Derrick Muneene

Background: Artificial Intelligence (AI) platforms, increasingly deployed in public health, utilize robust data systems as a critical component for health emergency preparedness. Yet, Africa faces numerous challenges in the availability, analyses, and use of data to inform health decision-making. Countries have limited access to their population data. Those with access, struggle to utilize these data for program improvements. Owing to the rapid growth of mobile phone ownership and use in the region, Africa is poised to leverage AI technologies to increase the adoption, access and use of data for health. To discuss and propose solutions for responsible development and adoption of innovations like AI in Africa, a virtual workshop was organized from the 21st to 24th June, 2021. This report highlights critical policy dimensions of strengthening digital health ecosystems by high-level policymakers, technical experts, academia, public and private sector partners. Method: The four days’ workshop focused on nine sessions, with each session focusing on three themes. Discussions during the sessions concentrated on public and private sectors, the academia and multilateral organizations’ deployment of AI. These discussions expanded participants’ understanding of AI, the opportunities and challenges that exist during adoption, including the future of AI for health in the African region. Approximately 250 participants attended the workshop, including countries representatives from ministries of Health, Information and Technology, Developmental Organizations, Private Sector, Academia and Research Institutions among others. Results: The workshop resolved that governments and relevant stakeholders should collaborate to ensure that AI and digital health receive critical attention. Government ownership and leadership were identified as critical for sustainable financing and effective scale-up of AI-enabled applications in Africa. Thus, government is to ensure that key recommendations from the workshop are implemented to improve health sector development in Africa. Conclusions: The AI workshop was a good forum to deliberate important issues regarding AI for health in the African context. It was concluded that there is a need to focus on vital priorities in deploying AI in Africa: Data protection, privacy and sharing protocols; training and creating platforms for researchers; funding and business models; developing frameworks for assessing and implementing AI; organizing forums and conferences on AI; and instituting regulations, governance and ethical guidelines for AI. There is a need to adopt a health systems approach in planning for AI to reduce inefficiencies, redundancies while increasing effectiveness in the use of AI. Thus, robust collaborations and partnerships among governments and various stakeholders were identified as key.

Background: Discussions on the use of digital health to advance health have continued to gain traction over the past decades. This is important considering the rising penetration of mobile phones and other digital technologies and the opportunity to leverage those digital and electronic health methods and innovations to accelerate Universal Health Coverage (UHC) and the health Sustainable Development Goals (SDGs). In Nigeria, however, the full benefits of digital technologies to strengthen the health systems are yet to be fully harnessed due to critical challenges in the sector. These challenges include but not limited to weak health systems governance, weak infrastructural investments, inadequate resources, weak human resource capacity, high cost of scaling-up and coordination issues among others. Lack of systems thinking, and design have significant impact on coordination of efforts and has resulted in the fragmentation and non-interoperability among various applications. To discuss these challenges and propose the way forward for rapid sustainable, scalable and cost-effective deployment of digital health in Nigeria, a digital health capacity development workshop was held in Abuja and across the six geo-political zones of Nigeria from 20th – 30th November 2019. This paper documents key conclusions and achievements at the workshop. Methods: The workshop was organized around eleven modules and seven thematic areas which explored the Nigerian digital health governance and coordinating mechanisms in view of its status, leadership, financing and deployment for effective service delivery. It was attended by over 100 participants from varied background including Ministries of Health, Ministries of Communications and Digital Economy, International Organizations, Operators, Civil Society, Academia and Private Sector Experts. Results: The workshop resolved that while digital health technologies offer profound opportunities to strengthen Nigerian health systems for UHC and the health SDGs, there should be a move from donor-driven pilot projects to robust, sustainable, cost-effective and nationally owned projects. This will involve a people-centered approach that should be demand-driven and not supply-driven to avoid wasting time on ineffective interventions, duplication of efforts and wastage of scarce health resources. Government ownership and leadership was identified as critical for sustainable financing and effective scale up of Digital Health projects in Nigeria. Conclusions: The DH capacity development workshop was a good forum to deliberate important issues regarding sustainable and cost-effective DH solutions that could be scaled to strengthen health service delivery in Nigeria. Insightful ideas for scaling DH in Nigeria and other related settings emanated from the workshop, necessitating the need for a focused government commitment and leadership in institutionalizing digital health in Nigeria.

Debate regarding the impact of information and communication technology (ICT) on health outcomes has prompted researchers to conduct analyses across many parts of the globe, yet, still little is known about the ICT impact in the African continent. Using a robust multivariate approach, this study examined system-wide impact of ICT diffusion on multiple health outcomes for HIV and tuberculosis among sovereign countries of Africa. This study utilized longitudinal panel data from the World Bank and International Telecommunication Union databases between 2000 and 2016. We relied on a robust linear dynamic panel model to incorporate lagged time variables to estimate the relationships between ICT infrastructure (mobile phone use, internet access, and fixed-telephone subscriptions) and HIV and tuberculosis outcomes. Econometric analyses found that the coefficients of the aggregate ICT variables were all negative (except for fixed telephones) for tuberculosis health measures and HIV prevalence, and positive for access to antiretroviral therapy. The diffusion of mobile phones and internet was associated with decreased incidence of tuberculosis, HIV prevalence, and tuberculosis mortality rates. However, increased diffusion of these three ICT tools was associated with increased access to antiretroviral therapy. Thus, African governments should identify investment strategies for adopting and implementing ICT to improve population health outcomes.

The use of digital technologies to improve access to health is gaining momentum in Africa. This is more pertinent with the increasing penetration of mobile phone technology and internet use, and calls for innovative strategies to support implementation of the health-related Sustainable Development Goals and Universal Health Coverage on the continent. However, the huge potential benefits of digital health to advance health services delivery in Africa is yet to be fully harnessed due to critical challenges such as proliferation of pilot projects, poor coordination, inadequate preparedness of the African health workforce for digital health, lack of interoperability and inadequate sustainable financing, among others. To discuss these challenges and propose the way forward for rapid, cost-effective and sustainable deployment of digital health in Africa, a Digital Health Hub was held in Kigali from 8th to 9th May 2018 under the umbrella of the Transform Africa Summit 2018. The hub was organized around five thematic areas which explored the status, leadership, innovations, sustainable financing of digital health and its deployment for prevention and control of Non-Communicable Diseases in Africa. It was attended by over 200 participants from Ministries of Health and Information and Communication Technology, Private Sector, Operators, International Organizations, Civil Society and Academia. The hub concluded that while digital health offers major opportunities for strengthening health systems towards the attainment of the Sustainable Development Goals including Universal Health Coverage in Africa, there is need to move from Donor-driven pilot projects to more sustainable and longer term nationally owned programmes to reap its benefits. This would require the use of people-centred approaches which are demand, rather than supply-driven in order to avoid fragmentation and wastage of health resources. Government leadership is also critical in ensuring the availability of an enabling environment including national digital health strategies, regulatory, coordination, sustainable financing mechanisms and building of the necessary partnerships for digital health. We call on the Smart Africa Secretariat, African Ministries in charge of health, information and communication technology and relevant stakeholders to ensure that the key recommendations of the hub are implemented.