Working Smart in an Era of Economic Constraint and Security Challenges Using Digital Technology

By Dr I. Miriam Ezekwe
Zonal Coordinator South East.

There are about 1.9 million Nigerians living with HIV at the end of 2022. Nigeria has the second highest burden of HIV in the world and the country with the highest population of pediatric HIV persons. In the context of healthcare provision in Nigeria, health services are provided by the government (federal, state, and local); nongovernmental organizations; religious organizations; communities and private individuals. Irrespective of the various health service providers, user fees (i.e., immediate cash payment required to access health care services) are required from patients to access healthcare services in most centres.

The percentage of patients who have healthcare insurance is negligible. Universal Health Coverage (UHC) aims to ensure the quality, accessibility and affordability of health services. However, shortfalls remain in ensuring access to all who need health services and in ensuring that they are delivered with the intended quality without causing financial hardship to the people accessing them.

Insecurity is a major challenge in Nigeria. The challenges include but are not limited to armed banditry, kidnapping, terrorism, farmer-herder conflicts. Almost every corner of the country is affected. The healthcare sector has not been exempted. The insecurity challenge has impacted the health sector in form of brain drain, industrial disputes, ineffective funding through overriding defence budgets and a decline in efficiency and effectiveness of healthcare interventions. It has actually worsened its woes and puts a lot of pressures on the monitoring and evaluation of health services.

Digital health, is the use of digital technologies to address health needs. The term digital health is rooted in eHealth, which is defined as “the use of information and communications technology in support of health and health related fields”. Mobile health (mHealth) is a subset of eHealth and is defined as “the use of mobile wireless technologies for public health”. More recently, the term digital health was introduced as “…a term encompassing eHealth (which includes mHealth), as well as emerging areas, such as the use of advanced computing sciences in ‘big data’, genomics and artificial intelligence”.

People are increasingly accessing health information and services using digital and virtual platforms, including social network sites and messaging platforms. In 2021, about 60% of people worldwide were connected online and 54% of them were social media users. The Covid-19 pandemic opened up the space further for the use of digital technology to offer healthcare services. Mobile technology can improve access to healthcare in Nigeria.

Evidence from low- and middle-income countries suggests that digital and mobile communication technology can improve management of diseases. Due to the COVID-1 9 pandemic, the use of telemedicine has been highlighted, especially in specialties, such as the management of HIV.

Benefits included retention in care for patients who lived a far distance from clinic, privacy for patients not wanting to be seen attending an HIV clinic, and more flexibility in scheduling appointments. Some limitations included patients’ access to technology, ability and willingness to use technology, and privacy of patients who are homeless. Greater limitation is access to appropriate devices for telemedicine and digital technology by patients. Areas of quick wins for the National HIV programmes in the use of digital health are HIV prevention, early detection and monitoring by supporting the use of self-test kits, referrals, linkages, real time patient monitoring, scheduling clinic visits. Less time spent in onsite clinic visits and less health facility resources utilised. The advantages for the patient include communicating in real time with healthcare workers, receiving SMS messages, rescheduling appointments. The Differentiated Services Delivery (DSD) components that rely on community pharmacy, home-refill, VL sample collection & dispatch, medication way billing, and facility locator can all be deployed using digital health tools. Patient satisfaction and safety can be monitored using anonymous questionnaires to assess stigma and discrimination. Patients may self-report drug-drug interactions and adverse drug reactions.

Digital health promises to close the gaps in HIV care in Nigeria due to higher costs of living, especially transportation. It creates exciting opportunities for health promotion along the continuum of HIV care and prevention. The empowerment of both healthcare workers and persons on HIV treatment.