Rwanda and the Dreamers of Digital Health in Africa: Wakanda Is Real
Rwandans in remote villages are using an artificial intelligence-based algorithm on their mobile phones to get a diagnosis for their health problems, doctors in Kigali consult their colleagues in the Western Province about radiology cases through telemedicine, blood is delivered by Zipline’s medical drones, and a central electronic health records system ensures data is collected about health activities. Rwanda is a pioneer in digital health in Africa – a real Afrofuturistic embodiment of Black Panther‘s Wakanda. Let’s see how and why that happened.
Wakanda gets real in Rwanda
Black Panther’s Wakanda with its gorgeous African landscapes, fierce waterfalls, peoples living in harmony and technological absoluteness represents a mighty utopian endpoint for many countries. How does healing look like in a high-tech paradise like Wakanda? When CIA agent Everett Ross was shot in the spine by one of the main villains, Klaue, the Wakandan team brought him back to the country after stabilizing him on the spot. In the tech lab, Shuri, sister of the king uses virtual reality coupled with rapid diagnostic imaging to diagnose Ross. He wakes up 24 hours later, and his wounds are healed. We can see how he stands up from a bed, where all medical data is contained around his head, and his state is constantly monitored.
While the Rwandan economy isn’t based on the superstrong and powerful material, the vibranium, the technological advancement, especially in the area of creating a digital society backed up with digital health, sets it apart from its environment. Artificial intelligence, telemedicine, medical drones, health apps, and mobile solutions are bringing the country to the 21st century. And just as in Wakanda, they are combining high-tech with traditions. Let’s see in details, how it happens.
From community-based health insurance through broadband to digital health
After the devastating genocide 24 years ago, the Rwandans had to completely rebuild the entire country, including their healthcare system. The government has contributed immensely to this development; for example, expenditures on healthcare have increased from 3.2 percent in 1998 to 9.7 percent in 2008, and it did not stop there. Major healthcare reforms have gone down throughout the years – starting from introducing the mandatory health insurance scheme from 2008 on. Ten years later, more than 90 percent of the population was already covered by community-based health insurance schemes.
But that was just the beginning. Step by step, in line with the rapid technological development around the globe, Rwanda embraced digital technology on every level. Dr. Zuberi Muvunyi, Director General in the Clinical and Public Health Services Department, told The Medical Futurist that “the Rwandan government has made smart health as one of the pillars of their information and communication technology (ICT) policy. ICT was really something that the government has put in front in general for the development of this country.”
The backbone of the digital society: broadband, cables, and phones
Similar to the Baltic country, Estonia, Rwanda has aimed for digitalizing the nation in many areas. As a country with 12 million people and no significant natural resources, the leadership recognized that the service sector could mean the potential development path for Rwanda. They also identified the massive promise in the ICT sector very early.
It all started with cables and broadband. The government already invested a hundred million dollars in building a bandwidth or fiber network infrastructure over a 2,796-mile vast land. Dr. Zuberi says that 90 percent of the entire country is covered by 4G. Some are using even 5G, while fiber optic cables are covering almost the whole country.
The mobile phone penetration is 75 percent, and smartphone penetration started to skyrocket in the last months. “When I first went to Rwanda two and a half years ago, every mobile phone shop had feature phones, and smartphones were on the bottom shelf. Now, what’s happening is every shelf is smartphones except for the bottom shelf because new and cheap handsets are flooding into African countries from places like China”, explained Tracey McNeill, Chief Mobilisation Officer at Babylon Health, who has been CEO of babyl Rwanda and worked in the country for almost three years to establish their feature phone-based health service.
A principal factor of success: the digitally-savvy government
McNeill and Muvunyi both emphasized the decisive role that the government is playing in transforming the country apace towards a digital society – and shifting the entire healthcare system towards digital health. A great example was when Agnes Binagwaho, former Minister of Health held discussions on Twitter about the healthcare state of Rwanda using the #MinisterMondays hashtag.
“What amazes me about countries like Rwanda is that they have strong, focused leadership and the government really wants to improve the lives of the average Rwandan,” noted McNeill. She also believes that for the sustainability of digital products such as babyl, it is essential to understand how it’s going to be paid for in advance – and in most African countries, it’s either paid for by the patient in pocket expenses or by the government, she said. Thus, the government could signify kind of a safety guard, while the general health insurance scheme means a basis for further development.
Muvunyi explained that Kigali was careful enough to make the digital transformation a step-by-step process in every area. After having introduced the electronic ID in 2016, and the electronic passport this year, the healthcare sector was not to stay behind. At first, Rwanda introduced electronic health records for HIV services in partnership with intergovernmental organizations, WHO, Global Fund, OCDC or the US Government. Then they expanded the EHR system to manage financial aspects, registration, consultation, clinical records, etc.
Currently, they are using an e-LMIS for the management of medical supplies, lab management systems for logistics in laboratories and a rapid SMS system. Using the latter, the approximately 60,000 community health workers in the country can report about any emergency to the Health Ministry in a short time. Muvunyi noted that right now, they are integrating all the various systems together, and approximately within the next ten years, the Rwandan medical landscape will be completely transformed with a strong focus on digital health.
Key to innovation: partnerships and no overregulation
Not only the step-by-step process, but collaborations have also played a pivotal role in shaping the healthcare system in the African country. These collaborations do not just mean joint work with governments, NGOs or IGOs as mentioned before but also with companies such as Zipline or babyl. “Rwanda approached us: when we launched Babylon Health in the UK, the Rwandan ambassador to the UK came to our event and said this is exactly what we need in Rwanda. So he invited us to go to Rwanda and meet the Ministry of Health. And then the Ministry of ICT called us, and we decided in partnership with the government to set up our network in the country”, explained McNeill. Currently, the feature-phone based health service has over 2 million users, and they have done 200,000 consultations for just under two years.
Also in 2016, the Rwandan government teamed up with Zipline, a medical drone manufacturing company to deliver medical supplies to five of its hospitals. The American start-up appeared earlier on the African market than in the US – as the government supported it and looser regulations allowed it. It was only after its Rwandan success that the White House reached out to Zipline expressing interest in delivering medicine and blood to rural parts of the US. When The Medical Futurist asked Justin Hamilton, Zipline’s spokesperson, why the start-up first choose Rwanda, he mentioned two factors: “On one hand due to the high medical needs, on the other hand, due to the low complexity of navigating the airspace – it is much less crowded and regulated as in the US. “
Jointly shaped rules and easy start for businesses: a recipe for success
However, the lack of regulation can also pose challenges for companies eager to enter the Rwandan market. McNeill said that one of the biggest challenges for Babylon Health in the African country was working with the government because “there was no regulatory framework and no standards for digital healthcare.” As a result, they worked very closely with the Ministry of Health, and they developed the regulatory framework and standards together for a successful operation in Rwanda.
In spite of the challenges, entrepreneurs and start-ups are flocking to Rwanda, so it is clear that they can get out benefits from co-shaped regulations. Muvunyi said that companies from India, Japan, Korea, so mainly Asians are knocking on Rwanda’s doors – Europeans rarely do that, although the director general would welcome them, too.
It is far from rocket science to launch a business venture in Rwanda. Foreign nationals can easily obtain an entrepreneur visa for tech start-ups in a short time span, at no cost and online. More so, Rwanda is secure, and the corruption level is almost non-existent. In case of a healthcare company, the Rwandan Development Board is responsible for explaining the requirements, then companies have to state their compliance with the Rwanda Utility Regulatory Authority, then register at the Ministry of Health. As everything could be done online, it shortens the process and lowers the costs as well.
Fight against doctor shortages: phone-based platform, telemedicine, drones
That’s the best recipe for attracting businesses: making it easy and smooth for innovative start-ups to operate. In countries like Rwanda, you genuinely need that when you have to fight against shortages of medical professionals and diseases such as malaria, HIV, respiratory infections or Hepatitis B and C.
Muvunyi mentioned that they only have “one doctor for more than 10,000 that is way above WHO recommendations. For nurses, maybe we have one nurse for 5,000, while the WHO recommendation is one for 3,000.” He believes that telehealth solutions, phone-based platforms such as babyl, and medical drones mean a viable solution.
And not only are these companies present in the country, but they are also expanding and innovating with the full support of the Rwandan government. Zipline is deploying its second launching site, while babyl is working on its artificial intelligence solution for tablets used by community health workers. McNeill explained that they started to use A.I. in their call center as a method for triaging patients, while their final goal is to „put an artificial intelligence doctor’s brain into the hands of community-based health workers.”
Meanwhile, telemedicine became a daily routine for doctors in Rwanda. Muvuny proudly explained how someone in the provincial hospital in the Western Province of Rwanda could send a CT scan to a hospital in Kigali, and in 5 minutes, could have a report back. Through videoconferences or online consultations, they can decide whether they operate the patient, if they put in more medical treatment, and so on.
The government has also partnered with the organization Vision for a Nation (VFAN) to train more than 3,000 eye care nurses based in 502 local health centers, prescribing glasses and referring those with serious eye problems to public clinics. Nurses have visited each of Rwanda’s 15,000 villages.
John Lennon and Rwanda as a beacon of digital health
Muvunyi mentioned that countries from around the world are interested in the Rwandan experience. Delegations from the Middle East, from Latin America or from other African nations come to Kigali and discuss best practices and how to implement solutions in their own countries.
Regarding the region, Kenya is particularly intrigued. McNeill said that Babylon Health is also looking at the country as well as Nigeria, and they hope to roll out their services next year. “Kenya is perfect timing for us at the moment because the government that was reelected has made healthcare one of the four key pillars of the next four years regarding an essential area for growth and investment,” added McNeill.
And what about the future of Rwanda? Muvunyi says that in two years, they plan to perform minimally invasive surgeries using artificial intelligence and robots in some hospitals. When looking further down the road, he sees a wholly transformed medical system within ten years. He said he likes to describe the situation with John Lennon’s song, Imagine.
“Some people think that we are dreamers, but we are no longer dreamers, we are living it now with babyl, Zipline, and many other initiatives. We hope that many will join us to form a bigger community of dreamers in digital health”, he added.
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