Challenges facing health apps in Africa
Mobile based health apps proliferation in Africa has come with both benefits and challenges.There’s no single country where app developers haven’t deleted apps meant to address health sector problems and we all know Africa has the least developed health care system globally. The key difference between apps developed in Kenya to those in Nigeria or in Tanzania to those in South Africa is that patient enrolment is switched to opt out rather than opt in. This means any of the patients included in the apps who don’t want their data shared will have to actively ask not to be part of the system.A mobile developer based in Port Elizabeth South African recently told me that patients should be able to make their health records available to third parties and app developers to facilitate the management of their own health.He said, for instance, that were the data incorporated into an app, a doctor could use the technology to remotely monitor their patient’s blood pressure or insulin levels. However, he lamented that South Africa politicians likely assume the simple combination of apps and data will lead to the same type of transformation in health that taxi companies like Uber has achieved in their respective industries.While South Africa’s younger generation may indeed want to interact with health care in the same way that they stream a TV program or hail a Uber taxi, he confided to me that it is optimistic to assume this transformation will be brought about simply by making mobile based health apps data available to app developers.As much as I agreed with my colleague in the coding industry, being able to use data meaningfully requires it be collected, managed and made available in very specific ways. Advocates of making government owned data publicly available should outline principles that should be met to ensure this can happen.These highlight some of the challenges that African countries like South Africa need to overcome before anything practical will come out of using information from the electronic record.One of the most important of these principles is the need for data to be comprehensive. This has been a major problem from the beginning with the entire concept of apps already developed in the continent.This is largely because the contribution of data to the electronic record is up to individual clinicians and limited by the systems they use, there are no guarantees there won’t be gaping holes in the information.
Using the data to make clinical decisions would then be almost impossible without the missing pieces.Another challenge is that for data to be understood by apps, it needs to be machine processable. In other words, it needs to be understandable by computer software, which traditional medical data simply isn’t. For example a letter between a General Practitioner and a specialist, for instance, might declare a diagnosis buried in everyday language.It is a significant challenge for a software program to uncover this type of data. Sadly, almost all of Africa’s health information about patients is still in the format of letters and documents that limits their usefulness to apps.Although there are significant challenges to making data within apps being developed now useful in the management of a person’s health, moves to make them more open is positive.The very act of making health data visible to the patient will force providers to produce it in a more structured way. It could also put pressure on those who may not be publishing data into apps to find a means of doing so.But if African population is going to be allowed to decide who has access to their data, this should automatically be extended to making it available to researchers. African are notorious in making it difficult for researchers to access population data from medicare systems.Patient data should be underpinning the management of their health on a continuous basis. The information should follow the patient in any journey that involves interactions with health providers or the health system in general.Instead, it is locked up by health professionals, health organisations and the government. When I was handling development of robotic surgery related project, I learnt there was very little of such information available to the patient and certainly not in a form that allows them to make use of it in any meaningful way.In fact, doctors i have spoke to from different African countries have a view that patients should not have access to their own laboratory tests or radiology reports because they would be liable to misinterpret them.The principles behind sharing patient data should be encouraged in Africa just like is happening in the western countries. African countries attempts to implement such personally controlled electronic health record have so far been poor.The technology, as it currently stands, would prevent the effective use of the data it might contain. Allowing for the data to be extracted practically and effectively would be a positive first step and I can only hope African countries will take.