Digital Health Error 404

Digital health is the provision of health care services using digitized health recordings and electronic mechanisms. In developed countries, it evolved into an ecosystem where even surgery operations are remotely operated, or blood is delivered by drones at emergency spots.
But recently, physical distancing measurements introduced under COVID-19 increased the demand for digital health services even in developing countries like Ethiopia, where even the concept of digital health is at an early stage.
A number of medical graduates and computer engineers are teaming up to design applications to solve the completely manual health services of Ethiopia. Newly established startup incubation centers are also targeting idea creation, nurturing, and linking digital health innovators with investors. Nevertheless, they can hardly find financers as a startup, nor favorable support and policy environment from government. EBR explores the opportune moments knocking at the door for digital health innovators, and the monumental task ahead in digitizing Ethiopia’s health system.

Kaleab Girma, is a Medical Doctor that graduated from Gondar University last year. While working at a COVID-19 quarantine center, he observed how doctors themselves are exposed to the pandemic. “No mechanisms have been developed to digitally trace and monitor patients. Even other African countries have applications where patients can learn of their result online. Doctors can also trace every route the patient has taken, helpful in identifying the spread of the pandemic,” said Kaleab.

He soon came up with ideas to digitize health service deliveries. However, there was little room to translate his idea to the ground. “No institution could openly accept our idea and provide us with support. There is no accessible digitized health information. It is difficult to build a data server alone. Even if there is digitized data, there is no regulator to allow patients’ data storage on cloud computing as well as oversee data accession. Everything is manual, so I almost gave up on my ideas.”

The need for digitized healthcare exponentially increased particularly after COVID-19 spread with its demands for reduced physical contact and for which digitized care delivery is an ideal solution.

Medhin Getaneh, another Medical Doctor that just graduated from Gondar University, faced a similar challenge. She dwelled on providing digital solutions for health problems that patients and hospitals frequently face. “Doctors and nurses in Ethiopian hospitals spend more than half of their time locating files and recordings, instead of treating patients. I came up with an idea that helps digitize recordings and enable online bookings, follow ups, and staff scheduling. For instance, there is no mechanism informing doctors and nurses in advance of a scheduled night shift. The application we envisioned digitally notifies them of shift programs, so that they can prepare psychologically for their night shifts.”

Although both have approached a number of institutions and individual investors to access finance and turn their ideas into reality, they have hardly succeeded.
“Many people emotionally supported our ideas, but not financially,” said Kaleab.

It was a eureka moment when the innovators found out of an innovation hub established in Addis Ababa to nurture digital health startups. They submitted their ideas to Orbit Innovation Hub, which just opened and started taking in its first applicants. “Some 51 ideas have been submitted in the first round and 15 reached the final round, of which half focus on digital health. We could not believe that there were so many people with shelved digital health business ideas due to lack of support. We have planned to finance the establishment of 15 digital health startups this year through two rounds,” said Saminas Belayneh, Mentor and Coordinator at the hub.

“The major challenge in linking startup ideas to investors is a lack of awareness. Local investors are not attracted towards investing in technology companies. Most of them do not think digital health solutions are profitable. That is a lack of knowledge. Local investors look for quick returns but it takes patience and hard work to create such tech companies,” he added.
“They taught us how to translate an innovative idea into an implementable one on the ground. They provided workstations and trained us using professionals. We are now working with various professionals to establish our own company, integrating health with technology,” said Medhin. Her team is currently working with software and electrical engineers, web designers, and marketing experts.

Orbit Innovation Hub is recently established through a cooperation between Orbit Health and funds from the Mastercard Foundation. “There are no digital health solution providers in Ethiopia, affecting us ourselves. We cannot do everything by ourselves, so we must create and nurture startups,” said Pazion Cherinet, CEO and Founder of Orbit Health and Orbit Innovation Hub. With a background in electrical and computer engineering, Pazion worked for Boeing as well as Ethiopian Airlines before he observed the digitization gap in Ethiopia’s health system.

Established four years ago, Orbit Health is a pioneer private company working on digital health care services in Ethiopia. It is currently digitizing the recording systems of Abet Hospital, Tirunesh Beijing Hospital, and other health facilities including outside of Addis Ababa in Adama. “Thus far we have inputted over 15,000 medical records into our systems. Over 2.5 million prescriptions are encompassed into our systems across several facilities. That is a substantial amount of data. Right now, we are working on seven projects with development partners to scale up our digital health systems, by building systems. We have achieved a lot of development but we are beyond our dreams. We really need strong collaborative works to create a digital health industry. We have a number of new digital products in the pipeline.”

Apart from Orbit, there are very few public institutions working on digital health. The Ministry of Health launched the Digital Health Innovation and Learning Center in August 2020, in cooperation with St. Peter Specialized Hospital in Addis Ababa and with support from the Bill and Melinda Gates Foundation. However, the center trains practitioners on digital health but does not incubate and nurture startups. The Ministry of Innovation and Technology provides workstations for all innovators in general but has no specific team to nurture digital health startups.

The Addis Ababa City Administration recently inaugurated Abebech Gobena Maternal and Children’s Hospital at a cost of ETB700 million which operates paperless. Over 95Pct of health information in Ethiopia is not digitized according to studies. For instance, a severely ill patient will have to physically search from pharmacy to pharmacy in search of essential drugs because there is no digitally accessible information database on the stock situation of pharmacies. This absolutely needs to change.

“Developing and implementing data and demand-driven health systems is critical. Government is already working on building capacity in sustainable implementation and ownership of digital health systems,” informs Liya Tadesse (PhD), Minister of Health.

According to the World Health Organization’s (WHO) global digital health strategy, covering the years between 2020 and 2025, there is a growing need to ground digital foundations within national strategies and emphasize the need to work with all-level sectors and stakeholders. The “digital determinants of health, such as literacy in information and communication technologies and access to equipment and broadband internet, becomes more important as digital health becomes more prevalent,” states the document. The strategy also urges “every country to own, adapt, and strengthen its strategy on digital health in a way that best suits its vision, national context, health situation, and trends. Countries are also expected to include digital health into SDG targets and establish a quantifiable reporting system to WHO.”

The organization launched its first report on Digital Health Implementation Approach to Pandemic Management, recommending “collaboration of countries in developing data standards and interoperability specifications for all types of surveillance; open-source digital health applications to be compliant with interoperability standards and specifications; and sharing telemedicine tools and platforms for free/ open source during a state of emergency, among others.”

Digital health is the ability to streamline digital service delivery. That could be an improved way of meeting with doctors, booking schedules, and going as far as using drones to deliver blood. In this context, telemedicine and virtual consultation are also included. Digital health is a brainchild of medical, computer, and electrical professions.

“Patients are in remote areas as the majority of Ethiopia’s population lives in rural areas, whereas almost all specialists in the country are in Addis Ababa. The practicality of coming and going to Addis to visit doctors is burdensome. With telemedicine, the patient can now come to Addis for surgery or treatment, return to their hometown where they can still follow-up with their local doctor. Of course, this happens if they have access to video conferencing,” says Pazion.

Digital health can also minimize medical tourism outflow, where a substantial number of Ethiopian patients have to visit Thailand, India, South Africa, Dubai, Kenya, or other countries for better care.

However, patients might fail to comprehend what specialists prescribe online. In a bid to solve this, a hybrid model of telemedicine is devised where local doctors participate. “Then local doctors can undertake examinations with the recommendations of the specialist in Addis, Dubai, Kenya, USA or any other part of the world. In Ethiopia’s context, I do not think we can implement telemedicine in full capacity. We have major barriers vis-à-vis telecom disconnection and power outages. But we are heading towards that direction. The full-fledged implementation of telemedicine is not practical yet. But with a hybrid concept it can be done as long as there is an internet connection,” adds Pazion.

Apart from the lack of digitalized health data, the absence of governmental regulation towards data is another challenge in Ethiopia, according to practitioners. Ethiopia also needs policies and a clear roadmap on digitization and effective data usage enabling hospitals, laboratories, health facilities, patients, and regulators electronic accessibility.

For Pazion, adoption is where developing countries can start the journey to a digital health ecosystem. “Adopting digitization is the rudimentary work before going to reap benefits of digital health. Policy, incentives, and the will to make digital service delivery mandatory are required. Ethiopia does not have the right incentives and support in place for the private sector to fully engage in digital health care. Technology adoption, from policy makers all the way to end users, is critical to form an ecosystem for digital health. Developed countries succeeded because they really believed digitized health improves the health system and helps in running a very smooth operation and business. Adoption is at a very early stage in Ethiopia.”

Although government is going in the right direction in terms of policy, practitioners say it is still difficult for any innovator with a brilliant idea to easily communicate with hospitals and stakeholders to implement new ideas. Nevertheless, innovative companies must come up with digital health solutions. Digital health services can be easily adopted from developed nations, fulfilling international standards for safety, security, and interoperability.

Health sector tech is a long-term investment and cannot interest the Ethiopian private sector without incentives, according to Pazion. “The Ethiopian private sector is succumbed to making quick money. As for us, we are not expecting profits in the short run. Making money could have been very easy for us. But we are investing to be part of the future’s health care. Our motivation is providing value to health care. Business has a lot to do with values, rather than profitability, for me. We plan to start digital health services in Kenya and around Africa—wherever it is needed—in two years’ time. Ethiopia’s 4G telecom service is improving. No territory can be held back from digital health services. After two years, we will be working in three different countries outside of Ethiopia. In ten years, we will be one of the most successful digital health technology companies in sub-Saharan Africa. Innovative ecosystems are highly critical to motivate investors. As Orbit, we are creating an innovative ecosystem now.”

Birhanu Gizaw (PhD), is an Industrial Engineer, Technologist, and President of the Ethiopian Electrical Engineers Association with decades of experience in Germany and at the Addis Ababa Institute of Technology (AAiT). Recently, he initiated the establishment of a medical engineering department and production facility for modified health technologies such as portable X-ray machines. “Universities have ample knowledge and resources but they are not working on digital health solutions. There is a bridge-break between government, universities, and the private sector. For instance, private companies can partner with universities to incubate, accelerate ideas, and establish a business by joint venturing. Universities can provide the knowledge, while the private sector does the production and business part. Legal frameworks are required to this end. Digital health is best served when both public institutions and private innovators are aligned.”

Birhanu also states government must train staff in public health institutions on digital health care to interface with the private sector and patients, apart from including digital health care in the health education system.
Kaleab agrees that “government institutions should at least be open to new ideas.” EBR

9th Year • Feb 16 – Mar 15 2021 • No. 95