The authors wish to thank Patrick Russel and Natacha Mugeni for their contributions to this article.
Public healthcare spending has doubled in sub-Saharan Africa over the last two decades, with the per capita going from $100 in 2000 to $205 in 2018. But, despite this progress, access to primary care remains a challenge for many people. In remote areas, it’s still difficult and costly to access a doctor, a nurse, or the appropriate treatment. Six out of ten people are not covered by Universal health coverage schemes, and for those covered, the out-of-pocket expense is significant and can be as high as 76% in Nigeria. Moreover, going to the hospital is associated with bad personal experiences for many people discouraged from seeking preventative care. The challenge is even daunting when we factor in the population growth on the continent. By 2050, the continent’s population is projected to double to 2.5 billion people, with one in four people in the world living in Africa. The healthcare sector needs a massive increase in productivity to address this challenge, and we cannot see it happening without bringing in new innovative approaches and leveraging digital technologies.
Provide better health through digital
With the recent uptake in smartphone and internet usage, there is an opportunity to take a different approach to quality and cost-effective primary health. Digital health services could transform people’s experience with healthcare. Even in rural areas, internet uptake has increased to 60% in some countries such as Senegal and Zimbabwe. Seeking a doctor consultation could be as simple as pulling out a phone to book a virtual appointment. The patient could order her medication through an e-commerce health platform doing last-mile delivery in rural areas. This scenario is already a reality in Kenya, but most people in sub-Saharan Africa are not yet benefiting from this opportunity. Given population growth projection for the next decades, this opportunity is one that stands to grow exponentially.
The good news is that Africa is only at the onset of its digital health journey, and we are seeing the rapid growth of highly scalable innovations that have the potential to disrupt global health. Startups like Kasha and Totohealth are bringing concrete and fast-to-market digital health and self-care solutions for women with novel business models that benefit both patients and providers in urban and last-mile environments. Focusing on the customer experience helps these businesses to improve patients’ interaction with primary health and enhances spaces such as self-care. Other players such as Crib MD are building on-demand preventive care platforms. Beyond primary care, BIMA seizes the opportunity to safeguard people from economic shocks by providing cost-effective health insurance.
Unfortunately, too few of these solutions are available at scale and customers without access to smartphones are not often prioritized. Entrepreneurs face multiple challenges to bring their products to the masses and reach those still using a basic mobile phone. It is important that whilst we acknowledge the power of digital health care and the benefits it provides, we do not forget those who do not have easy and affordable access to digital solutions. We believe there are complementary opportunities between these private initiatives and the public health systems to build affordable, cost-effective, and sustainable primary care services to the hard-to-reach.
Seizing the digital health opportunity
Our experience suggests that building platforms that bring together startups, public health systems, and regulators will enable countries to take advantage of the digital health opportunity fully. Similar approaches have yielded benefits in other countries. For example, Doctolib, a French startup offering online doctor-appointment services, has increased access to providers with a user-friendly experience, an area in which the public health offering was lagging. During the Covid-19 pandemic, public bodies, startups, and regulators collaborated closely to make PCR-tests and vaccine appointments widely available, leading to other innovations such as ChronoDose or ViteMaDose, built as soon as the vaccines were available.
Empathize with patients
Getting a deep understanding of patient needs and behaviors is the best place to start for all ecosystem actors, that way platforms are built with a customer first approach. Patients need a space to share their pains and aspirations, which are necessary to build sustainable digital health products and services. Additionally, each country is different, and understanding people’s cultural norms, behaviors, and specific digital profiles will increase digital health adoption and utilization.
Create space for entrepreneurs to grow
Enabling the new digital health startups to emerge should be a priority for countries. It starts with standard innovation building blocks such as dedicated support, mentoring programs, coupled with eased access to financing to demonstrate product-market fit. For digital health, it also requires evolving the regulatory framework to enable use cases such as remote consultations and task shifting while protecting patients’ data and privacy.
Experiment boldly within the public health systems
Too few health systems are digitalized today, data is not collected, and most investments provide basic needs. While this remains critical, bringing technology could bring massive operational efficiencies within the current healthcare systems and improve patients’ experience. But it requires a bold vision to bring the technology within the public health system. Starting with patient-facing services could be an excellent place to begin building a digital and data-driven culture within public health agencies. The future of public healthcare relies on engaging new models alongside the traditional public health models and leading with successful public-private partnerships or success.
Share and collaborate
Public health systems have an established distribution system across countries, and startups have innovation and the ability to deliver market-ready products with a novel business model as well provide traceability back to the provider. Learning platforms where people will learn from each other through local organizations are critical. These platforms will help entrepreneurs understand the challenges in the healthcare systems while exposing public health bodies to the innovation mindset that startups bring. Finally, collecting and sharing data through open data platforms will be critical to foster concrete solutions that will ultimately benefit the patients wherever they are.
 Current health expenditure per capita, PPP (current international $) – Sub-Saharan Africa, European Union | Data (worldbank.org)
 UHC service coverage index – Sub-Saharan Africa | Data (worldbank.org)
 Out-of-pocket expenditure (% of current health expenditure) – Sub-Saharan Africa | Data (worldbank.org)
 DHS Survey : Usage of internet, ownership of a mobile phone
 Vite Ma Dose : trouvez un créneau de vaccination COVID-19 (covidtracker.fr)