This is the 30th post in a blog series to be published in 2022 by the Secretariat on behalf of the AU High-Level Panel on Emerging Technologies (APET) and the Calestous Juma Executive Dialogues (CJED)

Non-communicable diseases (NCDs) account for over 41 million fatalities annually, equivalent to 71% of all deaths worldwide, making NCDs the largest cause of mortality worldwide[1](see figure 1). The World Health Organization (WHO) estimates that every 2 seconds, someone aged 30 to 70 years dies prematurely from NCDs.[2]The most common NCDs include cardiovascular diseases, cancer, diabetes, hypertension, and high blood pressure. Over the past two decades, the burden of NCDs has significantly increased in Africa.[3] This has been primarily because of the increased prevalence of risk factors such as poor diets, insufficient exercise, dyslipidaemia, obesity, and air pollution.[4] It has been estimated that by 2030, NCDs will be Africa's leading cause of mortality rates.[5]

Figure 1: Fatalities from NCDs since 2000

 

Non-communicable diseases pose a serious threat towards accomplishing the African Union's (AU) Agenda 2063 Goal 3 of healthy and well-nourished citizens and ensuring healthy lives and promoting well-being for everyone across all ages according to the United Nations Sustainable Developmental Goals.[6],[7] To address the danger posed by NCDs, the AU developed the African Health Strategy 2016–2030 (AHS 2016–2030) policy framework to provide strategic mechanisms for Africa's efforts towards establishing healthcare systems.[8] This African-led strategy is progressively lowering the burden of diseases through improved health systems, expanding healthcare interventions, enhancing cross-sector cooperation, and empowering local communities. Consequently, the framework has enabled AU Member States to reduce NCDs' morbidities and preventable mortalities.[9]

To tackle the burden of NCDs, African countries have been progressively instituting standardised programmes to tackle chronic and severe non-communicable diseases by guaranteeing that basic medicines, technologies, and diagnostics are afforded to district hospitals.[10] African governments have also been ensuring that African people seeking healthcare in private and public hospitals can also access services for severe non-communicable diseases.[11] Furthermore, African countries have been bolstering their protocols to prevent, care and treat chronic non-communicable diseases through the training and strengthening of health workers' skills and knowledge.[12] However, this is falling short because, as of 2019, the World Health Organisation (WHO) revealed that only 36% of African countries reported having vital medicines for non-communicable diseases in public hospitals.[13]

Unfortunately, it has been reported that NCDs are causing most of the out-of-pocket spending by patients in Africa. In addition, due to their chronic nature, they frequently result in devastating health expenditures.[14] However, when availing of NCDs' healthcare service packages at primary and district health facilities, patients can decrease their expenditures considerably on transportation, accommodation, and commuting expenses in cities close to the health facilities.[15] Also, African countries focus on initiatives for integrated detection, diagnosis, treatment, and care of NCDs in primary healthcare facilities. Such efforts are exhibiting promising results in Liberia, Malawi, and Rwanda, as demonstrated by the considerable number of patients accessing severe NCD treatment and the consequently improved outcomes for these patients.[16]

However, accessing healthcare facilities and services remains challenging in most African countries. A global shortage of healthcare workers, especially in several African countries, is expected to reach 18 million by 2030. This strengthens the case for investing in smart technologies that can assist community health workers and nurses in diagnosing and treating NCDs that doctors typically see.[17] Thus, considerations towards accessing various healthcare programmes using smart technology interventions are being considered and developed to deliver a wide range of healthcare services to people living with various NCD healthcare issues.[18] The different devices and platforms, such as mobile phones, websites, software, wearable devices, and tablet computers, are progressively being employed in healthcare by employing online and offline digital technology platforms. These technologies are collectively referred to as digital health.[19]

The African Union High-Level Panel on Emerging Technologies (APET) recognises the potential of digital healthcare interventions to accomplish and ensure high-quality healthcare coverage for NCD patients. Digital platforms such as mobile smartphones, portable computing devices, internet-based applications, and social media are interfacing with digital health solutions to provide preventive, diagnostic, therapeutic, and palliative care for patients living with NCD. In addition, digital platforms provide opportunities for seeking and sharing health information and monitoring behavioural risk factors. This also enables healthcare facilities to assist and monitor health information related to behavioural risk factors at individual and population levels.[20] This data is crucial in developing intervention programmes and formulating policy implementation programmes on preventative health care.

APET urges African countries to incorporate digital technologies in their healthcare interventions to improve access to healthcare services in hard-to-reach areas and enhance the safety and quality of healthcare services and products. This can enhance cost-effectiveness and efficiency in the delivery of healthcare services. Digital health can also improve access to health information and knowledge-sharing between healthcare workers and their patients. This also enhances healthcare delivery and access to social, economic, and environmental determinants.

APET encourages African countries to leapfrog their healthcare interventions using digital technologies such as short messaging services (SMS), telemedicine and telehealth, social media messaging, mobile health applications, robotics and artificial intelligence, telepharmacy, e-prescription and tele-education. Fundamentally, some African countries are progressively adopting emerging technologies to treat NCDs. For example, Nigeria is implementing telepsychiatry to share mental healthcare information and enhance access to mental healthcare treatments. In addition, Nigeria is also incorporating smartphones and SMS communication protocols to manage and care for patients with diabetes and sickle cell anaemia in hard-to-reach areas. SMS are primarily used to remind patients to take their medication. The patients are also using smartphones application to communicate and undertake consultations with their doctors.

Big data and telemedicine are also gaining traction in Africa. Broader adoption of telemedicine has proven to be beneficial for countries such as Nigeria, where according to the World Health Organisation (WHO), there are only four doctors per 10,000 patients, and South Africa, where at least 80% of the population reportedly lacks direct access to professional medical advice because they either cannot afford it or live in remote areas without medical facilities.[21]Capacity strengthening can also be undertaken using online platforms such as Zoom, Google Meet, Blackboard, and Microsoft Teams. For example, a virtual online training programme in Kenya enables the country's few mental health experts to learn psychological first aid. Such skills have enabled the experts to help individuals in need during and after the lockdowns. Additionally, teleconsultations in Tanzania were predominately utilised during the peak of the communicable disease COVID-19 pandemic in 2021 to connect patients and doctors virtually.[22] Therefore, such communication and management technologies can be used towards NCD patients for awareness campaigns.

APET also notes that relying on healthcare facilities for data and information about illnesses impedes the detection of an outbreak or seasonal increase of NCDs as they happen and complicates the estimation of the total case numbers.[23] Consequently, delays in understanding the NCD cases and under-reporting are experienced, thus, making the public health responses less effective. However, APET notes that the sooner the cluster of NCD cases is detected, the better possibility of formulating mitigation and management protocols.[24]

APET suggests that African countries can adopt data management systems to collect and manage NCD outbreaks through digital participatory surveillance. These digital participatory surveillance platforms can allow the population to routinely report their symptoms through online systems via the internet, mobile applications, or participate in social media surveys.[25] These systems can also enable the population to record questions about health-seeking behaviour. Subsequently, the health authorities can digitally analyse the collected data and understand the prevalent disease trends within the population.[26] These trends can then allow African countries to best prepare and manage their healthcare systems.

On the other hand, some African countries have been using surveillance technologies to manage outbreaks of communicable diseases. For example, the National Institute for Communicable Diseases in South Africa has been undertaking a pilot phase of the digital participatory surveillance platform.[27] This enables the assessment of the system's feasibility and further informs its structure before incorporating it into the existing facility-based surveillance programmes. The pilot phase was particularly utilised to survey respiratory diseases such as influenza and COVID-19. Notably, digital participatory surveillance is cost-effective and can be easily scalable to cover a wider variety of communicable and non-communicable of public health significance. Fundamentally, the users can report their symptoms and experiences related to their illnesses every week.[28] Furthermore, this system enables the collection and monitoring of real-time estimation of cases without the need to access medical care or testing capacity. As such, South Africa is utilising the data to forecast how the outbreaks may spread within a community.

African countries can utilise a similar approach towards non-communicable diseases. Regrettably, APET observes that only a few African countries are adopting digital participatory surveillance despite its huge potential value.[29] However, other parts of the world, such as Europe, Mexico, the United States of America (USA), and Australia, are adopting this technology for surveillance systems. For example, Europe first used this platform during the 2003/2004 influenza season,[30] and the system has since been adopted in several countries to detect flu outbreaks earlier. The USA, Australia, and Mexico have also adopted their own digital participatory surveillance programmes.[31]To date, 11 European countries have implemented a continent-based digital participatory surveillance network called InfluenzaNet[32] , enabling comparative monitoring of influenza trends within and between European countries. These countries have also bolstered sustainable participation on these platforms using media campaigns and public health messaging. The National Institute for Communicable Diseases is embarking on a similar public relations and media strategy in South Africa. As mentioned earlier, this approach can also be adopted for NCDs.[33]

However, APET notes that Africa's digital participatory surveillance can face limited information and communications technology challenges. Notably, some parts of Africa have limited internet connectivity.[34] There is also the digital divide existing within the African population. Consequently, some segments of the population may not have access to technology because of limited access to smartphones and internet connectivity.[35] Furthermore, there are some concerns and scepticism about social media and mobile applications concerning data confidentiality and privacy. APET observes that these are longstanding challenges that African governments and the private sector should address.

Furthermore, APET appreciates that as the digital world evolves and improves, African countries have an opportunity to utilise digital participatory surveillance technology to disentangle critical challenges of public health management and responsive regimes. For instance, digital participatory surveillance enables the community to share the responsibility of disease surveillance. This is substantially contributing to the control and prevention of disease outbreaks.[36] This is useful in managing outbreaks of NCDs so the governments can formulate and implement policy interventions such as creating micro-healthcare facilities, services, and mobile clinics.[37]

Finally, APET observes that NCD monitoring and management technologies can be tailored to suit Africa's realities. For example, clinics can tailor reminders for each of their various and periodic prescriptions using mobile applications such as Care Zone Health Information Organiser, Dosecast, Mango Health, and My Meds.[38] Additionally, African countries can utilise Electronic Health Data (EHR), a patient-centred records management system. This can bolster the management protocols for NCDs such as diabetes.[39] Only authorised users and healthcare providers can promptly and securely access the patient's health information to enhance privacy and safety.[40] As such, since Africa is facing a rapidly growing chronic non-communicable disease burden and continual high rates of infectious diseases, APET urges African countries to invest in smart technologies. Such technologies can efficiently manage NCD healthcare and accelerate economic development. This will ensure the attainment of the African Union's Agenda 2063, "The Africa We Want".

 

Featured Bloggers – APET Secretariat

Justina Dugbazah

Barbara Glover

Bhekani Mbuli

Chifundo Kungade

Nhlawulo Shikwambane

 

 

[1] https://www.who.int/data/gho/data/themes/topics/topic-details/GHO/ncd-mortality.

[2] https://news.cgtn.com/news/2021-05-27/Graphics-Will-we-have-more-deaths-from-non-communicable-diseases--10A1d0tOW1q/index.html

[3] https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases.

[4] https://www.thelancet.com/journals/langlo/article/PIIS2214-109X%2819%2930370-5/fulltext.

[5] https://www.un.org/africarenewal/magazine/december-2016-march-2017/lifestyle-diseases-pose-new-burden-africa.

[6] https://au.int/en/agenda2063/sdgs.

[7] https://africacdc.org/download/africa-cdc-non-communicable-diseases-injuries-prevention-and-control-and-mental-health-promotion-strategy-2022-26/.

[8] https://au.int/sites/default/files/pages/32895-file-africa_health_strategy.pdf.

[9] https://www.frontiersin.org/articles/10.3389/fpubh.2020.574111/full.

[10] https://www.weforum.org/agenda/2022/09/africa-noncommunicable-chronic-disease-strategy-who/.

[11] Maphumulo, W. T., & Bhengu, B. R. (2019). Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review. Curationis, 42(1), e1–e9. https://doi.org/10.4102/curationis.v42i1.1901.

[12] https://www.afro.who.int/news/african-health-ministers-endorse-new-strategy-curb-chronic-disease-crisis.

[13] https://www.afro.who.int/news/deaths-noncommunicable-diseases-rise-africa.

[14] Wang, Q., Fu, A. Z., Brenner, S., Kalmus, O., Banda, H. T., & De Allegri, M. (2015). Out-of-pocket expenditure on chronic non-communicable diseases in sub-Saharan Africa: the case of rural Malawi. PloS one, 10(1), e0116897. https://doi.org/10.1371/journal.pone.0116897.

[15] https://www.emro.who.int/noncommunicable-diseases/publications/questions-and-answers-on-management-of-noncommunicable-diseases-in-primary-health-care.html.

[16] Tesema, A. G., Ajisegiri, W. S., Abimbola, S., Balane, C., Kengne, A. P., Shiferaw, F., Dangou, J. M., Narasimhan, P., Joshi, R., & Peiris, D. (2020). How well are non-communicable disease services being integrated into primary health care in Africa: A review of progress against World Health Organization's African regional targets. PloS one, 15(10), e0240984. https://doi.org/10.1371/journal.pone.0240984.

[17] https://insights.omnia-health.com/hospital-management/focusing-africas-challenges-and-opportunities-digital-health

[18] de Villiers, K. Bridging the health inequality gap: an examination of South Africa’s social innovation in health landscape. Infect Dis Poverty 10, 19 (2021). https://doi.org/10.1186/s40249-021-00804-9.

[19] Dodoo, J.E., Al-Samarraie, H. & Alsswey, A. The development of telemedicine programs in Sub-Saharan Africa: Progress and associated challenges. Health Technol. 12, 33–46 (2022). https://doi.org/10.1007/s12553-021-00626-7.

[20] https://www.thelancet.com/journals/landig/article/PIIS2589-7500(20)30028-5/fulltext.

[21] https://insights.omnia-health.com/hospital-management/focusing-africas-challenges-and-opportunities-digital-health

[22] https://onlinelibrary.wiley.com/doi/10.1002/hbe2.297.

[23] Kroll, M., Phalkey, R. K., & Kraas, F. (2015). Challenges to the surveillance of non-communicable diseases--a review of selected approaches. BMC public health, 15, 1243. https://doi.org/10.1186/s12889-015-2570-z.

[24] https://www.nicd.ac.za/south-africa-is-testing-digital-technology-to-detect-outbreaks-of-respiratory-diseases/.

[25] Silenou, B. C., Nyirenda, J., Zaghloul, A., Lange, B., Doerrbecker, J., Schenkel, K., & Krause, G. (2021). Availability and Suitability of Digital Health Tools in Africa for Pandemic Control: Scoping Review and Cluster Analysis. JMIR public health and surveillance, 7(12), e30106. https://doi.org/10.2196/30106.

[26] Saah, F. I., Amu, H., Seidu, A. A., & Bain, L. E. (2021). Health knowledge and care seeking behaviour in resource-limited settings amidst the COVID-19 pandemic: A qualitative study in Ghana. PloS one, 16(5), e0250940. https://doi.org/10.1371/journal.pone.0250940.

[27] https://www.nicd.ac.za/wp-content/uploads/2017/10/NHLS_Annual_Report_2015_NIDC.pdf.

[28] https://www.nicd.ac.za/tracking-symptoms-of-respiratory-diseases-online-can-give-a-picture-of-community-health/.

[29] https://www.nicd.ac.za/malaria-in-africa-why-most-countries-havent-beaten-it-yet/.

[30] https://www.who.int/initiatives/global-influenza-surveillance-and-response-system.

[31] https://www.euro.who.int/__data/assets/pdf_file/0020/90443/E92738.pdf.

[32] Paolotti D, Carnahan A, Colizza V, Eames K, Edmunds J, Gomes G, Koppeschaar C, Rehn M, Smallenburg R, Turbelin C, Van Noort S, Vespignani A. Web-based participatory surveillance of infectious diseases: the Influenzanet participatory surveillance experience. Clin Microbiol Infect. 2014 Jan;20(1):17-21. doi: 10.1111/1469-0691.12477. PMID: 24350723; PMCID: PMC7128292.

[33] de Fougerolles, T.R., Damm, O., Ansaldi, F. et al. National influenza surveillance systems in five European countries: a qualitative comparative framework based on WHO guidance. BMC Public Health 22, 1151 (2022). https://doi.org/10.1186/s12889-022-13433-0.

[34] https://carnegieendowment.org/2022/04/26/to-close-africa-s-digital-divide-policy-must-address-usage-gap-pub-86959.

[35] https://www.brookings.edu/techstream/the-promises-and-perils-of-africas-digital-revolution/.

[36] https://www.emro.who.int/noncommunicable-diseases/publications/questions-and-answers-on-importance-of-surveillance-in-preventing-and-controlling-noncommunicable-diseases.html.

[37] https://extranet.who.int/ncdccs/Data/ZAF_B3_NCDs_STRAT_PLAN_1_29_1_3%5B2%5D.pdf.

[38] Boudreaux C, Barango P, Adler A, Kabore P, McLaughlin A, Mohamed MOS, Park PH, Shongwe S, Dangou JM, Bukhman G. Addressing severe chronic NCDs across Africa: measuring demand for the Package of Essential Non-communicable Disease Interventions-Plus (PEN-Plus). Health Policy Plan. 2022 Apr 12;37(4):452-460. doi: 10.1093/heapol/czab142. PMID: 34977932; PMCID: PMC9006066.

[39] Lebina, L., Oni, T., Alaba, O.A. et al. A mixed methods approach to exploring the moderating factors of implementation fidelity of the integrated chronic disease management model in South Africa. BMC Health Serv Res 20, 617 (2020). https://doi.org/10.1186/s12913-020-05455-4.

[40] https://www.nepad.org/blog/exploring-medical-management-technologies-improve-diabetes-healthcare-africa.