Healthtequity 1.0

How is technology in healthcare making and breaking health equity?

Health technologies simultaneously hold the potential to significantly improve healthcare access and delivery, but also to dramatically widen the 'digital divide' that exists in healthcare.

Before we dive in, 2 quick definitions to set the scene:

Global health: an area for study, research, and practice that places a priority on improving health and achieving health equity for all people worldwide.

Health equity: Health equity?is?defined?as the absence of unfair and avoidable or remediable differences in?health?among population groups?defined?socially, economically, demographically or geographically. More on health equity here from Yale School of medicines.

Tech in healthcare is booming, with a host of products and solutions that promise to solve the plethora of challenges within it. Simultaneously these very products can negatively impact health equity in underserved and marginalised communities and low income countries due to factors such as health data poverty and the like.

What opportunities for innovation and impact lie in the intersection between tech and global health? And who are the companies that are making a positive impact on health equity right now?

Here is a snapshot of those doing the most for the people with the least:

1. Wardworx

Oh how I wish I'd had this in lieu of roughly drawn patient lists on the back of prescription pads and scribbled reminders on the back of my hand when practicing! Wardworx is a mobile app designed to assist doctors with their patient task management in hospital settings.

Health: Created by a South African doctor, and made with doctors working in resource constrained hospitals in Africa front and centre of mind. Hospitals that typically have no Electronic Medical Record (EMR), an extremely high patient turnover and are manned by staff that are burning the candle from all ends. (If you have ever waitered tables, imagine the feeling of spinning with more orders than you can keep track of, x10000 and then add the stress of patients lives on the other end of that scrambling adrenaline).

Tech: A secure, POPIA compliant mobile and web based app made for speedy task allocation & teamwork.

Equity: Optimising and improving the workload of healthcare workers in overburdened healthcare systems goes a long way in improving healthcare outcomes and health equity (and let's not forget work satisfaction of doctors).

2. InON Health

InOnHealth (formerly access.mobile USA) provides?adaptive health engagement to improve?health access, equity and outcomes. Having successfully implemented their solution in Africa, they have expanded their footprint to the US with InOnHealth.

Health: Optimised?patient outreach?based on individual needs, profiles, behaviours and preferences focusing on untapped communities, including communities that are minoritised or historically underserved.

Tech: InOn Health uses?equity indices?along with analytics visualisations to guide outreach, applying cross-cultural expertise and a multi-channel, mobile-first approach to?communications. See this great StartUP Health interview with founder KP Yelpaala which digs into how the use of big data can help healthcare providers communicate more effectively with entire patient populations, often over culturally competent and targeted text messages.

Equity: Their impact on health equity spans across diverse populations in the U.S. driving COVID-19 testing and vaccination for Black populations in Atlanta, improving diabetes care compliance among Latinx on Medicaid in East Los Angeles, and increasing appropriate service utilisation for rural populations in Klamath Falls, Oregon.

3. EMGuidance

My peers and I used EMGuidance HEAPS whilst whilst working the wards in South Africa. It is impossible for a single human to be able to recall all the treatment protocols and finicky pharmacodynamics of every medicine they could possibly prescribe (yes, doctors and nurses have to use google sometimes too). The peeps at EMGuidance have developed both a medicines and treatment platform for medical professionals to solve for this.

Health: An application that medical professionals can access for medicines info and clinical guidelines anytime, anywhere.

Tech: Web based and mobile medicines and treatment platform for medical professionals.

Equity: An on-demand evidence based medicines resource with over 1200 locally relevant clinical guidelines is literally a life saver for medical professionals in rural hospitals. This review speaks for itself: 'This app is essential to patient care and saving lives in the rural parts of South Africa, where there are (in most cases) no doctor or any other support structure for nurses such as myself. I am on nightshift as we speak and regularly use this app for diagnosis and treatment of all patients in my institution as I am the only one capable of providing care during the night, this app helps me do just that... '

4. Access Afya

Access Afya is a social enterprise running high-quality, affordable primary healthcare in Nairobi's informal settlements.

Health: Their model comprises a chain of quality assured, low-cost micro-clinics. These sites operate in slums, are run by a local care teams, and are stocked and ready to work with a wide range of primary care needs, from diagnosing and treating infectious disease to family planning to first aid, and more.

Tech: In addition to using data to optimise how they run their physical clinics, they also run a virtual clinic that provides comprehensive health access online.

Equity: By providing healthcare at a low costs within slums in Nairobi, health equity is directly impacted as patients living in these areas would typically not have access to quality care. Access is key here.

This blog piece by founder Melissa Menke, talks to how in countries like Kenya, the conversation should not be about 'disrupting healthcare' but rather 'creation' of new healthcare solutions. ***(More on the concept of the 'leap frog opportunity' in digital health in Africa in another piece, but if you are curious - have a look here at 'e-Health in Africa: What will it take to harness the leapfrog opportunity?' in the interim)

5. Vula Mobile

The status quo for referrals in rural public hospitals in South Africa often comprises hanging on the phone for hours trying to get a specialist in a secondary or tertiary hospital to give advice for and accept a patient in their already overflowing wards.

Health: Vula solves for this inefficient process with their medical referral app and online platform that makes it easy for primary healthcare workers to get advice from and refer patients to specialists.

Tech: A mobile app designed to work in remote and rural areas, consuming 20x less data that Whatsapp.

Equity: In a system where clinicians working in rural hospitals often work with no specialist support, a mechanism for secure, timely and efficiently referrals adds immense value in improving access to and quality of healthcare for patients in rural areas.

6. Right ePharmacy

Robotic ATM like PDUs (Pharmacy Dispensing Units) that dispense medicines to patients living in remote areas = genius!

Health: Right ePharmacy is solution provider for the dispensing, distribution and collection of medicines based in South Africa.

Tech: Using tech to enhance differentiated models of pharmaceutical care in South Africa is the main aim of the game for Right ePharmacy. A high impact example: a PDU in ATM style that uses electronic and robotic technology to dispense medication and integrated cloud-based tech to enable remote dispensing, labelling and live patient counselling. The cloud-based information system hosts and manages patient data and links the patient to a remote pharmacist via an audio-video link (hello smart telepharmacy!).

Equity: Imagine living hundreds of km from the nearest pharmacy? Simply getting your meds would involve significant time, money, transport, time off work etc etc. Enabling access to medicines via the PDU/ATM Pharmacy is a game changer in improving access to healthcare for remote communities.

7. Swoop Aero

Swoop Aero provides a drone logistics platform and service that integrates into medical supply chains to delivery emergency medicines, blood, vaccines and pick up pathology samples. Headquartered in Melbourne (AU) they have expanded their footprint across Africa in partnership with NGO's and governments, to the Democratic Republic of Congo, Malawi and Mozambique.

Health: First and last mile supply chain delivery for critical medical supplies and samples.

Tech: Physical drones are only one part of the picture. Swoop Aero provides an integrated tech platform that bridges gap in logistics supply chains by overcoming vast distances, traffic congestion, location accessibility, inhospitable terrain, and data shortages.

Equity: The ability to deliver critical medical supplies to remote locations, disaster areas and conflict zones significantly improves the health equity of the communities in these locations. As the global Covid-19 vaccine effort unfolds, the roll of robust supply chains in many African countries will be key to ensure equitable and timely vaccine distribution.

This list no doubt only scratches the surface of the great people chipping away at the complex challenge of improving health equity. Feel free to share other companies and entrepreneurs you have come across in the comments!

As parts of the world start to emerge out of Covid-19, never before has health equity been as important as it is now. Without equitable access to vaccines the risk of variants lurks on all our doorsteps. Without equitable access to healthcare services and medicines, healthcare systems will not be able to bounce back in addressing the healthcare burden of all other chronic diseases, surgeries and 'business-as-usual clinical care' that has been put on the back burner as they have dealt with wave after wave of Covid-19. Many of us (myself included) are privileged in our access to healthcare, and it is important that we do not relegate the responsibility of addressing health equity to 'another', but rather seek to make a difference within our realm of influence, talk about it and take action within the means possible to each of us.