Dr.Elsa is currently working across 20 healthcare facilities in Tanzania, in several regions. She is supporting healthcare workers, particularly in rural areas, to make more accurate diagnosis and make better decisions about a patient’s next steps. The aim is to improve their health outcomes and overall wellbeing. Dr.Elsa is direct, straightforward and is an expert in her field. But she isn’t a human, Dr. Elsa is a mobile app, which uses Artifical Intelligence and machine learning.
According to data from the World Health Organisation, there is one medical doctor for every 20,000 people in Tanzania, making it difficult for every person to be able to access quality care. This is the challenge that the creators of Dr. Elsa saw, and wanted to utilise emerging technologies, such as AI, to be able to improve access to care and health services. Megan Allen, the Head of Operations, explained that they are targeting rural areas in particular: ‘initially, we wanted to use technology as a way to get people healthier and focus on the prevention side of things, but then we realised we can make a lot of impact at the point where people come into the healthcare centre to get services. The health infrastructure isn’t the same in rural areas as it is in urban areas, and similarly there are not as many doctors and specialists in rural parts of the country. This means that communities in these areas are not getting access to expertise.’
Since 2017, Megan and her team have been working to create a mobile app, which aims to bridge the gap between healthcare access in rural and urban areas. The mobile app, which uses artificial intelligence and machine learning is supporting healthcare workers to more accurately diagnose patients, and then give them better recommendations on how the patient can best recover.
Megan notes that the impact of misdiagnosis is far-reaching: ‘often patients in remote areas are not getting diagnosed appropriately, and so they spend a lot of unnecessary time in the healthcare system, as we are not able to figure out what is wrong with them. This can also lead to the overuse of antibiotics, as a result of not knowing what patients are dealing with – contributing to antimicrobial resistance (AMR).’
The app works like this: the technology is put inside a tablet and operated by the healthcare worker. On meeting the patient, they input information about the patient, what symptoms they have, and their history. Dr. Elsa will then generate further questions relevant to the health provider.
At the end, they get an assessment which shares the diseases that the patient is likely to have and the recommendations for the next steps. Dr. Elsa is able to generate these questions and assessments thanks to the medical expertise and data that has been input into her, with a machine learning model. Megan says that this tool ‘puts the knowledge of specialist healthcare providers in the hands of a dispensary worker, so they can then use this to make better decisions.’
The opportunity of using technology as a way to improve access to healthcare services was also noted by Dr Fabian Mwombeki, the founder of Savannah Informatics. Dr Mwombeki built a technology which provides a service for teleradiology, allowing for a range of images, such as X-rays, CT and MRI scans to be uploaded to a Cloud-based system, where they can then be downloaded from a radiologist based anywhere in Tanzania, who can then give a quick diagnosis.
Similar to Megan, Dr Mwombeki saw that there was a concentration of quality healthcare services focused in the urban areas of Tanzania, namely Dar es Salaam: ‘if you look into the number of radiologists in Tanzania, there are less than 100, and currently our population is just over 56 million. So the number of healthcare workers is not keeping up with the growing population.
Additionally, training a radiologist takes time – around 10-15 years, but we can access their expertise through technology. This technology is the first of its kind in Tanzania which allows images to be uploaded to the system using internet, and downloaded immediately by a radiologist in Dar es Salaam, who can send back a quick report.’
Dr Mechris Mango, a radiologist at Muhimbili Hospital, says the impact this can have on a patient’s outcome is huge: ‘in medicine, time is critical in making decisions and getting the results back.
Before we used this technology, the patient would often have to travel for days to Dar es Salaam, with their images on film or on CD, seeking a diagnosis. With teleradiology, patients no longer have to travel – a radiologist is able to view the images via the internet and send quick feedback.
This is mostly supporting those who are living in rural areas – these sorts of technologies are helping to decentralise the healthcare system. In emergency situations, it has greatly improved the time we are able to give a diagnosis – and this can save lives.’
Social media has also become a vehicle for providing health information, and bringing people closer to health services. This is due to increased use of smartphone users in the country. Research from Tanzania Communications Regulatory Authority (TRCA) shows that in 2017, there were 40.08 million mobile phone users, with around 19.01 million people accessing the internet on their phone.
Mr Joachim Mabula, a clinical officer, is one of the medics providing health information via social media, through his platform TibaFasta. TibaFasta has a presence on Twitter, Facebook and Instagram, and shares a range of health tips, and also the opportunity to direct message doctors to get their advice.
Mr Mabula said he started the platform as he noticed a lack of health information available in Swahili. He believes that with the increasing number of internet and smartphone users, reaching communities through phone with verified health information that can prevent common dieases and infections.
As with all technology, there are pros and cons. And while mediums like social media, artificial intelligence and cloud-based systems are helping to bring people closer to healthcare services, there are also challenges along the way. Megan and Dr Mwombeki, both note that while internet use is growing, it is still a challenge in rural areas, and most technology will require a strong internet connection. Additionally, they both note that changing people’s attitude to technology and training medical staff on AI and new systems can be difficult.
Despite this, the new innovations in healthcare systems are proving to make services more accessible to those who would usually struggle to get quality care. As Megan summaries, the opportunities are significant: ‘technology is making us all more connected than ever. And in relation to healthcare that means we can bridge the gap between those who have the healthcare knowledge and those who need the services. We are moving in the right direction.’