Can a robot provide useful answers to your health problems? Like, “I’m 39 weeks pregnant and have a slightly pink discharge.” Or “what should I put in my hospital bag?”
That’s the goal of Reach Digital Health, an organization that uses mobile technologies – SMS and WhatsApp messaging – to provide helpful healthcare information and advice to people across sub-Saharan Africa who can’t easily reach a health care provider. As a testament to their success, the 15-year-old group have just been awarded one of this year’s five Skoll Prizes for Social Innovation, worth $2.25million, presented this week in Oxford, England ..
The Skoll Foundation, which invests in and honors social change, annually selects a group of social innovators “whose work targets the root causes of societal problems that are ripe for transformational social change.” Other winners this year included groups tackling the climate crisis, strengthening democracy and promoting economic growth for all.
“Reach Digital Health works for a world where marginalized people are safe from the disproportionate impacts of epidemics [and] disparities in health outcomes among the most marginalized are eliminated,” which is why the Foundation awarded the group the award.
Barriers to getting medical help
The need for some form of health intervention in Africa is obvious. The continent has 17% of the world’s population, 23% of the diseases that disable and kill, and only a small fraction of the world’s healthcare workers. Too often, says Debbie Rogers, CEO of Reach Digital Health, people travel long distances to reach the nearest healthcare facility and wait hours to briefly see a healthcare professional before making the long trip back to home – if they seek care.
/ Greg Smolonski/Skoll Foundation
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Greg Smolonski/Skoll Foundation
“So the problem is that [these individuals] don’t have access to the health care they need and deserve,” says Rogers. His organization is working to close this gap to “empower people when they don’t have someone to talk to about their health.”
The group reports that its MomConnect Africa project has enrolled 70% of all pregnant women in the public healthcare system in South Africa. The program provides maternal and child health information in many languages, including those of indigenous communities. And more than 14 million people nationwide have engaged with the COVID-19 service the team has built amid the pandemic. Both programs are in partnership with the South African Department of Health.
The organization is not just in South Africa. It is being expanded to work in eight more countries in sub-Saharan Africa. Additionally, through a collaboration with the World Health Organization beginning in 2020, they have expanded their services across the globe and set up programs in Bangladesh, Timor-Leste, and Indonesia.
Harness the power of cell phones
The key to the empowerment that Reach Digital Health seeks to create is the mobile phone, which for many in sub-Saharan Africa is the only technology they use to communicate electronically (since landlines and computers are rare in many communities) . So the organization relies on text messaging and WhatsApp — no user manuals required!, Rogers says — to have ongoing conversations with people about their physical, mental and reproductive health.
Individuals register in two ways. The first is through a clinical setting. For example, on their first prenatal visit, all pregnant women in the South African public health system are invited by a health professional to join MomConnect Africa. When a woman agrees to participate, she begins to receive automated updates on scheduling future prenatal appointments and how best to feed and care for her developing baby.
In an independent analysis of the program, a South African research team led by Donald Skinner of the Human Sciences Research Council found that there were some problems with translation quality and network coverage, but concluded that in the Overall, “women were consistently positive about MomConnect, attaching high value to the content of the messages and the medium in which they were delivered.”
To reach those outside of the health care system, Reach Digital Health uses mass media, advertising, and community organizations to encourage people to sign up. These invitations come in the form of specific calls to action, such as: “Need to register for a vaccination?” or “Are you afraid you have COVID-19?” followed by a prompt to dial a number. Once people are in the system, Rogers says they are exposed to the breadth of Reach Digital Health offerings. This includes being asked open-ended questions about their health and responding to automated inquiries about how they are feeling.
How bots answer questions
Reach Digital Health answers millions of questions and sends millions of automated and computerized responses every day. In other words, “we first try to automatically answer any questions they might have,” says Rogers, “because we want to be able to give them an answer as quickly as possible.”
Milton Madanda, director of platform at Reach Digital Health, explains that they’ve built a system that uses both simple question-and-answer algorithms and more complex machine learning approaches to analyze incoming queries at the same time. keyword research. Like “pregnancy” and “vaccine” during the height of the COVID-19 pandemic, when people were asking about vaccination safety.
Other words or responses trigger additional interventions. If someone includes a word like “bleeding” in their message, for example, the system will ask them to either get to the nearest clinic as soon as possible, or facilitate their connection to a healthcare facility. Same goes for this comment from the person who wrote that she was 39 weeks pregnant and noticed pink discharge. The system responded, “It looks like it could be serious. In an emergency, please go to your healthcare provider immediately or call one of the emergency numbers below.”
There are circumstances that elicit a different type of response. Take their Young Africa Live program. “If there are messages related to needing help, suicide, or depression,” Madanda explains, “we are able to choose certain words that we can then escalate from a mental health perspective.” This escalation may involve a more urgent suggestion to seek medical help and the ability to speak directly with a counselor through a government hotline if they wish.
According to Rogers, a fraction of the time someone will ask to get in touch with a real person or ask a question that the system doesn’t recognize. They are then routed to a real human being — “trained nurses who are able to respond and engage in a much more personal way,” Rogers says. “So it’s a mix of automated and personal.” All answers are verified by health authorities and medical professionals.
Reach Digital Health also uses the information they collect to improve health offerings for a facility, district, or even an entire country. After a woman’s first prenatal visit, for example, she will be asked via text or WhatsApp what happened and what didn’t. Has his urine been collected? Has he been prescribed medication? Was she made aware of any worrying danger signs? These responses are collected from millions of women, helping to identify and correct gaps in training or medical supplies by providers and government health agencies.
Additionally, symptoms and diagnoses reported through Reach Digital Health can be reported to governments in real time to enable informed public health decisions to be made quickly and responsibly.
The Skoll Prize financial award is offered in the form of unrestricted funding and flexible support. Rogers says Reach Digital Health plans to use this influx of funds to teach other organizations and institutions around the world to replicate their work. “The goal is not world domination,” she says. “We’ve now built a model that we know is having an impact. It’s saving lives. We know it’s scalable.”
Now, says Rogers, “We need to be able to empower other organizations to do what we’ve done.”
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