Pandemic is drawing attention to promise of digital health technologies

For all its devastation, the COVID-19 (coronavirus) pandemic has nonetheless exposed pre-existing health system weaknesses.  It has also given a further boost to the role digital technologies can play in bridging the gaps in care for a range of health needs, including detection and treatment of non-communicable diseases (NCDs).

That’s important to the World Bank, which supports a number of NCD initiatives. Among them is a partnership with Access Accelerated, a collaborative of industry, multilaterals and leading non-profit partners that helps lower-income countries improve NCD detection and treatment.

The World Bank has also partnered with City Cancer Challenge Foundation (C/Can), which supports cities around the world as they work to improve access to equitable, quality cancer care.

C/Can took this moment as a cue to initiate in June the Digital Health Discovery Forum, which is surveying cancer care practices around the world and sharing information among health leaders in nine cities across Africa, Asia, Latin America and Eastern Europe. Ultimately, C/Can will support cities’ efforts to adopt digital health solutions and enabling policies and processes that will make cancer care systems more resilient and effective well after the pandemic subsides.

“Expanding digital health solutions for cancer care is something cities have been interested in exploring for a long time,” says Dr. Susan Henshall, C/CAN’s CEO. “Now, as cities are adapting to the challenge of COVID, the policy environment is opening up and opportunities to accelerate solutions are being created.”

And, even as the pandemic rages, C/CAN is moving ahead with a partnership with Project ECHO, the initiative whose digital platform is supporting cities from all over the world to exchange knowledge and best practices on cancer treatment and care.

Staying ahead with data

Managing data through digital technologies has been at the heart of mPharma, a growing Ghana-based company working to improve the availability and affordability of medicines across Africa. As the company’s founder and CEO Gregory Rockson explains, the technologies have provided a good view of how the pandemic was disrupting its supply chain.

mPharma could see unusual spikes in demand for medications in several countries, indicating that patients managing chronic conditions were anticipating shortages. Suddenly, the company’s urgent mission was to protect chronically ill patients from medication demand shocks.

So mPharma negotiated with manufacturers to buy six months ahead, rather than the usual two months, and offered patients guaranteed supply and prices if they committed in advance to a nominal security deposit. The result so far: mPharma has spared many patients the risk of running out their medications – such as, for example, the effective breast cancer drug Herceptin for Nigerian patients.

But “without that data,” Rockson says with relief, “we would have been caught flat-footed.”

Trust: the essential ingredient

With wider adoption of digital technologies to collect health data, there are emerging roadblocks.  So says Nicolás di Tada, Chief Technology Officer of INSTEDD – or Innovative Support To Emergencies, Diseases and Disasters, a developer of digital technologies designed for development and humanitarian challenges. Data collection through digital technologies, he stresses, works well only when there is an element of trust with those you’re trying to evaluate and when it is collected incidentally to something else useful.

If you call your bank, he illustrates, and they ask you to provide your bank number, you’ll probably be more inclined to disclose that information than if the bank calls you, with no real trusting relationship.

“It’s hard to build a trust relationship to achieve that interaction through mobile technologies alone. When you have interactions that require trust, you need to build that first. You can’t do that over a phone call or an SMS.”

“The massive elephant in the room”

That’s a lesson that reach52 has taken to heart. Founded four years ago to contribute to the goal of universal health coverage worldwide, the company deploys digital tools to provide community-run health services and marketplaces that are beyond the access of 52% of people worldwide.

In developing countries in Asia and Africa, the company organizes rural clinics, eliminating the high expenses, barriers and disincentives of traveling long distances for care. It also provides affordable pharmaceuticals to low-income patients – many of them managing NCDs such as hypertension and diabetes – as well as consumer health products and micro-insurance.

Moreover, reach52 founder and CEO, Edward Booty explains, “We’re also educating people how to be better consumers of health care.” Indeed, since the pandemic erupted, reach52 has created a chatbot on Facebook Messenger, which dispenses critical information and combats misinformation about COVID-19 .

Booty acknowledges that digital technology alone cannot succeed without villagers – “Access Managers” – who are known to and trusted by would-be patients. Using reach52 offline-first apps on Android mobile phones, Access Managers conduct basic screenings, order medicines and health supplies and even arrange consultations with providers in distant locations. All the while, reach52 can collect data that helps it better understand patient needs. Offline working has been essential, given there are nearly 4 billion people globally who still lack access to the internet.

When it comes to digital health technologies aimed at connecting patients in remote areas to faraway providers – practices that have gained wider use under pandemic lockdowns – Booty points to what he calls “the massive elephant in the room.”

“All it does is send more people to doctors,” he says. “But in emerging markets there’s a shortage of doctors, along with all health workers in general, who are mostly in cities where they can make a better wage.”

Booty adds that “there are already resource constraints at every level of lower-income health provision. We have to make sure telehealth doesn’t make that problem even worse. Leveraging digital to task-shift to community health workers and locally-delivered services is essential.”