This is the 33rd post in a blog series to be published in 2021 by the Secretariat on behalf of the AU High-Level Panel on Emerging Technologies (APET) and the Calestous Juma Executive Dialogues (CJED)

The African Union (AU) Health Strategy (AHS 2016-2030) is a policy framework that is premised on improving the continental healthcare systems and health policy commitments as well as healthcare instruments.[1] These aspirations are aligned with the AU’s Agenda 2063 and United Nation’s Sustainable Development Goals (SDGs).[2] As such, the AHS 2016–2030 aspires for an integrated, inclusive, and prosperous Africa that has its citizenry exempt from diseases, disabilities, and premature death.[3]

AHS is necessary, as the continent is still facing a myriad of challenges of which inadequate healthcare is prime. Threats to healthy citizens on the continent include the Human Immuno-Deficiency Virus - Acquired Immuno-Deficiency Syndrome (HIV/AIDS), Tuberculosis, Malaria, episodes of Severe Acute Respiratory Syndrome (SARS), Cholera, Diarrhoeal Diseases, Measles, and Dengue Fever, among others. Non-communicable diseases such as diabetes are also gaining traction across the African continent and threatening citizens as an evolving reality. As such, diabetes is currently a significant public health challenge, and its impact on productivity is contributing to the slow pace of socio-economic development of the African continent.

The burden of diabetes in Africa was estimated to increase by 80%, from 10.4 million people living with diabetes in 2007 to approximately 18.7 million people by 2025.[4] Three types of diabetes are currently prevalent within the African continent. These include diabetes Type 1, Type 2, and Gestational Diabetes. Type 1 diabetes is characterised by an autoimmune reaction that attacks the pancreatic cells responsible for producing insulin (a hormone responsible for regulating blood sugar concentration in humans). This type of diabetes can be inherited by patients genetically or can occur due to environmental elements.[5] It is estimated that between 5% and 10% of the diabetic population has Type 1 diabetes.

On the other hand, Type 2 diabetes occurs when the human body develops resistance against the insulin hormone responsible for the regulation of blood sugar in the body. This is also connected to genetic inheritance as well as lifestyle choices.[6] Notably, approximately 90% and 95% of the diabetic population is suffering from Type 2 diabetes. Gestational diabetes develops in pregnant women that are without a history of diabetes.

Diabetes poses significant financial distress to African families and patients that do not have sufficient health finance, such as medical cover and medical insurance. For example, in 2017, the total medical expenditure towards diabetes patients and medical cases was estimated at approximately $3.3 billion in sub-Saharan Africa.[7] Furthermore, diabetic patients are most likely to experience chronic illnesses such as high blood pressure and hypertension.[8] Consequently, this disease is responsible for a substantial number of deaths; and thereby, robbing the African continent of a productive workforce. In 2017 alone, approximately 298,000 people died because of diabetes, translating into a 6% mortality rate across the African continent.[9]

To mitigate the burden of the disease, the African High-Level Panel on Innovation and Emerging Technologies (APET) is encouraging African countries to adopt medical management technologies to improve diabetic healthcare. Medical management technologies offer more accessible and convenient healthcare options that reduce the burden of frequent hospital visits.

Diabetic patients require constant and periodic monitoring of their blood sugar levels to lead reasonably healthy lives. This involves utilising needles to test and monitor their blood sugar levels. Unfortunately, this monitoring method is unpleasantly painful to diabetic patients. To address this challenge, the stick-free glucose testing method has been developed to help patients avoid using needles. This involves inserting a tiny sensor under the patient’s skin, belly, or underarm and, in turn, wirelessly communicating the blood sugar levels into a pump and/or a smartphone.[10] In this way, patients can painlessly monitor their blood sugar levels. Subsequently, diabetic patients can determine their eating habits, exercising protocols, and insulin dosage concentration.

Medical reminder applications in smartphones have also been developed to remind diabetic patients of their medication schedules.[11] For example, applications such as Care Zone Health Information organiser, Dosecast, Mango Health, and My Meds allow patients to customise reminders for each of their different and periodic medications. Furthermore, Electronic Health Records (EHR) is also gaining traction towards managing diabetes through a patient-centred records management system. The EHR can instantly and securely avail the patient’s health information whenever needed by authorised users and healthcare providers.[12] Unlike traditional booklets, which risk getting lost and tearing apart, the EHR management system stores the patient’s medical history and data in computer servers. Subsequently, this can easily be retrieved whenever needed by medical practitioners in hospitals and clinics.

APET recognises challenges to effectively harnessing these digital technologies to manage diabetes, such as the lack of internet access, the high cost of mobile devices, and expensive monitoring devices. In addition, there are sometimes software glitches and mismatches between smartphones and glucometers. Consequently, this requires the users to purchase even more expensive smartphone mobile devices, which may become a barrier to non-affording patients. Also, most of these smartphone applications are operated in the English language only and not translated into common African languages, which makes it a hurdle for non-English speaking patients across the continent. These challenges, however, can be addressed through expanded infrastructure that caters for the use of digital technologies on the continent. More so, in this pandemic, the need for systems that support telemedicine and utilising digital health tools cannot be overemphasised.

Featured Bloggers – APET Secretariat

Justina Dugbazah

Barbara Glover

Bhekani Mbuli

Chifundo Kungade

[1] https://au.int/sites/default/files/documents/24098-au_ahs_strategy_clean.pdf.

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

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

[4] www.idf.org.

[5] https://www.cdc.gov/diabetes/basics/diabetes.html.

[6] https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes.

[7] M. Zimmermann, C. Bunn, H. Namadingo, M.C. Gray, J. Lwanda, Experiences of Type 2 Diabetes in sub-Saharan Africa: a scoping review. Global Health Research Policy 3, 25 (2018). https://doi.org/10.1186/s41256-018-0082-y.

[8] https://www.medicalnewstoday.com/articles/317220.

[9] Ama de-Graft Aikins, Nigel Unwin, Charles Agyemang, Pascale Allotey, Catherine Campbell & Daniel Arhinful, Tackling Africa's chronic disease burden: from the local to the global. Global Health 6, 5 (2010). https://doi.org/10.1186/1744-8603-6-5.

[10] https://www.webmd.com/diabetes/features/next-generation-diabetes-technology.

[11] https://healthinformatics.uic.edu/blog/how-to-use-mobile-technology-to-manage-diabetes/.

[12] https://www.healthit.gov/faq/what-electronic-health-record-ehr.