Africa Digital Health Requires Indigenous Approaches

Africa faces some of the most severe health system constraints anywhere. Of the 57 nations the World Health Organization identifies as critically short of health personnel, 36 are in Africa, at around 0.21 doctors per 1,000 patients. The continent holds 1.3% of the world's healthcare workers and 25% of the global disease burden.

Its epidemiological transition is incomplete, so it carries a double load: endemic disease — HIV/AIDS, malaria, tuberculosis — alongside chronic disease such as diabetes and cancer, with emerging infectious diseases including COVID-19, Ebola, Lassa fever and Monkeypox layered on top.

Financing compounds it. Most African countries have still not met the 2001 commitment to allocate 15% of national budgets to health.

What digital health can do

Digital technology is a genuine lever on universal health coverage because it removes barriers that money alone does not: cost, distance, and the absence of quality care. The paper sets out the gains as access for hard-to-reach populations, improvements in safety and quality, better information for health workers and communities, cost and efficiency savings in delivery, and improved access to the social and economic determinants of health.

Where the market is

• The global digital health market was worth an estimated $175 billion in 2019,

with a CAGR of nearly 25% projected to take it to roughly $660 billion by 2025.

• Investor funding reached $21.6 billion in 2020, the largest to date.
• Telemedicine was the most funded category that year at over $4.2 billion.

Where Africa is

41 of 54 African countries now have a digital health strategy in place, and consumer engagement is climbing fast: smartphone reach in sub-Saharan Africa is forecast to grow by almost 70% by 2025, and 41% of African internet users already use their phones to search for health information.

Why imported tools fail

This is the paper's central finding:

89% of the digital health tools — EMRs, EHRs, telemedicine and telehealth solutions

— did not undergo any research on the peculiar situations of the healthcare

environments they were deployed into. They became non-user-friendly, and were later

abandoned.

Deployment is further constrained by poor coordination of proliferating pilot projects, weak underlying health systems, limited awareness of digital health, unstable power, poor connectivity, and a lack of interoperability between the many solutions already in the field.

The argument for indigenous design

The architecture of the health ecosystem should be led from within the continent. The paper calls for an indigenous approach to designing digital health platforms — built for the conditions they will actually run in — with African Union governments setting a standard that accommodates local need without contradicting WHO digital health strategy.

That requires equipping African developers to factor African methods into the design, and actively recruiting and training creative developers across nations to build platforms durable enough to serve the continent.

And a data protection warning

Adopting non-indigenous tools carries real risk to the confidentiality of the continent's healthcare data. The paper proposes an African Agency for Data Protection (AADP) — noted by the author as a proposal rather than an existing body — and argues that because health data has become one of the world's most valuable assets, indigenous tooling with stronger security is a precondition for protecting it.

Success finally depends on Africa's ability to leverage the informal within the formal: given how pervasively social media, apps and search are already used for health, the task is to make that safe inside the health ecosystem rather than to pretend it is not happening.