Across much of Africa, healthcare systems continue to face immense challenges around access, quality, and affordability of care. These challenges have contributed to significant disparities in health outcomes and the well-being of the population. A scarcity of healthcare professionals, such as doctors and nurses, as well as inadequate healthcare facilities and medical equipment, has been a long, pervasive issue in most African countries.
However, amid these challenges, there is a notable transformation and promising growth of health technology, often referred to as HealthTech, and digital health solutions across the continent are beginning to reshape healthcare delivery and access. Innovative startups and companies are pioneering game-changing solutions that bridge gaps and provide renewed hope for improved healthcare delivery and management.
The transition from paper-based records to digital systems has the potential to improve the accuracy and accessibility of patient information, ultimately improving care quality and streamlining administrative processes.
Startups such as Babyl Rwanda, for example, have pioneered online teleconsultations, which use technology to connect patients in remote, underserved rural areas to qualified medical professionals in urban centers. This ground-breaking approach not only addresses the issue of geographical distance, but it also has the potential to alleviate the shortage of doctors in outlying areas. Patients can conveniently access medical consultations via their mobile devices, transforming their healthcare experience. Helium Health in Nigeria is yet another example of technology’s transformative power in healthcare. The company provides a platform for patient record digitization and efficient management. The transition from paper-based records to digital systems has the potential to improve the accuracy and accessibility of patient information, ultimately improving care quality and streamlining administrative processes. MyDawa, a Kenyan company, has entered the digital pharmacy space, providing online pharmacy applications that allow patients to easily manage their prescriptions and medication regimens via their mobile devices. This advancement not only improves patient convenience but also contributes to improved medication adherence, which is an important aspect of effective healthcare management.
It is critical to strike a balance between the benefits and risks of these innovations in order to create a more equitable and efficient healthcare system in Africa.
The rapid growth of health technology and digital health solutions in Africa also however brings its own hazards. While these innovations may offer potential solutions to healthcare challenges, they also raise concerns about corporate power, new forms of dependency, data privacy, regulation, and potential disparities in access. The widespread adoption of technology in healthcare necessitates careful examination to ensure that it genuinely improves healthcare access and quality while avoiding unintended consequences. It is critical to strike a balance between the benefits and risks of these innovations in order to create a more equitable and efficient healthcare system in Africa.
Corporations and Public Value
Protecting health data rights in Africa faces numerous challenges, including a significant knowledge gap among many citizens, particularly those living in rural areas, about the importance of their personal data. This lack of awareness makes it increasingly difficult to ensure that their health information is handled responsibly. Even if individuals were given access to their data, the majority would most likely struggle to understand the implications and nuances of the content, exacerbating the problem.
Even if individuals were given access to their data, the majority would most likely struggle to understand the implications and nuances of the content, exacerbating the problem.
This challenge is made worse by the existing lack of transparency between individuals and the technology companies collecting their health data. These tech companies wield significant data insights power, making it difficult for users to enforce their rights and have a meaningful say in how their data is used. To address these critical concerns and mitigate the power differential, it is necessary to establish and enforce strong laws and policies.
This centrality of the private sector is also a worrying proposition. As African countries have experienced with the history of digital payments and finance, the advent of new technological solutions can also lead to a loss of autonomy owing to new relations of dependence within capitalist and tech value-chains. While multinational actors do not play the same outsized role in health as they did in finance, it remains the case that large parts of the digital infrastructure – from submarine cables to cloud servers – continue to belong to Big Tech. Moreover, a lot of the venture capital that is being invested in local startups is also international in origin. In the absence of proper regulatory restrictions, this situation can lead to a healthtech industry that is driven by the profit motives of an international class of investors, as opposed to by a clear mapping of local needs and opportunities.
The Need for Interoperability
Essentially denoting the ability of different software and technical systems to be able to exchange information and communicate, the lack of interoperability is a challenge that healthcare practitioners, such as pharmacists, have often stressed.
According to a seasoned pharmacist whom I interviewed, “Interoperability is the heartbeat of healthcare in the digital age.” However, this is something that, from their experience, is evidently lacking, and this seemingly is creating roadblocks in the healthtech sector. The pharmacist went on to clearly paint the picture: “Consider this scenario: a patient is using a mobile health app to manage a chronic condition, such as diabetes. The app monitors vital signs and medication adherence. As a pharmacist, I’m here to offer sound advice and support. I’ve seen firsthand the impact of interoperability gaps. But we’ll hit a wall if the app cannot seamlessly share this critical data with my pharmacy system.” Interoperability is more than just a technical challenge; it is the link that connects patients, healthcare providers, and data. It’s not just about convenience; it’s also about patient safety and maximizing the potential of health technology in Africa. The desire for improved interoperability transcends technicalities; it is a responsibility that, according to the pharmacist, “is owed to our patients.”
Interoperability is more than just a technical challenge; it is the link that connects patients, healthcare providers, and data. It’s not just about convenience; it’s also about patient safety and maximizing the potential of health technology in Africa.
In Africa, interoperability solutions are still uncommon in most low and middle-income countries. However, some countries have made significant progress in developing and implementing national health information exchanges that enable cross-program data exchange. For example, Tanzania has implemented a five-step procedure to integrate the country’s vertical health management information system with the help of an interoperability layer that enables cross-program data exchange.
As healthcare in Africa becomes more digital, we need a connected healthcare network where data can flow freely. This has the potential to improve care quality and health outcomes for all.
The Sensitivity of Health Data
Furthermore, many African countries participate in international health data sharing through trade partnerships, a practice that gained prominence during the COVID-19 pandemic as foreign investments in health research and products increased. Moderna’s plans to open a vaccine plant in Kenya, for example, necessitated extensive data sharing, raising concerns about the adequacy of data protections in receiving countries in comparison to domestic regulations. The emphasis on harmonizing these safeguards across international borders is frequently lacking, resulting in critical gaps in health data protection.
As health data increasingly moves to digital and centralized systems, improper data handling can create opportunities for exploitation in the absence of effective oversight. Patients frequently lack understanding and control over how their health data is stored, analyzed, and shared.
As health data increasingly moves to digital and centralized systems, improper data handling can create opportunities for exploitation in the absence of effective oversight. Patients frequently lack understanding and control over how their health data is stored, analyzed, and shared. While systems may claim to be in compliance with laws, the practical application of these laws is frequently fraught with flaws and misapplications, contributing to opacity. Because of this lack of transparency, populations are vulnerable to invasions of privacy, profiling, and discrimination.
Recent events serve as stark reminders of the security and privacy risks associated with African health data. For example, a data breach at Nigeria’s PLASCHEMA exposed citizen data due to insufficient security measures, highlighting the critical need for robust security protocols. Similarly, a cyber attack on Life Healthcare, a South African healthcare provider, compromised the personal information of over 11 million patients, highlighting the continent’s vulnerabilities in protecting consumer health data.
The Legislative Landscape on Data Protection
Given the centrality of the issue of data, it is worth surveying a couple of cases with respect to legislative intervention in the continent. In regards to health data protection regulations in Africa, one is presented with a patchy picture. While many Sub-Saharan African countries have passed data protection legislation to protect citizens’ information, several issues and gaps remain, particularly with regard to the protection of personal health data and de-identified data.
For instance, Article 31 of Kenya’s constitution firmly upholds the right to privacy, emphasizing the importance of protecting personal information. This right is further defined by the Data Protection Act of 2019, which establishes principles for the proper handling of individuals’ data. Sensitive health data is given special consideration, reflecting the growing importance of healthcare-related information. The Kenya Health Information System Policy, on the other hand, presents a critical issue in the form of a lack of concrete guidance on health data handling protocols and access controls. As the system’s transparency falls short, this lack of clarity poses a significant challenge for individuals seeking to verify the security of their data. Although standards for eHealth interoperability exist to facilitate efficient data transfer across institutions, transparency regarding other entities’ data access remains inadequate.
Similarly, health data practices in South Africa are primarily governed by the Protection of Personal Information Act (POPIA). This legislation defines the rights and responsibilities associated with the collection, storage, sharing, and security of personal health information. Key requirements include lawful, fair, and transparent data processing, reasonable security safeguards, obtaining consent for third-party data transfers (with limited exceptions), and ensuring individuals have access to data processing practices. In addition, other laws, such as the National Health Act, apply. Notably, the South African government is developing comprehensive legislation solely focused on health data, indicating a commitment to improving health data protection. That said, implementation remains at a rudimentary stage, and there continue to be problems with respect to regulating data’s flows, especially when its taken out of the country.
Several factors influence the effectiveness of these data protection efforts in Africa. Awareness, a critical component, frequently lags behind, leaving individuals unaware of the safeguards afforded to their data by legislation such as POPIA. Compliance costs pose challenges for organizations, potentially discouraging them from adhering to data protection regulations. Furthermore, enforcement resources, particularly the capacity of regulatory bodies such as the Information Regulator, may be limited, potentially jeopardizing the effectiveness of the laws. Finally, while issues such as privacy and citizen rights have become a prominent part of public perception of the issues, these remain a subset of relevant concerns for digital justice. Questions of the distribution of value that data generates, of who gets to own and control key social infrastructure, and to what extent a nation’s technological autonomy needs to be protected are all important questions. These have not yet become central to the public debate.
The Way Forward for Healthtech
More and more, African visions of development are articulated with healthtech components woven in. The Africa Union’s Digital Transformation Strategy 2020-2030, for instance, cites the health sector as critical to driving digital transformation for prosperity and inclusivity. In the same vein, The Africa CDC’s Digital Transformation Strategy 2023-2030 aims to harness digital health to leapfrog existing barriers affecting public health in the region.
However, as the discussion here has tried to highlight, the lure of any ‘magic bullet’ type solutionism must be avoided. Not only does the manner of implementation matter a great deal, the current trajectory of digitalization leaves a lot to be desired in terms of robust guardrails. Indeed, while the momentum builds in the start-up space, it is important that these various issues are dealt with in earnest.
Data protection requires both strong legislation, as well as a large civic campaigns for building mass political consciousness around the economy. Without a wider understanding of what is at stake in this rapid proliferation of data use, there is every reason to believe that the profit motive will prevail, and that attempts to enshrine proper data rights for citizens will fall by the wayside. What is more, while it is commendable that privacy and other civic rights have become a prominent part of policy-making, it is important that this does not occur at the expense of other tenets of digital justice. The need to counter problematic dependencies and build technological autonomy is a crucial imperative, as well as ensuring that the dividends of data value flow to the entire community, and not just to a handful of large private actors.
The need to counter problematic dependencies and build technological autonomy is a crucial imperative, as well as ensuring that the dividends of data value flow to the entire community, and not just to a handful of large private actors.
In addition to this, it is also important to ensure that the right values are also built into the technical structure of digitalized healthcare. Interoperability, for instance, not only greatly enhances the power of these technological solutions, it also serves as a ready counter to data-silos and monopolistic behavior. Similarly, the use of open-source options and cryptographic tools can help ward off both proprietary dominance and threats to privacy. Ensuring that these political decisions are shaped democratically is a key mandate for civil society groups in the development of healthtech.
Africa has a unique opportunity to define forward-looking, patient-centered models for digital healthcare. If it works to build the right kinds of governance frameworks, technological capacities, and popular engagement, it can set an example for countries across the South when it comes to this space. However, a commitment to equitable and public-centric solutions as well as collaborative efforts between governments, technology providers, and civil society will be essential to achieve this goal.
