GSMA Report Unpacks the Health Systems and Digital Health Solutions in Response to COVID-19 in Bangladesh, Myanmar, Pakistan, Benin, Nigeria & Rwanda

This article was originally published on GT Perspectives.

The previous post focused on a report by the GSMA on a report about utilizing digital health as a health system strengthening tool for developing countries. This post explores a subsequent report published by the UK-based organization representing the interests of mobile operators worldwide, which unpacks the health systems and digital health solutions in six developing countries: Bangladesh, Myanmar, Pakistan, Benin, Nigeria and Rwanda.

The report explains that "the state of play of digital health in each country . . . varies quite considerably. Bangladesh and Rwanda treat digital health as part of a whole-of-government approach and seek to leverage government-wide infrastructure and standards. Pakistan and Nigeria, which have a strong federal tradition, have a more fragmented approach. In Myanmar and Benin, digital health is still in early stages and relies more heavily on contributions from development partners."

What is more, "Several insights were gleaned from our key informant interviews (KIIs). A common theme was that broad stakeholder involvement in digital health ecosystems is a growing trend that should be fostered, but how this is done varies from country to country. While some respondents want governments to create an enabling environment, others see start-ups and mobile operators playing a greater role. Another emerging theme was the lack of shared understanding among stakeholders of policy requirements and frameworks."

I concur with the report's assertion that the "COVID-19 pandemic is a challenge confronting all countries, and the report briefly reviews some of the digital health approaches each country has taken." Given their importance, I have included each country's digital health approach below.

Bangladesh ? Digital health: COVID-19 response

"Digital tools and digital health solutions have provided critical support to Bangladesh's COVID-19 response, enabling access to essential information and health services. The government's digital health strategy focuses on developing instant and quality healthcare services via mobile apps, and tapping into the country's large number of mobile subscribers to establish a countrywide digital health system.

"The government has encouraged public-private partnerships (PPPs) since the beginning of the crisis, emphasizing close collaboration with digital health start-ups. The surge in demand for telemedicine has led to the advent of 15 digital healthcare providers providing these services. The launch of virtual hospital HelloDoc in April 2020, and the launch of the Daktarbhai telemedicine platform, have both supported the development of a telehealth system during COVID-19. In May 2020, the government collaborated with ride-sharing platform Pathao, digital health solution Maya and Praava Health to provide instant healthcare services via the Pathao Health mobile app. Pathao Health connects users to an online COVID-19 symptom checker and provides one-on-one medical services through phone and video consultations. Users can also obtain prescriptions and order medicines through the app. Bangladesh has also begun to use surveillance, reporting and contact tracing features in a COVID-19 module for DHIS2, as well as Go.Data for contact tracing in the Rohingya refugee camps in Cox's Bazar.

"Data is a critical resource for supporting public health actions across the different phases of the COVID-19 pandemic. Mobile operators are working with key stakeholders, including a2i and the National Telecommunications Monitoring Centre, on a COVID-19 Collective Intelligence System. More details can be found in GSMA's report, Keeping Bangladesh connected: The role of the mobile industry during the COVID-19 pandemic."

Myanmar ? Digital health: COVID-19 response

"In April 2020, the Myanmar Computer Federation (MCF) developed the country’s official contact tracing app Saw Saw Shar to help contain the spread of the virus. The app was developed in partnership with the COVID-19 Control and Emergency Response ICT team under the Ministry of Transport and Communication and the Ministry of Health and Sports. In addition to monitoring symptoms, the app provides timely notifications of nearby areas that have positive cases and are potentially high risk, as well as official COVID-19 hotline contacts and the closest fever clinics and quarantine centers. The app also has a dashboard that visualizes COVID-19 transmission and infections by region in Myanmar."

Pakistan ? Digital health: COVID-19 response

"Technology has played a significant role in Pakistan's response to COVID-19, and the development of digital health platforms has been a priority for the government.38 Pakistan’s Ministry of National Health Services Regulations and Coordination (MoNHSRC) is working with software companies such as CIT Solutions, telemedicine companies such as Sehat Kahani and doctors247online and start-ups from the tech hub National Incubation Centre.

"The mobile industry has been contributing to the digital health response to COVID-19. Mobile operators have provided free calls to emergency numbers, helped distribute information and alerts via SMS and expanded a polio hotline for COVID-19 enquiries. The government also worked with mobile operators to replace the standard call ringtone with COVID-19 messaging, and established a mobile track-and-trace system and dashboard that centralize COVID-19 data, both of which are active. Live data on hospital capacity is generated, and an app is available for citizens to identify nearby hospitals and their capacity. Data on index cases is mapped onto population centers using geotagging to identify hotspots and inform a smart lockdown strategy. Social media and traditional media have also been used to raise awareness and distribute information on sanitization techniques, handwashing and social distancing.

"Provincial governments have set up phone helplines for COVID-19-related enquiries and advice. The Yaran-e-Watan telehealth platform was launched in partnership with Sehat Kahani to harness the expertise of Pakistani health professionals living outside the country and to connect them with appropriate institutions in Pakistan. Health professionals can deliver teletraining sessions, provide consultations and triage assistance using telemedicine and participate in research collaborations. Telehealth and tele-education have been used extensively. The Government of Pakistan recently launched a COVID-19 telehealth portal on Twitter, as well as a website. Pakistani doctors and health professionals have been invited to register and volunteer to help COVID-19 patients.

"The Sindhi government developed the CoronaCheck app that allows users to check their symptoms through a screening tool that utilizes an AI-assisted chatbot. It also provides information from the World Health Organization (WHO) and lists relevant services."

Benin ? Digital health: COVID-19 response

"A centralized, government-led platform that provides frequent COVID-19 updates is freely available to all mobile subscribers in Benin, and there are a range of awareness-raising videos and press releases on various social networks. An interactive WhatsApp messaging system has been set up and helps the national COVID-19 response team to communicate directly with citizens.

"Sèmè City, with support from UNFPA Benin, has created Taskforce Innov COVID-19 Benin to mitigate the challenges presented by COVID-19. This initiative aims to develop local solutions that deliver healthcare services to women and strengthen the economic resilience of youth entrepreneurs. The task force is comprised of various players (start-ups, SMEs, large corporates, academics and scientists, government agencies and NGOs) that are developing innovative solutions adapted to Benin's social and economic context. Sèmè City is responsible for coordinating the task force's activities. Digital health start-ups, including KEA Medicals and REMA, are part of the task force, working closely with the government during the pandemic."

Nigeria ? Digital health: COVID-19 response

"The Nigeria Centre for Disease Control (NCDC) launched a COVID-19 eTraining course on Infection Prevention and Control. The online course is available to the public and is aimed at healthcare workers to reduce the risk of transmission of COVID-19 and other infectious diseases while administering healthcare in Nigeria.

"Since the first COVID-19 case in Nigeria was confirmed in February 2020, the NCDC has supported the training of about 17,436 health workers in Infection Prevention and Control (IPC), and works in collaboration with the Department of Hospital Services and the Department of Food and Drugs under the FMoH. Since February2020, Nigeria has increased its molecular laboratory network for COVID-19 testing, from two laboratories to 28 in states across the country. To achieve this, the NCDC collaborated with private sector partners, such as start-up 54Gene and eHealth Africa, which were instrumental in expanding testing capacity for COVID-19.

"LifeBank, a blood delivery digital health start-up, has collaborated with the Nigerian Institute of Medical Research to develop rapid testing kits and create a shared database to track available medical equipment. Wellvis Health created COVID Triage,54 a digital self-assessment tool that helps users test whether they have been exposed to the virus and take the next steps. In turn, the NCDC collects this data to see who might be at high risk of contracting COVID-19 and isolate them. GloEpid by Tech4Dev has developed a contact tracing tool that uses a smartphone, GPS and Bluetooth connection to trace the movements of those who have been potentially exposed to the virus."

Rwanda ? Digital health: COVID-19 response

"Digital health has been a key enabler for Rwanda's COVID-19 response, particularly in terms of access to information and healthcare. The government has set up a toll-free national helpline and a USSD platform for self-triage. Information from the WHO was disseminated via SMS and drones, and AI-enabled drones operated by technology company Zipline have been used to deliver medical supplies to more remote areas of the country. Mobile money transaction fees have been waived to increase uptake and encourage cashless payments.

"The following digital solutions have helped the government respond effectively to the COVID-19 outbreak:

• "Contact tracing: Infections are being traced through the paperless Open Data Kit app that can be downloaded on a mobile device. Data is collected for analysis by outbreak investigation teams.
• "COVID-19 surveillance: A digital reporting surveillance system for health facilities is being used to monitor influenza-like illnesses and severe acute respiratory infections in real time to provide early warnings of suspected COVID-19 cases.
• "Infection prevention: Robots have been used in healthcare settings to perform simple tasks, such as checking temperatures and monitoring patients to reduce healthcare workers' exposure.
• "Data visualization: Geographic Information System (GIS) is being used to monitor COVID-19 cases at the household level to assess the need for lockdown measures, to focus public health interventions where there is evidence of community transmission and to monitor at-risk populations."

Lastly, the report explains that its final section "features case studies from each country. Again, while these are just snapshots, taken together they illustrate some of the progress that is being made in strengthening health systems with digital health solutions."

COVID-19 has significantly impacted health systems in countries worldwide. During my travels to developing countries prior to the global pandemic, I saw just how fragile these health systems are. Since the start of the pandemic, my colleagues who live in these countries have shared how COVID-19 has exasperated the health system's vulnerabilities in providing quality healthcare to the general population. The GSMA report, however, provides much encouragement on how governments, civil society, and the private sector can collaborate in creating sustainable digital health solutions.

What are your thoughts about the report? What digital health solutions are you seeing that were created as a result of the COVID-19 pandemic?

Aaron Rose is a board member, corporate advisor, and co-founder of great companies. He also serves as the editor of GT Perspectives, an online forum focused on turning perspective into opportunity.