Leveraging Telcos to Bridge the Healthcare Gap in Nigeria
It is no secret that telco companies in Nigeria see opportunities for them in the fintech world. They aim to replicate the success of mobile money services such as M-Pesa in Nigeria, as seen in East Africa by companies like Vodafone and Safaricom in Kenya.
Despite late approval for mobile money licenses, Nigeria has favourable legislation for new financial services such as API-based open banking initiatives, allowing fintech startups to introduce mobile-based financial services in partnership with the banking industry. This has led to the emergence of successful startups, including Paystack which was acquired by Stripe for over $200 million, and Flutterwave, and Kudabank, with valuations over $1 billion and $500 million respectively.
Moreover, there is still a need to expand financial access to under-served areas, with mobile money services seen as the best solution.
What is however less known is the interest that Telcos have in the Nigerian healthcare sector, which is riddled with several challenges, including:
- Lack of funding: The Federal and State governments do not allocate enough funds to the healthcare sector, which results in poor infrastructure and inadequate medical equipment.
- Shortage of healthcare workers: Nigeria has a shortage of healthcare workers, especially in rural areas, which makes it difficult for people to access medical care. Moreover, there are endless daily reports of healthcare workers across all the subsectors leaving for opportunities in other climes.
- Poor infrastructure: Many healthcare facilities in Nigeria are in poor condition and lack basic amenities such as running water and electricity.
- Corruption: Corruption is a major problem in Nigeria, and it is also prevalent in the healthcare industry.
- Lack of access to healthcare: Many people in Nigeria, particularly those living in rural areas, do not have access to basic healthcare services.
- Poor health education: A lot of people don’t have access to information on how to take care of themselves or their families or have misconceptions about health and illnesses.
- Inadequate healthcare coverage: Many people in Nigeria cannot afford to pay for healthcare, as there is a lack of affordable and comprehensive health insurance.
Now it is impossible for the Telcos to come up with solutions that can solve all these problems, but there are some opportunities that do exist for them which will be discussed in this article. In order to fully exploit those opportunities at scale, Telcos will need to follow the basic principles underlined in consumer health informatics.
Consumer health informatics involves utilizing digital tools and information to enable individuals to make knowledgeable choices about their health and well-being. This comprises gathering and evaluating health data, offering tailored health advice and feedback, and linking people with healthcare professionals. This area merges the expertise of computer science, psychology, health sciences, and data science to create resources that can be utilized by people to make knowledgeable choices about their health.
Some of the solutions that could be created by the Telcos in Nigeria based on the unique challenges that have already been mentioned include the following.
Personalised Health Information and Education
Telcos can use their networks to deliver health information and education to people in Nigeria. This can help increase awareness about health issues and promote healthy behaviours. This has occurred at one point or the other in the past when some of the operators offered to send health tips to individuals who subscribed to a value-added service (VAS).
Airtel Nigeria offered it as part of its 3–2–1 service, where subscribers received messages on healthcare, family planning, nutrition, and sanitation. As did Glo Nigeria back in 2014 through its GloMedicare service. The problem with both services is that often, the messages and tips sent were too generalized for the recipient of the messages.
Generalized messaging has a role to play in public health education, especially in the outbreaks of an epidemic, however, what tends to have the most impact and keep consumers engaged with the service is when the messaging is tailored for them. This is stated as one of the guidelines in the toolkit for improving health literacy in low to middle-income communities developed by WHO, which states the need for information to be context and content-specific, as health literacy in one setting, or relating to one health decision, will be different from another.
For instance, Nigeria has one of highest maternal mortality rates in the world, and this is due to a combination of factors, including inadequate access to quality healthcare services, limited access to family planning and reproductive health services, poverty, cultural practices, and a lack of education about maternal health, with the last often preventing women from seeking prenatal care and giving birth in a medical facility.
SMS messages can be used to provide antenatal and postnatal advice to pregnant mothers based on how far along they are. This can be done by sending the mothers regular messages with tips and advice that are tailored to their stage of pregnancy. For example, the messages could include tips on nutrition, exercise, and other lifestyle changes that are beneficial for pregnant women. Additionally, the messages could include insights and advice from healthcare professionals, such as information on the importance of prenatal care and tips for managing labour and delivery.
By providing relevant and timely advice, SMS messages can help to ensure that pregnant women receive the information and not only provide the support they need to have a healthy pregnancy but as well as providing tips and advice on how to safely raise a healthy baby and watch clues to look out in case of serious illness to both mother and child.
Population Health Management
Population Health Management (PHM) is an approach to healthcare that aims to improve overall health, enhance patient experience, and reduce per capita cost. It uses predictive modelling to identify patients with the greatest need for care and delivers the right care at the right time. PHM has been successfully deployed in various parts of the world for preventive health and disease management.
As a cornerstone of PHM, preventive health focuses on preventing or slowing disease progression through vaccines, screenings, lifestyle modifications, and health coaching. While disease management is for patients with chronic conditions and involves empowering patients with education, goal setting, and self-motivation techniques.
Nigerian telcos already have biodata on their subscribers as required by law. So when subscribers opt-in to their population health management service, the telcos can further use their networks to collect and analyze data on health trends and patterns in Nigeria. This data can be used to inform public health policies and interventions as well as provide the backbone for personalisation of the health information and education to subscribers to their service.
For instance, if the PHM can detect an increase in cases of diabetes and risk of cardiovascular disease in individuals based on several characteristics and living in a certain area. Those affected persons can then be provided advice on exercise and nutrition, including culturally relevant changes to their diet. They can also be encouraged to track their weight and diet by inputting information directly into their medical records via a health app, SMS, or USSD (Unstructured Supplementary Service Data).
Telemedicine
This seems obvious given its name and involves partnering with healthcare providers to offer telemedicine services, allowing patients to consult with healthcare professionals remotely.
There is already an example of this happening in Nigeria, with 9Mobile having partnered with a health tech start-up, MobiHealth International to deliver telemedicine services to its subscribers back in 2019. One of the interesting aspects of the partnership is the use of USSD (Unstructured Supplementary Service Data) to report blood pressure readings.
This is important, as while mobile phone penetration is high in Nigeria at 87.6% according to the latest MICS report, internet penetration lags far behind which may deter mobile app usage.
One huge potential area where the telcos might thrive will be the provision of a telephone triage service that provides medical advice over the phone, typically by a nurse or other healthcare professional such as a community health worker. The goal of telephone triage is to assess a patient’s symptoms and provide initial guidance on whether they need to seek immediate medical attention, such as by visiting a healthcare facility, or if they can manage their symptoms at home or with a follow-up appointment with a primary care physician.
Telephone triage can be a useful tool for patients who have questions or concerns about their health but are unable to see a doctor in person. By providing guidance over the phone, it can help reduce the burden on patients who lack access to see a doctor, while allowing them to receive care in a timely and appropriate manner from another trained professional. This can especially help increase access to healthcare in remote and underserved areas.
Another area of telemedicine that is well suited for telcos in Nigeria is telepsychology and telepsychiatry. These are the provision of psychological and psychiatric services through remote means, such as telephone or video conferencing. It is a type of telemedicine that allows individuals to receive psychological care from the comfort of their own homes or other locations outside of a traditional office setting.
Telepsychology or telepsychiatry can be a valuable resource for addressing the shortage of mental health professionals in Nigeria. According to the World Health Organization, Nigeria has one of the lowest ratios of mental health professionals to the population in the world, and this shortage is particularly pronounced in rural and remote areas. By providing access to mental health services through remote means, telepsychology or telepsychiatry can help to bridge this gap and improve access to care for individuals who may not otherwise have access to mental health services.
Telepsychology or telepsychiatry can also help to reduce the stigma associated with seeking mental health services, as individuals can receive care from the privacy and comfort of their own homes. This can be particularly important in Nigeria, where cultural attitudes toward mental health can sometimes discourage individuals from seeking help. Providing remote access to care, telepsychology or telepsychiatry can help to remove some of the barriers that prevent individuals from seeking the help they need.
In addition, telepsychology or telepsychiatry can also help to reduce the burden on existing mental health resources in Nigeria. By providing care over the phone or through video conferencing, mental health professionals can reach a larger number of individuals, which can help to reduce wait times and improve overall access to care.
Overall, telepsychology or telepsychiatry can play an important role in addressing the shortage of mental health professionals and improving access to care in Nigeria. However, it is important to note that telepsychology or telepsychiatry should be seen as complementary to in-person care, rather than a replacement for it.
Ecosystem Connectivity
By connecting different healthcare providers and leveraging technology, telecommunication companies can help support population health management efforts for an efficient and connected healthcare ecosystem.
Telecommunication companies can provide connectivity between different health service providers by offering various communication solutions. One of the ways to achieve this is by deploying private network solutions like Virtual Private Networks (VPNs) that can securely connect different healthcare providers within a single network. This allows healthcare providers to share data, communicate, and collaborate effectively.
A VPN setup can help establish secure and reliable connections between healthcare providers by encrypting the data being transmitted over the internet. This helps prevent data breaches and unauthorized access to sensitive patient information. Additionally, VPNs can provide a dedicated connection between healthcare providers, which helps ensure that data is transmitted quickly and efficiently, even in areas with high levels of internet congestion. This could involve sharing patient data and information on public health trends, allowing healthcare providers to better understand and address the needs of the communities they serve.
Another way that telcos can help healthcare providers connect is by offering cloud solutions. For example, cloud-based Electronic Health Record (EHR) systems can store patient data in a centralized location, making it easier for healthcare providers to access and share information. This can help improve patient outcomes by enabling healthcare providers to make informed decisions based on a patient’s complete medical history.
Also, they could roll out cloud-based data analytics tools to help healthcare providers analyze patient data and identify trends and patterns. This information can then be used to design and implement effective population health management programs.
mHealth
Telcos can develop their own mHealth apps to offer a range of services, such as health information and advice, appointment scheduling, and remote monitoring. Telcos can develop and implement mobile health (mHealth) app that allows people to schedule appointments, track their health status, and access health information as well as their personal health records (PHRs).
PHRs are digital versions of a patient’s medical history and health information. They are maintained and stored on the patient’s own device, such as a computer or mobile device, and can be accessed anytime and from anywhere. PHRs allow patients to store and manage their health information in one secure place, allowing them to easily share it with their healthcare providers. PHRs also allow patients to access their health information, such as immunization records, lab results, and medical history which could be retrieved from the EHRs as discussed earlier.
mHealth, can also be used to facilitate the process of electronic prescribing for community or retail pharmacies that the telcos have partnered with as part of the ecosystem connectivity drive. For example, mHealth apps can allow patients to order and manage their prescriptions directly from their mobile devices. mHealth apps can also be used to provide community pharmacies with real-time information about medication availability and pricing, helping them to make more informed decisions about their inventory.
Additionally, mHealth can be used to provide electronic prescriptions directly to community pharmacies, allowing them to dispense medications quickly and accurately. Moreover, the mHealth app can be used to facilitate payment for the drugs purchased.
Payment solution
Nigerian telcos have the potential to play a significant role in providing innovative payment solutions for health services and health insurance. With the increasing demand for healthcare services and insurance, there is an opportunity for telcos to provide a seamless and efficient payment solution that can meet the needs of both health services providers and consumers. This can help increase access to healthcare for people who do not have access to traditional banking services.
The payment solution can be designed to provide a one-stop shop for all health-related transactions. It will allow for instant payment for health services, as well as enrolling in health insurance plans and processing claims. The solution can be integrated with existing systems and processes to ensure seamless transactions and minimize manual intervention.
Health services providers can use the payment solution to receive payments for their services. Patients can use the solution to make payments directly to the providers, eliminating the need for cash transactions or manual payment processes. The solution can be linked to the patient’s health insurance plan, ensuring that the cost of the service is covered.
The payment solution can also be used to enroll in health insurance plans. Patients can choose from a range of plans offered by insurance companies and pay the premium using the solution. The insurance companies can use the solution to process claims and track payments. The solution can also be used to instantly verify what services will be covered based on the patient’s plan, ensuring that the enrollees are aware of what they are covered for.
The payment solution can also be used to process claims for insurance companies. The solution can track the claims, allowing the insurance companies to monitor the status of the claims and provide real-time updates to the enrollees. This will significantly reduce the time taken to process claims, increasing the efficiency of the system.
Challenges
It’s worth noting that, these solutions will work better when telcos work in collaboration with the government and other relevant stakeholders to create effective and sustainable solutions. Nigerian telecommunication companies that want to develop a health solution will face several challenges, including regulatory ones, as follows:
- Nigerian telecommunication companies will need to comply with the regulations set by the National Health Regulation and Accreditation Agency (NHRA) and the Nigerian Communications Commission (NCC) to ensure that the health information and services provided to customers are safe, secure and reliable.
- Providing personalised health information and education requires access to sensitive health information and data which can raise privacy and security concerns. Telecommunication companies will need to implement strong security measures to protect the privacy and security of customer data.
- Population health management is a complex task that requires access to data from various sources such as healthcare providers, insurance companies, and other relevant stakeholders. Telecommunication companies will need to work with these stakeholders to access and integrate data and ensure that it is used in a secure and ethical manner.
- Telemedicine services require reliable and fast internet connectivity which can be challenging in some parts of Nigeria due to the lack of infrastructure and availability of quality internet services. Telecommunication companies will need to invest in upgrading their networks to provide quality telemedicine services.
- Developing an ecosystem of connected healthcare services requires collaboration and integration with various stakeholders such as healthcare providers, insurance companies, and government agencies. The telecommunication companies will need to navigate the complex relationships between these stakeholders to ensure a seamless and integrated ecosystem.
- Mobile health solutions require telecommunication companies to have a deep understanding of the needs of their customers and the technology solutions that are most appropriate for the local market. The telecommunication companies will need to invest in research and development to understand the needs of their customers and develop appropriate mHealth solutions.
- Integrating payment solutions into the health solution requires the telecommunication companies to work with financial institutions and payment gateways to ensure that payment processes are secure, reliable and convenient for customers.
