Advancing digital health in Nigeria

*Smartphone test spots poisoned water risk to millions of lives
To bridge the gap of low doctor, nurse, midwife, pharmacist and health worker ratio to the over flowing number of patients, stakeholders are leveraging mobile technology for health or rather mHealth.

MHealth is defined “as medical and public health practice supported by mobile devices, such as (cell) phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices.”

Medical experts believe that electronic heath (eHealth) and mHealth have the ability to ensure universal health care (UHC) by increasing enrollment in the National Health Insurance Scheme (NHIS) and rendering services to patients in rural and hard-to-reach areas.

They are optimistic that the introduction of these technologies will reduce misdiagnosis and over diagnosis of diseases, medical errors, faking of medicines and poor treatment outcomes in Nigeria.

Stakeholders are exploiting the growing worldwide popularity of cell phones- and other such personal electronic devices- to create more convenient healthcare for all.

Indeed, “The proliferation of cell phones across the globe, even in locales without basic healthcare infrastructure, is spurring the growth of mHealth in developing countries,” according to West Wireless Health.

With nearly 4.7 billion cell phone users around the world, using such devices as a way to aid health is surely a step toward achieving global wellness. As mHealth Alliance explained: “The ubiquity of mobile devices in the developed or developing world presents the opportunity to improve health outcomes through the delivery of innovative medical and health services with information and communication technologies to the farthest reaches of the globe.”

A recent Digital Health Summit organized in Lagos by the Healthcare Federation of Nigeria brought together stakeholders in the digital health space including the Federal Ministry of Health, Federal Ministry of Communication, National Information Technology Development Agency (NITDA), NHIS, World Health Organisation (WHO), World Bank and Mobile Network Operators (MNOs).

The theme of the summit was “Leveraging Mobile Technology for Health: Progress and Challenges.”

Also, a smartphone device could help millions of people avoid drinking water contaminated by arsenic.

Researchers have developed a biosensor that attaches to a phone and uses bacteria to detect unsafe arsenic levels.

The device, developed at the University of Edinburgh, United Kingdom (U.K.), generates easy-to-interpret patterns, similar to volume-bars, which display the level of contamination.

Researchers say new devices could replace existing tests, which are difficult to use, need specialist laboratory equipment and can produce toxic chemicals.

Indeed, problems present solutions, and Nigerian entrepreneurs are quick to seize the opportunity which is seeing numerous local innovations such as online health insurance subscription plans by Avon HMO, telemedicine by Kangpe and Mobidoc, medical devices by MDaaS, blood centre services by Lifebank, clinical reference information and e-learning by Medenhanz, medication supply by Medsaf and Drugstoc, to the phenomenal aviation emergency ambulance such as Flying Doctors Nigeria.

PharmAccess has been playing a large role in advocating technology to improve access to UHC.

PharmAccess Foundation in its presentation at the Digital Health Summit said: “We believe that quality healthcare relies on efficiency and effectiveness. Mobile technology has helped to achieve this, revolutionizing the healthcare sector so that even the most remote places can be reached by the simple touch of a button.”

Meanwhile, the Bill & Melinda Gates foundation seeks ideas to apply for fund an emerging technology – or a combination of emerging technologies – for new and potentially transformative solutions in digital health priority areas.

The foundation will give out $100,000 USD grants to 50 organisations that can provide new ways of improving outcomes priority areas that encompass: infectious disease outcomes, pregnancy and birth outcomes, child growth and development outcomes, disease surveillance, and research for the development of new vaccines, drugs (including non-hormonal contraceptives), and diagnostics.

The deadline for the application is April 10, 2019.

A few of the many options the Foundation will consider include but are not limited to:
*Artificial intelligence for image analysis of human patients (example, foetal ultrasound, infant optical neuroimaging, or infant video data) or human bio samples (example, tissue sample microscopy or placental morphology) to reveal predictive biomarkers of adverse health outcomes or correlates of resilience
*Materials science for the design of laboratory model systems enabling investigation of new aspects of disease mechanisms (including pathogen persistence) or response to therapy, or enabling high-throughput screening assays (including culture systems to recapitulate complex biological systems)
*Wearable sensors to provide early indicators of treatment response, to identify causal factors underlying adverse pregnancy and birth outcomes, or to continuously monitor systemic metabolites to understand baselines and temporal fluctuation for biomarkers of health and disease
*Synthetic biology approaches to develop highly sensitive diagnostics (example, infectious disease diagnostics based on CRISPR technology)
*Nanotechnology for the creation of sensitive and specific biosensors
*Microscopy for intravital imaging of organ systems to reveal actionable mechanisms to prevent infectious disease pathogenesis or foster robust immune response
*Augmented reality to improve the quality of patient care through interactive guidance for diagnostic procedures
*Virtual reality to simulate host-pathogen interactions for insights into the design of agents to protect against infectious disease
*Geospatial mapping to understand and predict temporal changes in disease burden and design geographically-targeted interventions
*Robotics to enable new drug screening systems
*DNA sequencing combined with data analytical methods to facilitate a transkingdom view of the microbiota across body sites, including potential microbiota-mediated interactions between body sites

The Foundation said it will give highest priority to approaches that:
*Represent potentially transformative approaches that would not have been funded by mechanisms focusing on individual technologies or subject areas
*Represent new perspectives on the problem being targeted, including applying insights from fields outside the priority global health areas that are the subject of this challenge
*Leverage existing data or bio-samples from human cohorts or bio-repositories of proven value

Indeed, Nigeria is facing a boom of numerous tech hubs which are supporting upcoming tech entrepreneurs such as the Co-Creation Hub, as well as getting support from various players such as Facebook, which announced to launch a hub in the country, and the World banks’ US$3 million investments to back Nigerian tech hubs, making Nigeria a vibrant hotspot for digital health tech innovation in Africa.

According to a new DisruptAfrica report, 115 medical-related startups operating in 20 African countries have attracted over $19 million worth of investment, with countries such as Nigeria, South Africa and Kenya leading the scene. The rise in digital health startups in Nigeria can be owed to factors such as a big market with a population of over 180 million people placing a demand on healthcare services in the country.

It has been estimated that about 30,000 Nigerians spend $1 billion annually on medical tourism. To date, 115 Africa’s e-health startups combined have raised investment in excess of US$19 million. Major options to finance digital health startups across Nigeria and Africa include Seed investors and venture capitalists, such as the $100 million Tony Elumelu Entrepreneurship Program (TEEP), the US$1 million African Entrepreneurship Award, and the African Innovation Foundation (AIF), Government schemes such as the YouWin Connect programme, and the banks such as the World Bank and European Investment Bank (EIB).

However, one of the main challenges that healthcare practitioner now face is ensuring that their patients take the correct medication as and when they are supposed to.

A study that was published in the journal Risk Management and Healthcare Policy in 2014 included some worrying statistics.

“Medication non-adherence is widespread and varied by disease, patient characteristics, and insurance coverage,” the authors write, “with [drug] nonadherence rates ranging from 25 percent to 50 percent.”

Failures to take prescribed medication correctly, among other things, “is associated with poor therapeutic outcomes, progression of disease, and an estimated burden of billions per year in avoidable direct healthcare costs,” report the study’s authors.

Noncompliance with a medication regime has a whole host of issues, including hospitalization, relapse, disease flare-ups, poorer quality of life, and possibly even death.

However, there are certain mHealth apps — easily downloadable to a phone or other personal device — that can help people stick to their medication regimen by tracking pills they have and have not taken, prompting them to take a certain drug, and allowing them to log any symptoms.

A lot of mHealth apps can connect a patient with their healthcare provider to improve ease and speed of contact. Being able to chat with a doctor or get advice on a condition, symptoms, or drug at any time has a host of benefits — the most important being the possibility of earlier intervention.

If a patient expresses concerns about their health but can’t physically get to a doctor, they can use an mHealth app to communicate. The doctor might see fit to intervene, thereby potentially saving the patient’s life.

The app, which is called SlipBuddy, could help prevent obesity by aiming to alter user behavior.

Improved monitoring has benefits at the wider population level, too; some mHealth apps are able to collect patient and general healthcare data and store it in a single place.

This allows healthcare providers to peruse the most recent advances in the field, ensuring that the best possible patient outcome can be achieved.

By having such convenient access to health trends — often in real time — healthcare professionals can stay on top of up-and-coming practices, giving them a better idea of how to proceed with patient care.

Another worry about mHealth is lack of regulation. Before a drug is allowed to go to market, the National Agency for Food and Drug Administration and Control (NAFDAC) has to approve its safety. Without their approval, the drug cannot legally be sold.

However, mHealth faces many obstacles in achieving that goal. For mHealth to continue along its successful growth trajectory, there is need for proper regulation.

Many people believe that mHealth is the future of healthcare — but what is the future of mHealth? Where will this technology take the healthcare industry and all those who rely on it?

In several ways, the future is already here; “wearables” are now a part of millions of people’s lives, and seeing a doctor via an app has never been easier.

Using mHealth apps to track symptoms and keep in touch with a healthcare provider can reduce the need for invasive treatments by staying one step ahead of disease.

Openness is a key goal of mHealth developers. Senior mHealth and informatics analyst at Emory University’s Rollins School of Public Health in Atlanta, Georgia, United States, James Michiel, said: “The future of mHealth is open — open access, open source, open data, and open innovation.”

Researcher Harold Thimbleby, writing in the Journal of Public Health Research in 2013, explained that the “future of healthcare is about the patient (or stopping people becoming patients), but patients are not the main stakeholders in healthcare.”

“Insurance companies, big pharma, doctors, managers, suppliers, builders, governments, and many other forces will influence the future,” he added. “Will innovation help patients or will it be partly to help monitor clinicians delivering healthcare?”