Q&A: How digital and data are transforming health in Africa

March 27, 2019 by Sean Kelly

We recently chatted with Jeff Bernson, PATH’s chief data officer and vice president of Technology, Analytics, and Market Innovation, to get his thoughts on the state of digital transformation in Africa.

RG451939-Tz-2000px.jpg Nurses in Tanzania. Photo: Bill & Melinda Gates Foundation/Riccardo Gangale

Tanzania is leading the way in digitizing health data to improve care and decision-making. Photo: Bill & Melinda Gates Foundation/Riccardo Gangale.

Jeff, you’ve been living in Nairobi, Kenya, the past three years. Tell us how data and digital are accelerating progress in global health.

One example that has been exciting to see is Visualize No Malaria (VNM). This is an initiative we began with Tableau and other tech-sector partners to help Zambia eliminate malaria. We now have a powerful digital tool that we designed side by side with Zambian health officials that lets us see what’s happening with malaria in close to real time, making the job of coordinating interventions much more effective and efficient. Smart use of data has enabled a dramatic reduction in malaria-related deaths. Zambia’s Southern Province, for example, saw more than a 90 percent decline. And the thing is, we’re just getting started with how we can use this kind of digital tool to control and eliminate other diseases.


Visualize No Malaria dashboards.

PATH is also implementing a state-of-the-art HIV service delivery project in Kenya called Afya Ziwani, which uses data from Kenya’s electronic medical records system to create dashboards and other tools to help track individual cases so that people and communities are getting the care and information they need. Earlier this year, I saw a dashboard that showed that 88 percent of the approximately 50,000 patients taking antiretroviral medications who are tracked by the project were considered virally suppressed, which is very close to the goal of 90 percent viral suppression.

What do you see as some of the biggest challenges countries face when undergoing digital transformation in their health systems?

Three come to mind. The first is that we’re in a different space in digitalizing global public health than we were ten years ago. In many parts of East Africa, we’re now awash in data that have been digitized. That’s a good thing, but it brings complexity. We’ve become very efficient at getting data into a repository and structuring it—but gathering insights and putting them to use is still challenging. PATH is working hard to help decision-makers access and use their data more effectively through a few projects, including the BID Initiative and the Data Use Partnership, as well as Visualize No Malaria.

The second challenge is a good one to have. There are new digital tools and products entering the marketplace all the time—and we see a lot more of that development being democratized. It’s exciting to see the growing number of companies and organizations gaining ground in the digital and data space. But in that vibrant landscape, it also means we have to identify the truly transformative technologies as well as support those that have been widely adopted.

One promising idea we’ve seen is our Diagnostics program’s work on connected diagnostics for a low-cost point-of-care urine screening test to detect preeclampsia. But one thing we saw was that the dipstick showing results for the test could be difficult to interpret visually. So PATH worked with the World Health Organization and other partners to create an app that not only reads the test results accurately, but also gives health care providers information and protocol based on the reading.

Given the first two, the third challenge is: How do we activate digital and data champions? That’s why PATH is building partnerships with key health personnel—usually helping support and introduce new digital and data skills for people at the district, county, or health facility level who are accountable for health outcomes.

One of the most rewarding and humbling experiences was when our counterparts in the Zambian government told us the early version of the VNM dashboard was completely wrong. That was tough feedback, but it led to us working together to improve it into a leading-edge and easy-to-use tool. It’s been very special to see what gets ignited in terms of leadership and action when we collaborate to tap the potential of digital and data.

vnm1.png District health teams in Zambia use VNM dashboards to provide feedback to facilities during district data review meetings.

PATH is helping to support and introduce new digital and data skills for workers at the district, county, and health facility level. Photo: PATH.

What are some of the most exciting (or surprising) examples of digital health you’ve seen in East Africa?

Some are simple, but powerful. Often, our partners are looking at their data at a level of granularity they haven’t seen before, which can be intimidating. But what’s exciting is that we’ve made data accessible in a nonjudgmental way so that our partners can identify patterns and outliers, and really get the full story the data are telling in order to know what steps to take.

One specific example of this has been our work with the Ministry of Health in Kenya on developing their universal health care (UHC) dashboards and scorecards. Exposing them to easily navigable data allowed the Ministry to then also incorporate reproductive health and maternal, newborn, and child health data into a scorecard so that they could drill into the detail and see how counties, subcounties, and wards were performing. The minister of health is committed to UHC coverage, and these dashboards are a powerful tool to help track progress and course correct programs when needed.

Nurses in Tanzania look at a smartphone. Bill & Melinda Gates Foundation/Riccardo Gangale

Access to internet and 4G are growing quickly, bringing the ability to change the way we create feedback loops, push behavior change messaging, and collect and analyze data. Photo: Bill & Melinda Gates Foundation/Riccardo Gangale.

What big digital and data advances in the near future will improve health care workers’ ability to have impact?

At PATH, we’re increasingly building our capacity to use and deploy machine learning and artificial intelligence as well as natural language processing. These are very exciting technologies, and we need to be paying close attention to them to ensure they equip health care workers and decision-makers with the tools and information they need to advance health equity.

We will also need to get smarter about unified communications as a service (UCaaS). There is a real opportunity with UCaaS to take advantage of multichannel communications—harnessing tools like WhatsApp, MMS/SMS, voice, and email. We can use these to change the way we create feedback loops, push behavior change messaging, and collect and analyze data. The reality is, access to the internet and 4G are growing quickly, so I see UCaaS as an area we can really leverage to increase our impact, including connecting people with health care providers 24/7, linking health provider and supervisor networks, providing crucial newborn care information to mothers and families, and strengthening disease surveillance systems.

What lessons are you bringing back to PATH’s Seattle headquarters after living in Kenya?

I joined PATH in 2008. My focus has consistently been on making better use of health data and improving our measurement and evaluation. But I relocated to Nairobi about three years ago to also improve connections across PATH’s teams and geographies, and to develop partnerships in and around Nairobi, which is a big tech hub.

One of the most valuable things I’ve gained has been the technical relationships I’ve forged with teams across PATH. Working in our Nairobi country office has allowed me to collaborate shoulder to shoulder with some fantastic people. For example, our digital team in Nairobi, led by Solomon Simba, has been helping define the landscape of open source architecture and data solutions in Kenya. Solomon has also been building out a more robust data use curriculum through his work with Jomo Kenyatta University of Agriculture and Technology. It’s been great to see the work PATH’s in-country teams are doing to nurture relationships and amplify our impact.

I’ve also gained more appreciation for the nuts and bolts of systemic change in the ministries that we collaborate with. I’ve learned a lot from our advocacy and market dynamics teams as well as technical leaders in the maternal, newborn, and child health, reproductive health, and HIV/TB areas that are based out of Kenya. Most important, I have gained a huge amount of perspective on just how much innovation is happening. I recently toured “maker spaces” at several universities, agencies, and private companies. They are really impressive because they are not only incubating fantastic solutions, they’re producing the next generation of global health leaders and innovators.

Last, I feel endless gratitude. I’m thankful that we’re building a solid case for digital and data as part and parcel to accelerating impact in global health. It has been a real privilege to work side by side with PATH’s teams and so many of our local partners in Kenya and other parts of East Africa to unleash digital transformation to improve health. The past three years have been a solid reminder that PATH’s mission to advance health equity through innovation and partnership spans continents, nationalities, sectors, and affiliations of all kinds. For all of that, I’m grateful.