The Digital Health Connection in Africa
This article was featured in the latest issue of Novo Nordisk’s sustainability …
It’s 43 °C (104 °F) and Ulrik Uldall Nielsen has just travelled 70 kilometres to Thies from Senegal’s capital Dakar to visit one of the clinics expected to be enrolled in Novo Nordisk’s Changing Diabetes® in Children (CDiC) programme.[1]
As Global Project Manager, Ulrik hits the road frequently to speak with healthcare professionals at CDiC clinics throughout Africa and South East Asia. Seated in the office of the clinic’s lead doctor, they are discussing the programme when the doctor’s phone begins beeping. The doctor takes out his phone, opens the message and shows it to Ulrik.
“It was a reminder to check blood sugar levels,” says Ulrik. “It just goes to show how quickly Africa is embracing the power of mobile technology.”
21st century health without borders
mHealth, short for mobile health, is the use of mobile and wireless devices to improve health outcomes, healthcare services and health research. In contrast to desktop computers and their reliance on broadband or telephone wires, with mHealth, anyone with a mobile device and a good signal can get connected.
In just over a decade, mobile-cellular subscriptions have outpaced internet access substantially throughout Africa. In 2005, mobile subscription rates were approximately 12%, and only 1% had internet access in their home.[2] By 2015, mobile subscriptions had reached 73% while home internet access was slightly above 10%.[3]
Despite the huge uptake in mobile devices, traditional ways of providing training of healthcare professionals or patient education were not seizing the mHealth opportunity. As Ulrik would learn, the materials used in the CDiC clinics were a perfect example.
Type 1 diabetes in the developing world
Globally, an estimated 542,000 children under the age of 15 are living with type 1 diabetes.[4] Half live in resource-poor settings in the developing world[5] and many face life-threatening complications because families are not able to afford treatment or adequate health care is not available.
Since 2009, Novo Nordisk has been partnering with Roche, the World Diabetes Foundation and the International Society for Pediatric and Adolescent Diabetes (ISPAD) to improve delivery and accessibility of care for children with type 1 diabetes in resource-poor settings.
Today, the CDiC programme has established 108 clinics in nine African and Asian countries. More than 13,500 children have been enrolled in the programme, receiving free insulin, blood sugar test strips and treatment support, and more than 6,000 healthcare professionals have been trained.
“There are very few paediatric specialists in type 1 diabetes in many of the countries the programme operates in,” says Ulrik. “We usually work with a physician in the clinics, so we created training materials for them and educational materials for nurses who must work with family members and the children.”
The training and educational materials, created with ISPAD, have been translated into five languages and published in paper format and as a PDF download. They have been a valuable resource in the CDiC clinics and have also been recognised and used by diabetes educators and parents around the world. The catch is that you need a fast internet connection and preferably a desktop or laptop computer to really enjoy a PDF.
Rethinking education tools
“PDFs are heavy. They are not the best way to deliver health information in Africa,” says Line Kleinebreil, Vice President of Université Numérique Francophone Mondiale (UNFM) and consultant for the World Health Organisation’s non-communicable disease mobile health programme in Senegal.
Line started her career as a doctor but in 2005 began working with different organisations to develop health education tools that could be delivered over low-broadband connections to city hospitals. In her work at UNFM, Line has been a part of the team establishing a network of health centres in sub-Saharan countries. Once a month all these centres join an international webinar on diabetes using a special system which allows over 50 centres to connect at the same time, even in places where internet is still of poor quality.
“The monthly training is an opportunity for healthcare professionals to interact with diabetes specialists and discover new tools,” says Line. “The PDF versions of the CDiC material were too difficult to use so we created an interactive version, with games, to facilitate the necessary understanding of the disease and adequate daily management.”
After Line repurposed the CDiC training materials to be used in low-speed internet connections, they have been presented during webinars to over 1,000 healthcare professionals throughout French-speaking Africa.
According to Line, the feedback has been very positive and she is now working towards offering a Changing Diabetes® in Children game to each child newly diagnosed or hospitalised with type 1 diabetes. “Senegal and Ivory Cost are ready to start and we are exploring new games that could be added,” says Line. “These new games could help address needs in Muslim countries to increase education about type 1 diabetes and fasting for example."
Be He@lthy Be Mobile
Though there has been great success at the healthcare professional level, Line has come to realise that internet connections may not be the way to go to reach people living with diabetes.
“If you want to reach 10% of the population, use the internet,” says Line. “But with mobile, you can reach up to 90% of the population in Africa.”
With so many people owning a mobile device, even the most basic phone offers the opportunity to use text messaging to educate and remind people to improve treatment.
This has not gone unnoticed and in 2012 the World Health Organization (WHO) and the International Telecommunication Union (ITU) jointly launched the Be He@lthy Be Mobile programme in eight countries. The aim of Be He@lthy Be Mobile is to explore the effectiveness of using mobile devices to combat the rise of non-communicable disease.
“Senegal is one of these eight countries and has chosen to focus on diabetes,” explains Line. “Senegal’s mDiabetes plan aims to provide children with type 1 diabetes and their families with support via text messaging. We are hoping we can use the CDiC material that has already proven to be effective.”
Line and Ulrik agree that the partnership was a great match.
“Novo Nordisk has diabetes expertise and has developed excellent material with international experts,” says Line. “UNFM has the expertise and network to scale-up the dissemination of training material among health centres even in remote areas where children live. Together we have a better chance of improving the global care for children with diabetes.”
[1] For more information, see:http://www.novonordisk.com/cdic.
[2] ITU. Key ICT indicators for developed and developing countries and the world (totals and penetration rates), 2015. Available at: http://www.itu.int/en/ITU-D/Statistics/Documents/ statistics/2015/ITU_Key_2005-2015_ICT_data.xls.
[3] Ibi
[4] International Diabetes Federation. IDF Diabetes, 7 ed. Brussels, Belgium: International Diabetes Federation, 2015. Available at: http://www.diabetesatlas.org
[5] Ibid
