Published on Investing in Health

ICTs to transform health in Africa: Can we scale up governance and accountability?

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Uganda man sends health SMS.

Start-up eHealth innovations are popping up all over Africa, providing a glimpse of how ICTs can transform the delivery and governance of health services in the region. Many of these pilots show promise, but their rapid growth also poses challenges: At an eHealth conference held in Nairobi in May and co-organized by the World Bank, health professionals and development partners discussed how to identify the best of these evolving tools and bring them to scale.

Uganda is one example of a country where eHealth start-ups have developed quicklyUganda poster on SMS reporting of drug supplies..  One innovation, a simple text message-based application, can be used in a health center to report when lifesaving drugs are not available. Not only does the application improve availability of drugs, it also improves transparency and accountability by ensuring that patients and clients can report drug stock-outs directly without having to go through health workers.

Another tool, U-Report, captures citizen feedback on development issues through mobile phone-based data collection.  With a membership list of 121,000, the service has great potential to enhance citizen engagement and government accountability, and to improve health service delivery.

While such technologies are exciting, and they seem intuitively useful and have high potential for impact, we still lack empirical evidence that they improve the efficiency of delivery of health services. So, the World Bank is investing in evaluating some of these experiments. We also need to ensure that these small pilot projects are designed in such a way that they can inform broader transformations in the health system in the country, instead of remaining as small islands of excellence in districts or regions.

The map below, of Uganda, shows how even good intentions can translate into a case of “pilotitis” –with more than 50 eHealth pilots in one country. Most of these will likely remain as pilots for life, because they are not designed to be scalable from day one and/or because they do not necessarily share common platforms and are not inter-operable. The idea is not to suggest that all pilots must follow the design-pilot-evaluate-scale approach, but to ensure that all pilots and innovations are designed with scale and inter-operability in mind, from the get-go.


Since many countries are developing their own national eHealth strategies, we need to make sure that the wide array of eHealth applications can “speak” to each other (that is, they are inter-operable), and that they are designed as plug-and-play applications with a common platform.

How can countries scale up these types of innovations? What can the World Bank do to support this process? Should we support an overall systemic fix and a common platform, with simple plug-and-play “apps” for different diseases (malaria, TB, malnutrition) and issues (supply chain management, health information systems), or should we encourage countries to invest in different platforms for different diseases or problems?

When it comes to ICTs and health, the developed world has not always made the best choices. In the United States, for example, competing commercial electronic health record programs mean that even hospitals within the same city cannot smoothly transfer patient data. Perhaps ICTs and eHealth can be one area where developing countries can learn from the mistakes of developed countries and from south-to-south learning.

If ICTs are applied strategically in a way that they scale cost-effectively, surely they could be as transformational in health as they have been in finance in Kenya, for example, where many people pay electricity bills and transfer money via mobile phones (through the mPesa program) instead of going to the bank.

As one of our government partners in Kenya said, “The greatest challenge for us is change.” This refers not to the technology development or training or budgeting, but to the actual ability to change mindsets that may not be accustomed to an ICT solution, and to engage a younger generation for whom “tech-savvy” is an inherent quality. 

Are we up for the challenge?

Uganda map by Text to Change via Flickr.


Meera Shekar

Global Lead, Nutrition

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