Policies and regulations shaping telemedicine in Africa: Challenges and opportunities in COVID times
Some estimates suggest that currently the telehealth market in Sub-Saharan Africa is around a US$4 billion market and there are some projections that it is going to grow to be over US$5 billion in 2025, highlighted Nana Frimpong (pictured above), Vice President – Africa, Vezeeta, a digital healthcare booking platform and practice management software in MENA.
Frimpong said that due to COVID-19, Vezeeta had to fast-track its roadmap for launching its telehealth products. “We saw a 50 to 60 per cent drop in March in face-to-face consultations. However, we were still receiving calls and requests through our call centre for ways to interact with doctors, which meant that we had to launch our telehealth services immediately,” he shared.
Vezeeta launched its telehealth services in Egypt in collaboration with the government and launched it in Saudi Arabia for free. Through the service, people were able to access doctors if they were having issues or symptoms related to COVID-19 and could get a quick triage, and were referred to a hospital for physical consultation if needed. “We saw around 1,500 consultations each day via the platform,” said Frimpong. “We continued to see this uptake in Egypt and Saudi Arabia for a while until things stabilised, and we introduced a paid service as a way to expand the service to other hospitals and clinics who wanted to use our technology.”
One of the challenges that were seen was on the payer side, as they were not necessarily set up to pay for these consultations via telehealth early on. Therefore, Frimpong said, patients had to pay out of pocket, which led to a dramatic dip in the numbers. “That was when the conversation around regulatory challenges in the long-term surfaced.”
On the other hand, Akinoso Olujimi Coker, Chief Executive Officer - Lagoon Hospitals, Nigeria, highlighted two challenges. The first was that at the start of the pandemic, platforms such as Zoom and WhatsApp were used for teleconsultations, but these platforms had their shortcomings, related to the privacy of medical records, data and cybersecurity breaches and particularly continuity of care. The second issue is the credentials of practising doctors to ensure patient safety. He said: “When there are cross border teleconsultations happening, one can easily foresee a scenario where an Egyptian doctor is looking after a Nigerian patient. So, what regulations would be applicable here? Teleconsultation and the scope of accreditation don’t concern healthcare alone. There is also the issue of information technology and data protection.”
While Katlego Mothudi, Managing Director - Board of Healthcare Funders of Southern Africa, stressed: “When you talk about telehealth, be it for diagnostics or procedural support, you have to make sure that all the laws that are in place to support it. For example, if we talk about electronic health records, protection of personal information, quality measures, accreditation, etc., all these should start talking about the facilitation of telehealth.”
Covid-19 lessons learned so far: Embracing crisis as an opportunity
A panel talk moderated by Dr Hala Daggash looked at how COVID-19’s disruption of the healthcare industry has created opportunities for innovative organisations and leaders.
Joining the panel were Dr Adebajo Adewole, Managing Director/CEO - Alimosho General Hospital; Irene Atuhairwe Duhaga, Technical Advisor – Nursing and Midwifery - Seed Global Health; and Karen A.S Hendrickson, CEO of Rabito Clinic.
Both Dr Adewole and Karen Hendrickson began pandemic preparations in Nigeria and Ghana, respectively, with the emergence of news of an outbreak in China. "It was only a matter of time," they both agreed. Dr Adewole explained that Lagos was a hub of international air travel. Meetings were commenced from January, and the behaviour of the virus was learned based on information received from across the world.
For Dr Adewole it was an opportunity to see how different healthcare systems responded worldwide, and how they affected communities. He recognised it as being "completely different from Ebola" and they "knew what to do". This included training, face masks and hand washing, and doctors were put in a state of constant readiness.
Similarly, Hendrickson and her leadership team considered "what if", despite that many people in Ghana assuming it wouldn't affect them for they would be protected by the heat or "God". As part of their initial preparations, they bought sanitiser for branches, in institutional size, though they did not think the nation would go into lockdown.
When the first case had become known, the country entered into a "panic" and Rabito Clinic saw almost zero clients as a private facility. The financial impact was described as shocking.
Despite this, with the prices of PPE escalating (quadrupling) and significant price gouging, the business did what it could to support, through ordering 10,000 PPE for government nurses and doctors, and 5,000 individual hand sanitisers were given for free to police officers.
Technical Advisor Irene Atuhairwe Duhaga said Seed Global Health (non profit providing medical training) had to refocus with the pandemic forcing closure of universities and students out of six months, and support the government in responding to the pandemic. This refocusing involved the harnessing of technology, though online training that included videos, while it was a challenge in part because of inaccessible areas.
Post-COVID, what have we learned about the supply chain, capacity and demand for African medical devices manufactured products?
A panel comprising speakers from Handel Street Automotive, Africa Investor, Afrisky Holdings and Guidehouse discussed supply chain issues affecting medical devices in Africa during the pandemic.
Rob Botha, Chief of Party: Global Health Supply Chain Technical Assistance (GH-SCTA) - Guidehouse, highlighted the regulatory environment as a challenge "for some", while acknowledging it was good in areas, explaining that it was not easy to understand.
As such he suggested that there was much education that needed to take place. For instance, while there are excellent manufacturers, they might not necessarily be familiar with medical. He added that the harmonisation of standards and specifications across the continent would help in supporting manufacturers, making compliance much easier.
Ashraf Ismail, Marketing Director at Handel Street Automotive, agreed that one of the biggest challenges was understanding regulations. It took a long time for the local regulatory body in South Africa to understand standards, he said, and this "decimated" local manufacturing to a certain extent. He suggested the need to harmonise standards in line with the EU or US, and working with manufacturers towards getting there. This will help South Africa and the general economy of African countries, and foster collaboration.
Hubert Danso, CEO of Africa Investor, went further, describing issues relating to logistics, trade facilitation and regulation, and the lack of preparedness overall. He identified five key challenges and recommendations.
The first challenge was around bans on the export of PPE - notices were published in local languages, presenting difficulties in translating into a universal language. The second concerned changes in controls and in regulation of borders.
Third, there was a lack of internal coordination among some agencies, in some cases within regions and countries, and this created confusion.
Fourth, inspections of PPE; and finally, there was a lack of international cooperation, meaning that some measures were more stringent than others.
Danso suggested that harmonising standards across the African Continental Free Trade Area (AfCFTA) was a crucial first step in facilitating local production and trade across the healthcare industry. This meant deepening pan-African networks on both commercial and policy levels. He recognised that the AfCFTA was already prioritising regional harmonisation for 2021, announced last month, and that the private sector was behind the curve on this.
Bridging the gap in communicable diseases: The Future of Infection Prevention & Control (IPC)
The current training provided by African CDC for Infection Prevention & Control (IPC) is targeted at frontline workers. However, to bridge the gap, it is important to go back to the fundamentals and understand what IPC is, said Prof Folasade Ogunsola, Honorary Consultant Microbiologist & Infectious Disease Specialist, Chairman - Infection Control Committee - Lagos University Teaching Hospital.
“We have to institutionalise the routine part of IPC and have a solid foundation,” she said. “We need to train healthcare workers and set up programmes at the national and facility levels, and ensure these are running on a day-to-day basis, so when another epidemic comes around, we are used to IPC and can avoid the short-term training frenzy.”
Ogunsola explained that for a sustained IPC effort, there is a need to develop another cadre of staff that includes practitioners and experts who can drive the process daily. "We need to develop, what I like to call, the ‘institutional muscle’ for IPC,” she added.
According to panellist Dr Abiodun Egwuenu, AMR Programme Manager - Nigeria Centre for Disease Control, the pandemic has brought a lot of innovations in IPC. “There are now trials on how to decontaminate or recycle some of the PPEs that are crucial such as the N95 masks. Countries are also providing grants to produce PPEs in a self-sustaining manner.”
However, she stressed that IPC for patient safety goes beyond PPE and involves having clear policies or guidance in the facility and community on how to implement the procedures. It is also important to focus on data that is needed to drive improvement and see where there are gaps.
Panellist Dr Tochi Okwor, Antimicrobial Resistance and Infection Prevention and Control Programme Coordinator - Nigeria Centre for Disease Control, concluded; “Effective IPC doesn’t require expensive resources and can be implemented with minimal cost. What is required is a strategic approach.”