghana. One we all know where people may not have formal education and cannot read or write. With mobile technology we confront a second type called digital illiteracy, where one can be highly educated but lacks knowledge and experience in technological matters.”
In Ghana, like many countries in Africa, communication and usability also relate to language choice. English is the official language in Ghana and used in government, business and standard education, and Akan is spoken by more than half the population, but there are over 250 languages and dialects spoken across the country. People want to receive information in a language they easily understand, especially health information, so this can pose challenges.
Communication preferences in technology go beyond the literacy and language and refer to the method or platform for outreach as well. Mr. Hammond says, “In my work, the older population prefers voice calls to text messages or applications, and the younger generation prefers apps, social media.” These information delivery preferences can be difficult to accommodate for solutions that are developed to reach a wide range of the population.
Lastly we discussed challenge of cost. While not unique to the Ghana market, price for the buyer and the cost to the end-user including data charges will greatly impact use and scaling. These individual considerations are essential to understand and plan for when developing or scaling mobile technology in Ghana.
Potential for mHealth in Epidemics
What excites Mr. Hammond about the potential for mHealth? He says “mHealth can be used in so many ways to promote health. I am particularly interested in understanding the opportunities for using mHealth in the management of epidemics - just one text blast and thousands of people get critical information. It is so powerful!” Following this interest, Mr. Hammond has been researching how mHealth solutions can be used in the prevention and management of cholera epidemics and working with stakeholders in the Greater Accra Region. He hopes to understand the most viable opportunities for mHealth in the management of epidemics such as cholera, Ebola or meningitis and aims to inform public mHealth and online systems to expedite outreach and services for outbreaks in Ghana.