The pandemic, chronic disease, rising costs, an ageing population, limited resources, health worker shortages, and a data explosion are converging to accelerate digital health globally. WHO has launched a major transformative agenda on digital health, “The use and scale up of digital health solutions can revolutionize how people worldwide achieve higher standards of health, and access services to promote and protect their health and well-being.”
At a granular level, technology offers improved efficiency; better treatment choice; more efficient diagnosis; faster drug development; better prediction of disease outbreaks, medical consultations with patients where there is no doctor and improved medical training. Consumers can access information they need to proactively manage their own health and wellness. AI can identify specific demographics or geographies where population health issues exist, then targeting and precisely implementing education and prevention programs. At the system level, this will enable health care transformation from the traditional healthcare which is doctor and hospital-centric and slow to scale and transition to health care on a mobile device at the individual level that can predict and prevent disease.
Basic Human Needs
Health care is already inaccessible and unaffordable in emerging economies. This will only worsen as the Pandemic impacts hit, and it is predicted that up to 100 million people may fall into extreme poverty. Remittances, upon which many poor families rely, are expected to see the sharpest decline in recent history, falling by 19.7 percent to around US$445 billion, compared to US$554 billion in 2019. The need to innovate to provide affordable solutions for health care has intensified.
Many emerging economies are pushing a strong digital agenda because technology is a critical enabler. Mobile coverage is increasing and around 90% of the world’s population under 30 live in emerging economies, they are digitally savvy and want to innovate. Frontier technologies are already being used to meet urgent service delivery needs in clinical services, secure identity, self-care, payments, supply chain, medical records, personnel credentialing, and monitoring.
Here we highlight five key technologies transforming health in emerging economies.
Artificial intelligence (AI) in its many forms has immense potential for emerging economies.
Expert systems use a knowledge base and a reasoning engine to solve problems and can support physicians in diagnosis and treatment. They can substitute for a doctor if one is not available and facilitate medical training in geographies that lack human trainers. Researchers from Brazil, in partnership with Harvard University and the Massachusetts Institute of Technology, have developed an expert system for the prediction of birth asphyxia and the need for resuscitation for use in developing countries. The system relates maternal medical, obstetric, and neonatal characteristics to the clinical conditions of the newborn to predict the need for resuscitation, with high levels of sensitivity and specificity.
Machine learning (ML) automates data analysis by using algorithms that iteratively identify patterns in data and learn from them. Data mining is related to unsupervised ML and involves identifying patterns in large databases. For example, researchers at the University of Tokyo, De La Salle University in the Philippines, and Padjadjaran University in Indonesia used machine learning tools to identify weather and land-use patterns associated with dengue fever outbreaks in Manila. The machine learning algorithm learned over many iterations how to fine-tune its model to predict dengue occurrence with increasing accuracy.
Natural language processing (NLP) uses algorithms that allow machines to identify key words and phrases in unstructured written text and determine the meaning of the text. NLP has been used in epidemiological surveillance to predict epidemics using online news and social media data.
Signal processing uses non-image data (e.g., electrocardiograph data). Signals that can be collected with mobile phones (e.g. analyzing birth cries with mobile phones, stethoscopes connected to mobile phones) or multipurpose instruments that can collect multiple kinds of digital data, offers considerable potential in resource-poor settings, particularly when paired with ML and cloud computing.
Self-Care: Young people already use technology for their own health- related needs. Technology is used to address a wide variety of health needs, from finding health practitioners to scheduling appointments and using fitness tracking applications, to accessing critical health information and advice online. Wearables can track health trends, and relay chronic diseases can make them more independent and reduce unnecessary doctor visits. In Kenya, AfyaRekod is a digital health data platform, developed as a patient driven platform, where the patient maintains the sovereign right of ownership to their health data. Afya Rekod is collaborating with Telkom to pilot the use of the platform with health workers, for the facilitation of training and in-App consultation. The receptivity of mobile providers in Africa to collaborate for social impact will be a powerful enabler.
Voice Activation for reach is key for those with poor literacy levels. Voiced-based search has increased rapidly in developing countries and can reach disadvantaged, marginalized and hard to reach parts of the population. Google has realised this and is adding languages from developing countries to access the 781 million adults who can’t read or write. Cheap voice devices can enable people who cannot read to learn, sign up for social services, or get a mobile wallet.
Digital Payments: Poverty is a key determinant of health and mobile money platforms, notably Kenya’s M-Pesa, have increased per-capita consumption levels and brought 2 percent of Kenyan households out of poverty between 2008 and 2014, increasing financial resilience and savings, especially for female-headed households. The opportunity of digital payments coupled with a digital identity, could reduce transaction costs for remittances, giving unbanked access to financial systems and ensuring that funds intended for the poor actually reach them. They can also be used to incentivise positive health practices. Partnerships’ with mobile providers and technology companies offer opportunities to test whether some successful digital models can be scaled.
Health Data Markets: Technologists need huge data sets to train their machines that are consistent, reliable, and end-to-end data integration linking data from multiple sources. This will enable real-time and predictive analytics and comprehensive searches for subsets of data and algorithms linking laboratory and clinical data that create automatic reports that raise concerns about safety or efficacy. Emerging economies are projected to surpass mature economies in the overall generation of data by 2020, with the volume of healthcare data, one of the fastest growing segments of data, estimated to be increasing by 48 percent each year. Monetizing these data will be both an economic opportunity and a health benefit for the developing world.
These volumes of health data raise questions of data governance, privacy, and security, given the sensitive nature of healthcare data. This is particularly relevant for genomic data, one of the most sensitive types of information linked to a person and their relatives. The ‘Leapfrogging with Precision Medicine Project’ in Rwanda provides an example of how emerging economies can develop governance models for genomic data and bypass legacy systems and accelerate the adoption of precision medicine.
Technological change is a primary driver of productivity growth and facilitates reduction in inequality, the creation of new business models, and the generation of new jobs. Emerging economies are not just using technology to catch up, they are using the digital world as a source of ideas, to solve their own problems. Emerging economies are adopting new technologies to suit their specific needs. We will continue to see a transformation of health care as emerging economies experiment and innovate, and the West will learn from them as we cling to our comfortable legacy systems and old ways.