This is the 01st 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)

 

Robust healthcare for Africa is significant towards strengthening Africa’s sustainable socio-economic development. In addition, healthcare is also a fundamental human right, as reiterated by the United Nation’s (UN’s) Sustainable Development Goal Number 3 (SDG 3).[1] The UN’s SDG 3 strives to ensure healthy lives and promote the well-being of global citizenry of all ages. On the other hand, the African Union’s (AU) Agenda 2063 envisions a prosperous Africa based on inclusive growth and sustainable socio-economic development and growth.[2] However, for African countries to realise these aspirations, Africa should ensure a healthy and well-nourished citizenry. This requires adequate levels of investment and policy interventions so to augment access to quality maternal healthcare.

Even since independence, most African countries have been attempting to enhance their strategic healthcare facilities and services. Conversely, African countries have encountered various challenges imposed by the continent’s widespread poverty, epidemic diseases, and food insecurity.[3] For example, infectious diseases such as HIV/AIDS and Tuberculosis (TB) have been reported as responsible for the high mortality rates in Africa.[4] Concomitantly, other diseases such as cardiovascular diseases, diabetes, and cancer are also compounding the mortality rate in Africa.[5] Furthermore, epidemic and pandemic diseases such as COVID-19 and Ebola have further burdened the mortality rate in Africa.

Figure 1: Africa Maternal Mortality rate as at 2016. SOURCE: http://www.afri-dev.info/

Remarkably, the negative impacts of Africa’s healthcare challenges are predominantly experienced by African women. This is because African women are barely considered and catered to when formulating and improving Africa’s healthcare services and provisions. For example, Antenatal Care (ANC) receives limited attention and investments, characterised by limited equipment, technology, and necessary infrastructure. Even though there has been progress towards enhancing the child survival rates, ANC has remained challenging for most of Africa’s healthcare provision frameworks.

ANC services are crucial in prioritising and protecting women’s health and their unborn children. This preventive healthcare tool can potentially enable African women to learn from skilled healthcare personnel to encourage robust healthcare measures and behaviours during pregnancy. Moreover, ANC also enables pregnant women to have access to micronutrients and vitamins supplements, treatment from hypertension, and immunisation. In addition, ANC is providing HIV and other sexually transmitted diseases (STD) testing mechanisms. Therefore, such provisions enable the necessary ANC-based medication to prevent mother-to-child transmission of HIV.[6]

An estimated 1.12 million newborn deaths occur annually in Africa.[7] The common primary causes of these newborn deaths include premature births, low birth weight, infections, lack of oxygen at birth, and birth trauma.[8] In addition, African mothers have suffered high maternal mortality rates of approximately 533 maternal deaths per 100,000 live births.[9] This totals to approximately 200,000 maternal deaths annually.[10] Therefore, the ANC services are essential towards screening the women population so as to detect early signs of diseases, as well as determine the risk factors for such diseases. This can therefore help establish and implement timely intervention programmes. Most importantly, the early detection of signs and risks factors to the unborn babies and their mothers can also reduce the mortality rate associated with pregnancy and births.

Furthermore, ANC provides a platform for timely and meaningful interaction between health workers and pregnant women. This provides an opportunity for healthcare education and strengthening pregnant women with the capacity to detect and report pregnancy complication indicators in a timely manner. The healthcare practitioners and pregnant women can collaboratively develop a birth plan to ensure baby delivery at an available healthcare facility.[11]

Africa’s ANC coverage has been progressively improving because over two-thirds of pregnant women have received at least one (1) ANC contact during the course of their pregnancy.[12] However, the World Health Organisation (WHO) has recommended that pregnant women have four (4) ANC visits during their pregnancy cycle.[13] Nonetheless, African women with at least four ANC visits remain at 44% across the continent. This limited ANC attendance is attributable to the long distances between pregnant women in rural communities and their nearest ANC clinics. Consequently, this makes it difficult for pregnant women, and sometimes without the appropriate transportation, to attend their necessary ANC clinic appointments.

Furthermore, there is limited awareness about the significant benefits of attending ANC clinics. As a result, pregnant women may delay their ANC attendance appointments because they are not aware of the recommended frequency of their ANC consultations. Furthermore, there may also be unaddressed misconceptions accompanied by negative social, cultural and religious beliefs within African societies against ANC consultations. Regrettably, pregnant adolescents and unmarried younger women tend to hide their pregnancies to avoid potential exclusion from school and stigmatisation. There is also limited support for pregnant women from their peers, husbands, and family members.

Therefore, these challenges need to be addressed adequately by African policymakers through robust policy interventions. In realising the importance of ensuring maternal and infant health benefits of ANC consultations during pregnancy, the African Union High-Level Panel on Emerging Technologies (APET) is encouraging the deployment of emerging technologies to expand and support the acceptance and utilisation of ANC services and facilities in Africa. These emerging technologies can help pregnant women access information about pregnancy, remind ANC appointments, enable timely monitoring and interventions by healthcare professionals.

For example, the Zanzibar Island of Tanzania has leveraged mobile phone technologies to send ANC attendance reminders to pregnant women. These mobile technology reminders known as the “wired mothers” can send automated Short Messaging Service (SMS) to pregnant women and mothers with unidirectional text messaging. This SMS system also provides a mobile phone voucher system to afford the possibility of a direct two-way communication mechanism between the mothers and their primary healthcare providers.[14] Consequently, this intervention has significantly encouraged and improved the proportion of Zanzibar women towards attending and receiving the recommended four (4) antenatal care consultations during the pregnancy cycle. Therefore, APET recommends that African countries should expand these kinds of mobile phone “wired mothers” applications so to enhance the maternal and newborn healthcare systems.

APET is also urging African countries to adopt the Internet of Things (IoT) technologies to ensure the effective and efficient healthcare of pregnant women through expanded access to ANC services across the African continent. The IoT can interconnect pregnant women and healthcare facilities by using the internet of computing devices embedded in everyday objects and sending healthcare data to healthcare facilities.[15] For example, IoT devices such as the RF-Tags and sensors are attached to pregnant women to monitor and evaluate their vital signs such as body temperatures, pulse rates, respiration (breathing) rates, and blood pressure by professional medical staff on a daily basis. Potentially, these monitoring and evaluation using IoT-enabled mechanisms can help medical practitioners institute timely intervention for pregnant women. Therefore, these improved healthcare mechanisms can timely eradicate potential pregnancy complications and prevent any form of potentially harmful incidents. However, ethical and regulatory frameworks should be established to strengthen the relevant policy frameworks to enhance and consider safety, privacy, religious, legal, and societal concerns.[16]

The continued limited access to hospitals and adequate medical staff members have further caused challenges for pregnant women in Africa. This is predominantly observed in rural Africa. Furthermore, the insufficient data management systems within healthcare systems also negatively impact the quality of healthcare for pregnant mothers when accessing ANC clinic facilities and services. For African countries to enhance ANC facility-data-management-technology-systems (derived from IoTs), APET encourages African countries to utilise blockchain technology-enabled-management-systems. This is because blockchain technology management systems can enable efficient and reliable records keeping mechanisms for future use.[17] For example, Cameroonian medical doctors have developed a blockchain technology-enabled “Gifted Mom”[18] application to provide pregnant women and new mothers access to healthcare information and strengthen their linkages to antenatal care services.[19]

Figure 2: Gifted Mom Application: Bringing healthcare to the fingertips of pregnant women and nursing mothers in Africa. SOURCE: https://www.businesscalltoaction.org/member/giftedmom

Notably, the gifted mom application sends reminder notifications to pregnant women about their next appointment. In addition, the application sends pregnant women vital pregnancy, labour and delivery, vaccination, breastfeeding, and post-natal healthcare information for healthcare educational purposes.[20] Furthermore, the blockchain technology application enables creating and sharing common health information databases.[21] As such, the application assists healthcare providers consolidate the patient’s health data and subsequently formulating and implementing intervention in real-time. Blockchain-enabled healthcare systems can safeguard and exchange patient data between hospitals, diagnostic laboratories, pharmacy firms, and physicians.

Most importantly, blockchain applications can accurately detect acute and dangerous medical mistakes across the medical field to enhance the performance, security, and transparency of sharing medical data within the healthcare system. Furthermore, this technology can effectively enable medical institutions to enhance their capacity to analyse medical records. Thus, APET believes that the technology application within the African context can significantly improve the African healthcare systems.

For example, African countries can improve their electronic medical records (EMR) systems containing detailed patient encounter information such as an encounter summary, medical history, test results, and allergy details.[22] Currently, these African EMRs are collected, retained and handled by professionals from that specific medical institution. Regrettably, these useful EMR systems are limitedly collected, aggregated, and consolidated from multiple medical institutions. This limits the ability to ensure that the patient’s complete medical records are available to authorised practitioners during patient encounters. Notably, no African country has successfully implemented a nationwide EHR system.[23] Therefore, blockchain technologies can help consolidate EMR systems at regional and national levels to enable comprehensive medical assistance for patients.

APET believes that digital technologies such as IoT enabled by blockchain technologies can improve the healthcare and medical service systems for Africa’s pregnant women. As a result, such healthcare-based technology advancements can enhance the safety of pregnant women when accessing antenatal healthcare services. Therefore, African countries should adopt and expand the ANC-enabling technologies to address maternal healthcare challenges. As such, African countries should enhance their investments and resource mobilisation towards expanding their ANC clinics capacity and accompanying infrastructure vital for pregnant women. Furthermore, African countries should establish and develop the necessary enabling policy frameworks to expand their ANC development and implementation in Africa.

Featured Bloggers – APET Secretariat

Justina Dugbazah

Barbara Glover

Bhekani Mbuli

Chifundo Kungade

 

 

[1] https://sdgs.un.org/goals/goal3.

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

[3] https://www.afdb.org/fileadmin/uploads/afdb/Documents/Publications/Economic_Brief_-_Health_in_Africa_Over_the_Next_50_Years.pdf.

[4] Boutayeb A. The Impact of Infectious Diseases on the Development of Africa. Handbook of Disease Burdens and Quality of Life Measures. 2010;1171-1188. doi:10.1007/978-0-387-78665-0_66.

[5] Yuyun, M. F., Sliwa, K., Kengne, A. P., Mocumbi, A. O., & Bukhman, G. (2020). Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective. Global Heart, 15(1), 15. DOI: http://doi.org/10.5334/gh.403.

[6] https://data.unicef.org/topic/maternal-health/antenatal-care/.

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398680/.

[8] https://www.who.int/news-room/fact-sheets/detail/newborns-reducing-mortality.

[9] https://data.unicef.org/topic/maternal-health/maternal-mortality/.

[10] https://www.globalcitizen.org/en/content/maternal-mortality-sub-saharan-africa-causes/.

[11] https://www.researchgate.net/publication/234704943_Factors_Affecting_Antenatal_Care_Attendance_Results_from_Qualitative_Studies_in_Ghana_Kenya_and_Malawi.

[12] https://data.unicef.org/topic/maternal-health/antenatal-care/.

[13] https://www.who.int/pmnch/media/publications/aonsectionIII_2.pdf?.

[14] https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-14-29.

[15] https://www.oracle.com/za/internet-of-things/what-is-iot/.

[16]https://www.researchgate.net/publication/273648993_Internet_of_Things_as_Intimating_for_Pregnant_Women's_Healthcare_An_Impending_Privacy_Issues .

[17] https://www.linkedin.com/pulse/how-improve-healthcare-africa-blockchain-technology-michel-fotsing/.

[18] https://africa4tech.org/young-african-innovators/.

[19] http://www.giftedmom.org/about_us.html#.

[20] Kaaya, Elsie & Ko, Jesuk & Luhanga, Edith. (2021). Maternal knowledge-seeking behavior among pregnant women in Tanzania. Women's Health. 17. 174550652110384. 10.1177/17455065211038442.

[21] Abid Haleem, Mohd Javaid, Ravi Pratap Singh, Rajiv Suman, Shanay Rab, Blockchain technology applications in healthcare: An overview, International Journal of Intelligent Networks, 2 (2021) 130-139. https://doi.org/10.1016/j.ijin.2021.09.005.

[22] Tsegaye, Tamir, & Flowerday, Stephen. (2021). A system architecture for ensuring interoperability in a South African national electronic health record system. South African Computer Journal, 33(1), 79-110. https://dx.doi.org/10.18489/sacj.v33i1.838.

[23] Makubalo, T., Scholtz, B., & Tokosi, T. O. (2020). Blockchain Technology for Empowering Patient-Centred Healthcare: A Pilot Study. Responsible Design, Implementation and Use of Information and Communication Technology: 19th IFIP WG 6.11 Conference on e-Business, e-Services, and e-Society, I3E 2020, Skukuza, South Africa, April 6–8, 2020, Proceedings, Part I, 12066, 15–26. https://doi.org/10.1007/978-3-030-44999-5_2.