The ubiquity of mobile phones in Africa has increased connectivity between people, information, markets and services. Mobile phones have straddled the digital divide between urban-rural and rich-poor groupings in developing countries.⁽²⁾ Over the past few years there has been an array of research and pilot projects concerned with the integration and up-scale of mobile phone technology into healthcare systems within resource constrained environments.⁽³⁾ This research has highlighted the use of mobile phone technology to curb costs for healthcare centres and patients, provide systems of surveillance and monitoring of disease outbreaks, prevent stock-outs of medication and assist in patient adherence to treatment programmes.⁽⁴⁾

Since mobile phones could bring about new healthcare innovations that could potentially transform the state of weak healthcare systems in contexts where resources are scarce, this discussion paper argues that mobile phones can be used to address some of the challenges that are unique to the current outbreak of the Ebola virus, which to date has claimed over 2 000 lives in Guinea, Liberia and Sierra Leone. While some of the solutions offered by mobile phones to curb the spread of the Ebola outbreak can be instituted immediately, it is also argued that in order to derive the full benefit of mobile phones, a long term solution should be adopted. This paper also argues therefore that African governments, particularly in the affected West African region, need to make an urgent and concerted effort to invest in the integration and upscale of mobile phones into healthcare systems.

Fighting Ebola in the midst of healthcare challenges in Africa

African states and other countries in the developing world have experienced a number of healthcare challenges owing to the protracted fight against parasitic, communicable and, more recently, non-communicable lifestyle diseases.⁽⁵⁾ Aggravating the poor state of healthcare systems in the majority of African countries is a lack of basic service provision of sanitation, clean water and nutrition. Pressured by poor infrastructure in the form of hospitals, healthcare centres and testing laboratories as well as shortages of skilled healthcare technicians and workers, African states tend to face an uphill battle in their efforts to implement efficient healthcare systems that address the myriad of health needs of their populations.⁽⁶⁾ These challenges have recently come to the fore with the devastating impact that the Ebola virus has had in Guinea, Liberia and Sierra Leone.

Reports from international media often point at inappropriate human and infrastructure capacity to contain the outbreak of the virus. These reports emphasise an inability to conduct effective surveillance of affected areas so as to provide targeted treatment to the flashpoints where suspected cases have been reported.⁽⁷⁾ News and academic reports also reveal that the uncontrollable spread of the Ebola outbreak is partly due to the virus being previously unknown to this specific region of West Africa. As such, the virus went undetected for a while before doctors and healthcare workers realised what it was.⁽⁸⁾

Consequently, the battle to curb the spread of Ebola has essentially been fought on two fronts. On the one hand, Ebola has killed healthcare workers who were not aware of the safety procedures and regulations to be employed when nursing infected patients. On the other hand, a number of misinformed inhabitants of the affected countries who display symptoms of Ebola often refuse to get tested due to fear of being stigmatised or because of longstanding practices of consulting traditional healers in the event of death due to a mysterious sickness.⁽⁹⁾ In this instance people have opted for self-administered treatments or traditional medicines. Despite this, even if patients are willing to undergo testing few, if any, laboratories in the concerned West African region have the capacity to safely test a virus as fatal as Ebola.⁽¹⁰⁾

The potential uses of mobile phones to combat Ebola: Long and short term solutions

Dialogue centred on the role of mobile phones and other forms of information communication technologies (ICT) in addressing 21st century health challenges, coined “m-Health”, is a fairly recent topic which has generated much debate about the opportunities and efficacy of mobile phones to improve health systems, particularly in resource constrained contexts. Eleven ministers of health in West Africa have endorsed the use of mobile phones to fight the ongoing spread of Ebola.⁽¹¹⁾ However, none of the three countries most affected by it or the health-based transnational agencies treating the sick have outlined a comprehensive strategy through which to fight the virus, let alone the strategic incorporation of mobile phones in health systems to address the outbreak.

However, scientific studies show that mobile phones can be used as a tool to collect good quality data that can inform healthcare workers and authorities on the number of people that are sick and the number of people that have died. The findings of these studies reveal that healthcare centres that adopt such an approach are better placed to ensure a more accurate headcount as opposed to paper-based data collection methods that are subject to getting lost.⁽¹²⁾ Furthermore, an accurate data collection method using mobile phones to record and transmit data in real time could potentially empower healthcare authorities and technical experts to make better informed decisions on the kind of strategic interventions that are required to curb the ongoing spread of viruses like Ebola.⁽¹³⁾

Routine syndromic surveillance systems contained in laboratories in the affected West African region could also be designed to rely on mobile phones. This could assist in establishing early-warning systems and the provision of customised mechanisms through which to respond to an outbreak.⁽¹⁴⁾ Although such solutions may require time and resources to erect technological infrastructure and train healthcare officials, these same mobile phone-based solutions could potentially assist healthcare workers and authorities in the future to better track and monitor the geographic reach of the virus, which has since compelled government officials to shut borders between Guinea, Liberia and Sierra Leone.⁽¹⁵⁾ Even though boarder closures may seem to be the only alternative with an Ebola outbreak which has been declared an international emergency, they may adversely affect the livelihoods of communities that reside in towns and villages situated along the borders. By incorporating mobile phone-based data collection methods to syndromic surveillance systems, outbreaks of the virus in the near future could be traced rapidly and adequate methods of response could be developed in order to contain it. This in turn could not only prevent an uncontrollable spread of Ebola, and therefore the need for border closures, but also prevent the need to create quarantined zones of communities suspected of continuous outbreaks or high rates of Ebola-related deaths as witnessed in informal settlements and farming communities situated in villages in the three affected countries.⁽¹⁶⁾

Open-source software programmes that receive and send bulk text messages have been used in countries such as Zambia, Kenya and South Africa to communicate with HIV positive people and with pregnant women. In these three scenarios text messages have been used to disseminate healthcare information on adequate nutrition, adherence to drug treatments and clinic appointments.⁽¹⁷⁾ The success of these initiatives can largely be ascribed to the pervasive use of mobile phones by community members. Mobile phone usage in Guinea, Liberia and Sierra Leone is also rather pervasive with the market having grown remarkably over the past 10 years as each country boasts at least two mobile network operators. Mobile phone penetration is estimated at 65% in Liberia, 67% in Sierra Leone and 38% in Guinea.⁽¹⁸⁾ Similar trends can also be seen in the majority of West Africa and other regions of the continent, wherein the vast reach of mobile phones has rendered many parts of Africa as attractive markets for ICT development.⁽¹⁹⁾

When Ebola was discovered in the 1970s, healthcare workers would often venture into affected communities with megaphones to spread awareness about the virus to affected communities.⁽²⁰⁾ However, considering the ubiquity of mobile phones in urban centres and rural areas in the affected region, the use of open-source software programmes that enable the dissemination of bulk text messaging can be adopted as an immediate solution to the current Ebola outbreak by opening up lines of communication between healthcare workers and affected locals. This will enable the spread of crucial information about the virus and empower communities to adopt the necessary safety measures to encourage prevention and also counter misinformation and demystify inaccurate beliefs that often leave people vulnerable to contracting the virus and that have played a part in stifling the battle to eradicate the virus.

Up-scaling m-Health: Strategic considerations and implications

In 2012, the New Partnership for Africa’s Development (NEPAD) Council on Health Research and Development identified innovation, especially in the form of mobile phones and other ICT-based technologies, as a key element to address the resource and infrastructure gaps and challenges contained in the healthcare systems of African states.⁽²¹⁾ This was an important development, indicating a strong recognition, from a political and policy standpoint, of the need to formally incorporate mobile phones into long term healthcare solutions. However, in order for the use of mobile phones to improve and mitigate the challenges characteristic of healthcare systems in African countries like Liberia, Guinea and Sierra Leone, urgent integration into government-led healthcare structures is of utmost importance.

To establish their effectiveness, many of the m-Health initiatives within the continent have operated either as pilot projects that are implemented for limited periods or as NGO-driven projects. As such these initiatives very often receive limited support from governments operating at a micro level due to their implementation in rural or municipal clinics.⁽²²⁾ The integration of m-Health into national healthcare systems would not necessarily be an immediate solution to the current Ebola outbreak, as the policy and regulatory implications would require a significant amount of time, resources, infrastructure and technical expertise. However, the current outbreak of the Ebola virus, which has never been experienced in the affected region, stands as a startling reminder for African governments to move beyond paying lip service to the potential uses of mobile phones in healthcare and to urgently invest in the upscale of m-health into national healthcare systems.

Countries such as Ghana, South Africa, Kenya and Tanzania, have successfully integrated the use of mobile phones as support mechanisms in community based healthcare systems.⁽²³⁾ The best practices that have emerged from such up-scaled m-health projects could potentially be coordinated into healthcare interventions to fight future Ebola outbreaks or any other diseases. In order to set this process in motion, however, national governments and regional health bodies, such as the West African Health Organisation, need to make a concerted effort to engage in open dialogue and forge collaborative partnerships with mobile phone network operators and national healthcare authorities.⁽²⁴⁾

Concluding remarks

Weak healthcare systems in African states that have limited economic resources can be improved significantly by means of a potentially cost-effective and readily available technology – mobile phones. The Ebola outbreak in Guinea, Liberia and Sierra Leone has pronounced the ongoing healthcare challenges that many African states face. Evidence from pilot projects and research studies, however, reveal that mobile phones could potentially be used to collect and transmit data in real time. With quality and accurate data readily available through mobile phones, healthcare workers in medical emergencies like the Ebola outbreak, could make informed decision faster. As an immediate solution to the current outbreak mobile phones could play a role in rapid detection of the virus and as a means of surveillance over affected areas, assisting in containing the spread of the virus. Although strides undertaken on the continent acknowledge the innovative possibilities of mobile phones in healthcare, there is a need for national governments to show greater commitment to up-scale m-Health initiatives in order to realise their full potential for entirely preventing future health crises.

Written by Tinyiko Mushwana ⁽¹⁾

NOTES:

(1) Tinyiko Mushwana is a Research Associate with CAI. Contact Tinyiko through Consultancy Africa Intelligence's Africa Watch unit ( africa.watch@consultancyafrica.com). Edited by Nicky Berg. Research Manager: Claire Furphy.
(2) Siedner, M.J., et al., 2012. High acceptability for cell phone text messages to improve communication of laboratory results with HIV-infected patients in rural Uganda: A cross-sectional survey study. BioMed Central, 12(56), pp. 3-7.
(3) Aker, J.C. and Mbiti, I.M., 2010. Mobile phones and economic development in Africa. Journal of Economic Perspectives, 24(3), pp. 207-232.
(4) ‘Why mobile phones make a difference to healthcare in Sub-Saharan Africa’, The Global Poverty Project, 6 July 2014, http://www.globalcitizen.org.
(5) ‘The future of healthcare in Africa’, Report of the Economist Intelligence Unit, 1 March 2012, http://www.economistinsights.com.
(6) Ibid.
(7) Ansumana, R., et al., 2014. Ebola in Sierra Leone: A call for action. The Lancet, 384(9940), pp. 303-304.
(8) Grady, D. and Fink, S., ‘Tracing Ebola’s breakout to an African 2-Year-old’, The New York Times, 9 August 2014, http://www.nytimes.com.
(9) MacCrann, D. and Williams, W., ‘Fear and ignorance ad Ebola ‘out of control’ in parts of West Africa’, The Guardian, 3 July 2014, http://www.theguardian.com.
(10) Ansumana, R., et al., 2014. Ebola in Sierra Leone: A call for action. The Lancet, 384(9940), pp. 303-304.
(11) ‘Ebola virus toll passes 500 as experts look to mobile technology to help stop epidemic’, News.co.au, 9 July 2014, http://www.news.com.au.
(12) Seidenberg, P., et al., 2012. Early infant diagnosis of HIV infection in Zambia through mobile phone texting of blood test results. Bullitan of the World Health Organisation, 90, pp. 348-356.
(13) Berkley, S., ‘How cell phones are transforming health care in Africa’, MIT Technology Review, 12 September 2013, http://www.technologyreview.com.
(14) Ansumana, R., et al., 2014. Ebola in Sierra Leone: A call for action. The Lancet, 384(9940), pp. 303-304.
(15) Siedner, M.J., et al., 2012. High acceptability for cell phone text messages to improve communication of laboratory results with HIV-infected patients in rural Uganda: A cross-sectional survey study. BioMed Central, 12(56), pp. 3-7.
(16) Onishi, N., ‘As Ebola grips Liberia’s capital, a quarantine sows social chaos’, New York Times, 28 August 2014, http://www.nytimes.com.
(17) ‘One million community health workers: Technical taskforce report’, The Earth Institute, 2011, http://www.millenniumvillages.org.
(18) Haw, P., ‘Social media do their bit on Ebola’, BDay Live, 14 August 2014, http://www.bdlive.co.za.
(19) Fortune, F., et al., ‘Community radio, gender and ICTs in West Africa: How women are engaging with community radio through mobile phone technologies’, Search for Common Ground, July 2011, http://www.sfcg.org.
(20) Dunstan, I., ‘Ebola: Taming a killer virus’, Plan, 2014, http://plan-international.org.
(21) Nsabua, B., ‘NEPAD to implement policies to improve Africa’s health’, NEPAD, May 2012, http://www.nepad.org.
(22) Aranda-Jan, C.B., et al, 2014. Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa. BioMed Central, 14(188).
(23) ‘One million community health workers: Technical taskforce report’, The Earth Institute, 2011, http://www.millenniumvillages.org.
(24) Nsabua, B., ‘NEPAD to implement policies to improve Africa’s health’, NEPAD, May 2012, http://www.nepad.org.