This blog is part of a series of youth authored essays on Health futures: digital first health systems for and with young people. The views expressed in this blog are of the author and not of the Lancet and Financial Times Commission on Governing Health Futures 2030: Growing up in a digital world.
On the 24th of October, 2021, The Lancet and Financial Times Commission on Governing Health Futures 2030: Growing in a Digital World published its report, the findings of which challenged policymakers and other actors to adopt a mission-oriented, precautionary and value-based approach to governance in order to realise the full potential of digital transformations to advance health and wellbeing for all. The report advocated putting young people and children at the centre of this effort. As a young Ghanaian, I am generally satisfied with the Commission’s recommendations. However, I also wish to bring new perspectives on the design and governance of digital health systems that can deliver better health futures for young people in resource-limited settings.
Sustainable Development Goal 3 in Africa
Most African countries, if not all, are signatories to the Sustainable Development Goals (SDGs) and are working assiduously toward high performance outcomes against the SDG benchmarks by 2030. I consider SDG 3: Good health and Wellbeing to be the most critical and central to all the other global goals. This is accentuated by the ravages of the COVID-19 global pandemic. The shockwaves of the pandemic continue to reverberate throughout the world with worse ramifications in LMICs where poverty has increased due to high inflation rates, the quality of education has plummeted due to frequent and sometimes prolonged strikes by teachers and other educational workers for better conditions of service in the face of worsening economic conditions, and the majority of the population cannot afford health services.
Young people proofing of digital first health systems policies
Just as the rural proofing of policies is thought to promote equity of access and other qualities of universal health coverage, I hold the view that “young people proofing” of health technologies, digital solutions in health, and national health and digitalisation policies are critical for securing the health futures of the future leaders in Africa. The 4As of the healthcare ecosystem, i.e., acceptability, availability, affordability, and accessibility should be approached with children and young people centred in the design and governance of any digital solutions in health. These should also be counterbalanced with the clinical ethics of beneficence, non-maleficence, autonomy and justice.
A digital first health system must be available to all young people irrespective of their location in time and space. Africa is far behind in global digital transformations. Within a country like Ghana, and I believe in many other LMICs as well, multiple digital divides persist – rural-urban, gender, age, income-level, educational attainment, social status, among others – requiring deliberate public investments in infrastructure for a meaningful and equitable digital transformation.
Accessibility of digital technologies in Africa
A UNICEF report cited by Governing Health Futures 2030 Commission, Youth Edition (2021) indicates that only a third of all children and young people globally have Internet access at home and there is a big gap between access in high-income countries and low-income countries. The Internet is the backbone of the global digital transformation. Internet accessibility therefore translates directly into digital first health systems accessibility. Internet accessibility, or, for that matter, digital first health systems accessibility is affected by the three other As – acceptability, availability, and affordability. Africa is predominantly a consumer of digital technologies, and a change in this trend is not close in sight. One of the biggest digital divides in Africa is the financial divide. Mobile penetration in Africa may be reported as high, however, a nuanced analysis reveals that the majority of those who own a mobile device only use simple devices capable of telephony. Comparatively, fewer people use smartphones, and those few people are among the elite with high income who also own multiple devices apart from phones such as tablets and laptops, and live in cities and business enclaves where telcos invest heavily in network infrastructure. The cost of digital technologies in Africa make them the preserve of a small elite class.
Affordability of digital technologies in Africa
Most young people in Africa cannot afford the right tools. Already, there are wearable health technologies such as the Apple Watch and an Android alternative by Samsung, but these devices are simply unaffordable by most young people who are unemployed and totally dependent on families and friends for daily survival. The unaffordability of digital technologies is in itself becoming a health risk to young people and a and security risk to most African countries. This is illustrated by the surge of cases such as adolescent girls trading sex for iPhones and young men perpetrating various forms of cybercrime and money ritual, known as Sakawa in the Ghanaian parlance, to obtain these technologies.
If we are seeking to create a young people and children centred digital first health system, efforts must be made to ensure that all can afford it economically, intellectually, socio-culturally, and geopolitically. What forms will digital first health systems take in order to be available to all young people? Poor network infrastructure in Africa only means that the expected digital first health systems advantage of 24/7 availability is not the reality, as is the case in most resource-poor settings. Governments and tech companies must regulate the prices of digital technologies. Investment must be made in youth start-ups that seek to become enablers in the digital space in Africa. They must be encouraged and supported as their success will increase competition and reduce the effect of monopoly on affordability.
Digital first health systems and the African culture
A major issue in Africa that continues to slow down the development of the continent is the multiplicity of cultures and religious expression. Cultural, and often superstitious beliefs fuelled by high illiteracy rates can pose a challenge to the acceptance and adoption of a digital first health system among the general population. Young people, though digitally curious and amenable to cultural adaptation, do not hold decision-making power at household, community, or political levels nationally due to lack of financial independence. To be effective, therefore, digital first health systems in Africa must be culturally appropriate and value sensitive. The cultural diversity of Africa also means that the continent is linguistically diverse. How language/ethnic minorities, persons without formal education, refugees, and persons with visual, hearing, and speech impairments or other physical challenges can fully participate in a digital first health system needs serious consideration in the system design. This, of course, must come with empowerment for the youth to know their rights to autonomy, justice, and the privacy of their health data that will be possessed and collected by artificial intelligence.
Making children and young people the enablers
There is also the task of making young people the enablers. Although some young people are already in the tech space, they are unable to contribute to major decisions. Existing enablers must focus on appointing and placing more young people in positions where they can make and contribute to decisions on digital first health systems. These positions may be in the health sectors, digital technology space and the government. Young people must be involved in the right conversations about digitalisation and their health futures in Africa, and efforts should be made to appreciate their views as the Lancet & Financial Times Commission on Governing Health Futures 2030 is doing.
Digital first health systems and cybersecurity
Digital technology and data have always been targeted by hackers and other cybercriminals who seek to steal information or trick users into releasing their resources to them. Investments in cybersecurity are needed to create a safe digital space for health systems and to build trust in them now and in the future.
Digital first health systems and future healthcare trends
Health systems have never been constant. They keep on changing and progressing and the advent of digital technology has steeply increased the change and progress. In fact, dynamism is the reason this conversation is being held in the first place. We have recognised that we need to ride the tides of digital transformation to make healthcare better. In enabling digital first health systems that puts young people and children at its centre, considerations should be made about the dynamism of healthcare and how healthcare problems in future will be different from now. The systems we create must be open to accommodate future trends in healthcare especially in the tropics.
Digital health systems for and by the youth in Africa
Young people, particularly adolescents, are generally thought of as healthy, and indeed do think themselves healthy, and therefore have not been a major focus for most policy interventions in the health sectors of Africa in a long time. As the world continues to be digitally transformed, the narrative must change in Africa since young people are more digitally inclined than the rest of the population and can play a positive role in enabling digital first health systems. African Governments must embrace and commit to digital first health systems, which can reduce overcrowding of out-patients in hospitals and increase access to healthcare in remote settings where physical health facilities are not available. Digital first health systems and digital health literacy in Africa will not only promote the health of its peoples, it will also create immense job opportunities for young tech innovators in drug delivery, fitness and wellness, push notifications, and matching conditions to specialists for better health outcomes, thus reducing the huge youth unemployment burdens on the continent. Digital first health systems should be affordable, enabled by the youth, safe and secure and able to accommodate future trends in healthcare.
Governing Health Futures 2030 Commission. Governing health futures 2030: Growing up in a digital world. Youth Edition. Geneva; 2021: 7