Africa CDC aims to be more tech-savvy with new digital health strategy

At least 41 African countries have digital health strategies — and while some have started to implement them, others gather dust on shelves. The strategies are sometimes overly ambitious, leaving countries overburdened with unrealistic goals rather than small, solvable problems. Countries requested guidance on how to best forge the nexus between public health and advancements in technology from the Africa Centres for Disease Control and Prevention. The agency has worked to craft its first digital health strategy over the past eight months, which it expects to launch on March 6 in Kigali, Rwanda, at the Africa Health Agenda International Conference. Devex sat down with Jean Philbert Nsengimana, the chief digital health adviser for Africa CDC, to gain better insight into the agency’s vision of digital health. Previously, Nsengimana served as Rwanda’s minister of youth and information and communications technology for six years. He started with Africa CDC in late 2021. He said the new strategy has two main goals: transforming Africa CDC into a digitalized, “informatics savvy organization” and helping African nations on their “own journey for transforming their health care provision using technology.” “There is an opportunity cost in not working together. If we work together, we stand a much better chance to move faster,” he said. What the continent wants Africa CDC, which launched in 2017, has for years had a strategic public health information systems department established to help countries “develop and establish high-quality information and technology systems" — but only in name. “The intent was there from the beginning, but the time and resources to deploy were not,” Nsengimana said. But that doesn’t mean the agency hasn’t integrated different digital platforms into its operations — development partners have come to the table with various innovations, especially during the COVID-19 pandemic. And the African Union has existing digital infrastructure and platforms that Africa CDC uses. “We really want to build a strong pan-African digital health community.” --— Jean Philbert Nsengimana, chief digital health adviser, Africa CDC “There is a lot already happening in the digital sphere, but there was no strategy,” Nsengimana said. “Africa CDC came to a point where we realized it's high time and really urgent to go back and rethink our approach to using technology for public health.” Developing the strategy has included engaging with departments within Africa CDC to understand pain points and understand what is needed to build a tech-savvy organization. Discussions were also held with development partners investing in the health space and countries to understand what works and the maturity levels in the health tech space. This has included regional workshops and efforts to identify countries that are eager to champion digital health innovations. “We are working to build a coalition of the willing around some of these ideas,” he said. A top priority from the continent’s health leadership, he said, is to ensure that every health facility, front-line health worker, and patient is connected to the internet by 2030, although funding is a barrier — both on the government side as well as restraints on household income. It’s estimated about 30% of the population in sub-Saharan Africa is using the internet — but that figure doesn’t mean the access is consistent or of high quality. Nsengimana said that connecting the health sector and digitizing front-line health services is the only way the continent can reach universal health coverage by 2030. And even when connectivity is present, digital literacy must also grow for providers and consumers. Moving forward, Africa CDC wants to become a “digital and intelligent organization,” he said. And those efforts are already in the works. The agency recently unveiled its new headquarters building in Addis Ababa, Ethiopia, which includes an expansive health emergencies operations center screen, which Acting Director Dr. Ahmed Ogwell Ouma posits could be the largest in the world. Nsengimana said one challenge Africa CDC is facing is a lack of data and evidence on where the continent is on digital health. At the global level, the World Health Organization began to formally advise countries on developing their digital health systems in 2005 and also has a digital health strategy. According to the Global Health Security Consortium, digital health can be used in areas such as “immunisation registries, appointment registration, patient communication, clinical-trial enrolment, integration with diagnostics and labs, clinical-decision support, population targeting and collection of real-world evidence to support products.” “Africa CDC came to a point where we realized it's high time and really urgent to go back and rethink our approach to using technology for public health.” --— Jean Philbert Nsengimana A network of experts and scaling of startups Many of those developing digital health policies and implementing programs for African governments aren’t experts in both technology and public health, Nsengimana said. Africa CDC plans to establish a pan-African health informatics fellowship. It will also advocate for countries to offer their own national public health informatics fellowships, in partnership with domestic schools of public health — to increase education of health data and technology. Africa CDC is creating a pan-Africa Health Informatics Network to create a multiplier effect for those that already have that dual expertise, he said. If a person with unique digital health expertise lives in Zimbabwe, for example, stakeholders in countries across the continent should know how to contact that person and deploy their skills. “We really want to build a strong pan-African digital health community,” he said. Countries also must decide how to coordinate government efforts in the ministries of health, national public health institutes, and ministries in charge of technology. Countries are also asking for more country-to-country peer learning to get guidance from those in similar contexts, rather than from high-income countries. Kigali hosts The HealthTech Hub Africa which works with startups and governments on fostering health innovations. It graduated a cohort of 30 startups and is working with another 40 this year. Nsengimana said startups across the continent are looking for support in scaling up beyond their home markets to become pan-African health tech providers. Cross-border standards Nsengimana emphasized the need for countries to follow global open standards — which allows interoperability, meaning the integration of data from multiple sources. Patient data is often siloed in databases that don’t speak to each other. For example, if a person has HIV, their data might be in an HIV-specific database. A health care provider looking at this database wouldn’t necessarily know the person has diabetes nor that they need a COVID-19 vaccine. The vision, according to Nsengimana, is health facilities working with private sector providers as custodians of this data. Health facilities don’t necessarily all have to use the same providers, but the providers would follow the same global open standards. Then a patient has their entire health history on their mobile phone, which might be protected by passwords or biometrics. When a person visits a different health facility — even across borders — the health provider can see their health histories because that facility’s providers follow the same global open standards. “I can decide to do whatever I want with my data, including deleting my data if I don't want my file to be with that specific provider,” he said. “It's a digital single market where a person can get [high quality] treatment regardless of where they are.” Nsengimana gave the example of Nairobi-based Afya Rekod, a blockchain platform that allows people to store their health information digitally. Additionally, the Commons Project, in collaboration with the Mastercard Foundation, is working with the governments of Rwanda and Senegal to prove a new concept around a “person-centered” health data model. The goal, he said, is to ensure each African citizen can access and control their health data on their mobile phones by 2030. He also expects that digitization, especially of primary health care, will create jobs. “We believe when this information is aggregated, connected, centered on the person, then innovators can really start providing value-added services on top of that information,” he said. He said countries must also be empowered to stop donors from introducing programs that further silo information. An agile approach Nsengimana expects the strategy will continually evolve. “We can't figure out everything at once,” he said. “This is completely the opposite of what every other 5-year, 7-year, or 2030 strategy is about — which is to fix the goal posts, mechanisms, budgets, and lock them in 5 years in advance and start executing. Tech doesn't work like that.” But the strategy won’t be devoid of goals, he said, such as connecting all health facilities to the internet by 2030. According to a spokesperson for WHO, there isn’t a current estimate of the percentage of health facilities connected to the internet in Africa. “It's ambitious but I just can't imagine a world in which by 2030, a health care provider wouldn't have an internet connection. What kind of Africa is that?” Nsengimana asked.