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. 2022 Nov 28:2:987828.
doi: 10.3389/frhs.2022.987828. eCollection 2022.

Digital health systems strengthening in Africa for rapid response to COVID-19

Tobias F Rinke de Wit  1   2 , Wendy Janssens  2   3 , Maxwell Antwi  4 , Emmanuel Milimo  5 , Nick Mutegi  6 , Heri Marwa  7 , Njide Ndili  8 , Wasunna Owino  9 , Emma Waiyaiya  9 , Diana C Garcia Rojas  3 , Monique Dolfing  1 , Aafke de Graaff  1 , Ruan Swanepoel  10 , Mark H van der Graaf  1 , Dorien Mulder  10 , Teresa De Sanctis  1 , Santa Kratule  1 , Cem Koyuncu  1 , Khama Rogo  11 , Gloria P Gómez-Pérez  1   2 , Nicole Spieker  1
Affiliations

Digital health systems strengthening in Africa for rapid response to COVID-19

Tobias F Rinke de Wit et al. Front Health Serv. .

Abstract

The COVID-19 pandemic has painfully exposed the constraints of fragile health systems in low- and middle-income countries, where global containment measures largely set by high-income countries resulted in disproportionate collateral damage. In Africa, a shift is urgently needed from emergency response to structural health systems strengthening efforts, which requires coordinated interventions to increase access, efficiency, quality, transparency, equity, and flexibility of health services. We postulate that rapid digitalization of health interventions is a key way forward to increase resilience of African health systems to epidemic challenges. In this paper we describe how PharmAccess' ongoing digital health system interventions in Africa were rapidly customized to respond to COVID-19. We describe how we developed: a COVID-19 App for healthcare providers used by more than 1,000 healthcare facilities in 15 African countries from May-November 2020; digital loans to support private healthcare providers with USD 20 million disbursed to healthcare facilities impacted by COVID-19 in Kenya; a customized Dutch mobile COVID-19 triage App with 4,500 users in Ghana; digital diaries to track COVID-19 impacts on household expenditures and healthcare utilization; a public-private partnership for real-time assessment of COVID-19 diagnostics in West-Kenya; and an expanded mobile phone-based maternal and child-care bundle to include COVID-19 adapted services. We also discuss the challenges we faced, the lessons learned, the impact of these interventions on the local healthcare system, and the implications of our findings for policy-making. Digital interventions bring efficiency due to their flexibility and timeliness, allowing co-creation, targeting, and rapid policy decisions through bottom-up approaches. COVID-19 digital innovations allowed for cross-pollinating the interests of patients, providers, payers, and policy-makers in challenging times, showing how such approaches can pave the way to universal health coverage and resilient healthcare systems in Africa.

Keywords: Africa; COVID-19; digital; epidemic preparedness; health systems.

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Conflict of interest statement

Authors TR, MD, AG, MG, TD, SK, CK, GG-P, NS, MA, EM, HM, NN, WO, and EW were or are employed by PharmAccess Foundation. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Screenshot of dashboard SafeCare4Covid app showing Capabilities score of healthcare facilities.
Figure 2
Figure 2
Screenshot of SafeCare4Covid dashboard showing the aggregate information from the supply checklist.
Figure 3
Figure 3
Maternal care utilization dynamics over time before and after COVID-19. The months illustrated in the figure refer to the year 2020. The drop of utilization observed in this graph is due to the reach of the target for the enrolling cohort. ANC and delivery trends did not drop due to the MomCare COVID-19 support interventions, already active 1 week after the first case of COVID-19 was reported in Kenya on 13 March 2020 showed by the dotted, red, vertical line. ANC, antenatal care.
Figure 4
Figure 4
MCF Cash advance. In this figure the bars represent the number of clients with an MCF Cash Advance loan in each given month, while the red line indicates the average monthly M-Pesa payments in these clinics. MCF, Medical Credit Fund.
Figure 5
Figure 5
MCF increase in disbursement value in 2020. KES, Kenyan Shilling; USD, US dollar. 1 USD = 116.8 KES (July 4, 2022).
Figure 6
Figure 6
Utilization of CovidConnect in Ghana from April 2020 to January 2021.
Figure 7
Figure 7
Effects of COVID-19 on household income from work in 2020. “Holiday,” represent the period during which the interviews were suspended due to the holiday season.
Figure 8
Figure 8
Short-term effects of COVID-19 on household expenditures on food and education. This figure is based on a preliminary analysis performed early during the pandemic, year 2020.
Figure 9
Figure 9
Weekly prevalence of respiratory/airborne diseases in Kisumu, Kenya, before and after the onset of the pandemic in 2020.
Figure 10
Figure 10
COVID-Dx dashboard main page.
Figure 11
Figure 11
Prevalence of COVID-19 infections among immunocompromised patients. (A) Three times higher prevalence of immunocompromised status among COVID-19+ patients compared to non-COVID-19 patients; (B) Three times higher COVID-19 related hospital admission of unvaccinated immunocompromised patients.
See this image and copyright information in PMC

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