Emerging Markets Face New Diseases

BY GRACE MOEN

Developing nations are, for the first time, being impacted by the kinds of non-communicable diseases (NCDs) historically associated with wealthy countries, which now require interventions in similar measure. Diseases like cancer, diabetes, lung and cardiovascular disease are on the rise - 72% of all global deaths in 2016 were attributed to NCDs - and are caused by lifestyle and environmental factors such as poor diet, smoking, and toxic air quality.

Developing countries experience an earlier onset of these diseases followed by premature mortality, and existing healthcare systems cannot keep up. Wealthier countries on the other hand have had some experience in this area. The United States and others have faced NCDs for some time and have done so with the help of a technological infrastructure and digital health ecosystem that helps to bridge troublesome care delivery gaps. It’s not perfect, but it is solid groundwork that will be useful to other regions that are facing similar disease burden. As the data points more and more to regions like Africa, so does financial interest. For some, including the telecom industry, Africa looks like a frontier for digital health. Because it is. 

Back in 2015 the UN General Assembly outlined 17 key global goals to achieve by 2030. Health and well-being is listed as a top-three goal, just after eradicating poverty and achieving food security. Let’s pause to remind ourselves that Africa is geographically huge: a continent made up of 54 countries, 2,000 languages, and 11.73 million square miles. It is diverse in countless social, cultural, linguistic, religious, artistic, and economic ways, and therefore methods to meet these and other global goals cannot be discussed as a one-size-fits-all solution. With this in mind, there are contextual-specific challenges that span the continent.

First, there is a significant lack of data, both at the patient and population level. What exists is siloed and incomplete. To change this, as the US knows well, requires monumental commitment to and resources for technological infrastructure and data capture. Urban centers are better off than rural ones, where doctors and clinics (and wifi and water) are scarce. But NCDs are complex. They can often be tied to multiple causal factors and they require intense daily management. Aka they need as much data as they can get. 

If data is the silver bullet, then interoperability is the gold standard and EHRs are the treasure chest. To meet EHR interoperability standards requires infrastructure like internet and connected systems and devices. However, investment in developing countries is historically sporadic at best, and so future initiatives must take the shape of multipronged public-private-partnerships.  This will inevitably guide planning and policy in order to better serve patients. 

According to the GSMA, “governments spend about $1 trillion per year on health in developing countries. If local governments allocate 0.5% of that to digital health initiatives over the next five years, a cumulative $25 billion will be available for digital health companies, including operators.” Operators like telecom providers. The ubiquity of the cell phone, even in developing countries, and especially where other technological systems are still weak, has made for interesting market opportunities. The likes of Vodafone, Bharti Airtel, Telefonica, Telenor, America Movil, and others (GSMA) are leading digitization across widespread regions connecting patients with providers. An app called Medici, for example, who operates largely in South Africa, allows people to text, call, or video chat with their doctor. MobileODT is another smartphone-enabled device that allows for colposcopy and imaging assessments within women's health. 

Also leveraging telecom networks are new opportunities for micro-insurance bundles. Each year 100 million people who do not have health insurance in developing countries are plunged into poverty due to unexpected medical expenses. To alleviate this, MicroEnsure and their product Fearless Health, bundle insurance offerings with mobile network operators into a model that prizes financial liquidity. All three of these digitally-driven, private partnership examples are dramatically helping to lower the barriers to receive care -- functions only made possible because widespread telecom connectivity exists. 

On a national level, both Nigeria and the Democratic Republic of Congo (DRC) recently strengthened their commitment to digital health. In Nigeria, their “strategy resulted in increased access to health care, reduced cost of producing health services and improved quality of health consultations.” They did however remark that internet security and connectivity were critical challenges (NIH). In the DRC, they found success in investing in a population health data initiative to monitor and manage the Ebola outbreak. 

The African Alliance of Digital Health Networks, under the Digital Square banner at PATH, serves as a unique private coordination platform to manage investment dollars that unlock data silos, scales technology, and supports local innovation. 

There is perhaps no greater impact that technology can make than in supporting care delivery in emerging markets. These are just some of the initiatives that open doors and set a precedent for a future in which preventative care reigns. 

Let emerging markets reap the benefits of every lesson-learned, growing pain, and policy hurdle that others have faced. Let data sharing in Nigeria be implemented at scale because others were fragmented. Let telehealth take off in Kenya because others were policy-fraught. Let population health data reduce NCDs in Ethiopia because others were siloed. Let partnerships support local innovation to address unique local circumstances. 

Change can be both good and make good business sense.