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How can we improve health and lower the number of preventable deaths in Africa?
In the 2015 Gates Annual Letter, Bill and Melinda Gates predicted that better health “will be driven by innovation in technology—ranging from new vaccines and hardier crops to much cheaper smartphones and tablets—and by innovations that help deliver those things to more people.”
I agree: The potential for new technology to revolutionize and disrupt current models of healthcare delivery is enormous. However, from my experience working in the medical field in Africa, I know that existing healthcare tools, if better utilized, could start saving lives there today. These may not be as thrilling as the latest app or gadget, but they have enormous potential if used correctly. In its own way, that’s pretty exciting.
Here are five of these tools that have the potential to deliver cost-effective, life-saving, scalable healthcare interventions across the continent:
SMS is the only universal mobile platform for the masses. It does not require special equipment and is already available on nearly every cell phone. A recent Pew Research Center study found that across seven African countries, at least two-thirds of people own a cell phone.
So SMS is a powerful, inexpensive and effective tool for public health education and promotion. For example, a text-message based mHealth intervention carried out among pregnant women in Cape Town, South Africa showed that informational texts increased women’s healthy behaviors during pregnancy.
Entrepreneur Bright Simons recently said that the developed world has not created a “healthcare system.” It has developed a “sick care system,” because it places a disproportionate emphasis on the management of sick patients instead of the prevention of illness and the maintenance of health. In Africa, we can do better through health promotion, and with tools like SMS, health care professionals and community health workers can proactively send life-saving information by text to help keep people healthy.
2. Community Health Worker Programs
In many developing countries, especially in Sub-Saharan Africa, there are critical shortages of health professionals. Current medical and nursing schools cannot train enough workers to keep up with increasing demand for health care services. Meanwhile, internal and external emigration of health workers, deaths from AIDS and other diseases, low workforce productivity, and population growth are constantly reducing the supply of health workers.
Community health workers (CHW)—also referred to as village health workers or community health aides—provide basic health and medical care to their communities. They only need a limited amount of training, supplies, and support to provide basic but essential primary health care services.
3. Early Warning Score
Hospitals in Africa have much lower staff-to-patient ratios than their Western counterparts. Therefore, a monitoring system that is easy-to-use, cheap, reproducible, and scalable holds even more potential to deliver a revolution in patient safety. One of these systems is the early warning score (EWS), a guide used to quickly determine the severity of a patient’s illness and whether a patient is deteriorating or improving. The EWS is used by hospital staff as well as emergency medical services across the UK, but few places in African countries.
In a 2010 study, researchers found that EWS reinforces the need for regular physiological observations, which save lives. Early recognition, timeliness, and competent clinical response are a triad of key determinants of clinical outcomes in people with acute illness. Since EWS is easy to disseminate and requires minimal training, medical facilities could easily begin using it.
4. Surgical Checklist
For most of us, surgery is scary and patients may spend hours trying to find a surgeon with the greatest level of expertise. But no matter a surgeon’s skill or credentials, there is an intervention that has been proven to make surgery safer. The WHO states that using a checklist to improve the safety of surgery can save many thousands of lives each year.
A hallmark study published in the New England Journal of Medicine in 2009 looked at eight hospitals, across both low-, middle-, and high-income countries. Use of the Surgery Checklist reduced deaths and surgical complications by more than one-third across all eight pilot hospitals. The rate of major inpatient complications dropped from 11% to 7%, and the inpatient death rate following major operations fell from 1.5% to 0.8%. Like EWS, surgical checklists represent a relatively simple and promising strategy for addressing patient safety worldwide.
Every day, as many as 1,500 women throughout Africa die from preventable complications during pregnancy and childbirth. Many of these deaths could be prevented with ultrasounds (also called sonography), which are mainly found in larger, urban centers and have not become commonplace in rural areas.
But diagnostic ultrasound can help more than expectant mothers. Bedside ultrasounds can also be used to identify a variety of potentially life-threatening conditions, including trauma injuries like bleeding in the chest and abdomen; advanced heart failure; fluid in the lungs, abdomen, and hearts of AIDS patients; and blood clots. Its application is widespread, including in primary care medicine, emergency medicine, obstetrics, critical care medicine, and even orthopedics.
As ultrasound machines become more durable, portable, lightweight, and affordable, they are quickly becoming vital diagnostic tools in even the most rural areas. However, one drawback is that they are user-dependent and implementation requires widespread training. But it is worth it: As a piece of equipment that makes therapeutic procedures safer and holds the potential to save thousands of lives, its use should increase across the continent.
Innovation matters! But we can’t forget that we already have so many tools that are perhaps less sexy, yet brilliant in their own ways. Harnessing their potential could save thousands of lives across Africa today.