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A few thoughts on Covid surveillance technology solutions in Africa

p.awondo19 March 2021

Fig 1: Screen showing Covid-19 prevention messages in a UN office in Ouagadougou. Photo credit: Charles Somé.

A few days ago, I came across a rather unusual document. It is a compilation of different technologies put together by the European Investment Bank, entitled Covid-19: Africa’s digital solutions[1]. It was published last year, with the support of the United Nations Development Programme (UNDP), and it sets out to identify the digital solutions currently on offer in the response to Covid in Africa. Several things strike me as I read this document: firstly, the breadth of these initiatives seems to reflect a faith in the ability of technology to respond to the health crisis. The inventory reports that about 100 digital solutions have already been ‘implemented’ or tested as of 20 June 2020. It also gives an estimate of the investment needed to implement such ‘high-impact’ solutions.

Then, there are different types of tools being promoted in different countries. There are collaborative tools such as Zoom and Skype, which have multiplied greatly, and use messaging apps such WhatsApp in professional contexts such as education, has also gone up. Traditional media, such as television, for example, has remained important due its ability to reach a great number of people during the crisis. Innovations also include tracking applications based on geographic information technology for epidemic surveillance purposes. On page 15 of the document, contact tracing apps are described as follows: “These applications, which often use geolocation data from telecommunications companies, help to identify contacts of people who have tested positive and help to locate areas where the virus is spreading.” We learn that applications have been developed and put to use in Kenya, Morocco and Rwanda among other countries. FabLab, an innovation hub in Kenya, has developed an application called Msafari, which can track public transport users.

Other digital tools have been used for mass communication and self-assessment of risks and symptoms. In Sierra Leone, for example, an existing public platform using unstructured supplementary service data (USSD) has been expanded to allow citizens to self-assess their symptoms and get alerts on developments on the COVID-19 front in the country.

The use of drones has also been experimented with to deliver pharmaceutical products or to transport PCR tests from remote areas to laboratories in big cities like Abidjan in Côte d’Ivoire or Kigali in Rwanda.

But are all these innovations and techno-digital solutions going to make a difference in the medium or long term? Firstly, let us recall that there is a gap between the international presence and publicity around various technological innovations, some of which can even be award-winning, and what actually happens on the ground.  Throughout our 18 months of fieldwork in Yaoundé for the ASSA project, we noted this significant gap, which says something about the difficulty of digital applications and solutions when it comes to capturing the attention of users.

The profile of a young Snapchat user in Cameroon. The screen shows various COVID-19 messages superimposed onto a photo of the user. Photo sent to the author by research participant.

In most of these countries, although tracking applications were received with curiosity, they nevertheless worried public opinion because they raised problems of data use and privacy. Not only are they worrying, but they are not always seen as appropriate solutions for the local context. Interfaces such as the one in the picture above, where COVID-19 related messages fit into the user interface seamlessly, work well in the context because they fit into the social media landscape. Young people want to show concern about the virus and they might adopt features of a social media network that support COVID-19 messaging for a few hours occasionally during the outbreak. But for that, they also need to be reminded by other channels of support and communication that the crisis is still there. The resonance of this issue is strongly linked to the strategic orientations of African countries in terms of their politics, economic situation and sensitivity to innovations.

Another part of the current debate concerns the mistrust of not only technological solutions but also of vaccines against COVID-19. For example, medical anthropologist Alice Desclaux and a team of French researchers [2], who undertook an exploratory study among 215 people in four African countries this year, found that 2 out of 3 participants said they would refuse to be vaccinated against Covid-19. They say: “reasons for refusal included firstly fear of any side effects hidden by the pharmaceutical companies, and secondly the perception of the vaccine as a tool in a plot by Bill Gates to reduce the African population or by a coalition of the powerful (states, global institutions) to enslave populations and ensure a “new world order” using corrupt authorities in African countries (“coronabusiness”). The study also found there was a preference for endogenous solutions to control SARS-CoV2, such as traditional medicine or the protection provided by religion.” There is therefore an urgent need to study more seriously the sources of the constant doubt surrounding the surveillance of epidemics, which are reflected and accentuated at pivotal moments such as Ebola or recently, Covid-19.

The central hypothesis of this is that the operational responses of nation-states are aligned with a policy of systematically using surveillance (biometric) and the tracing of infected persons (mHealth) as the preferred institutional response to emerging epidemics. However, this response has underestimated the capacity for the circulation of alternative interpretations of epidemics favoured by an abundance of content conveyed via social networks and smartphones. The direct access of the public to this content reinforces a widespread suspicion of local governments that are seen as corrupt and that accept servile compromises with the leaders of large pharmaceutical groups to the detriment of ‘African solutions’. Therefore the solution for helping people accept technological and digital solutionism to the crisis is not just to blame them for pharmaceutical nationalism, or their non-openness to innovations, but rather like anthropology and the ASSA team’s approach, making an effort to understand and carefully analyse not only people’s perceptions of the vaccine and the Covid outbreak, but also the intertwining of the logics behind them.

References

[1] European Investment Bank (EIB): Africa’s digital solutions to tackle COVID-19, found at: https://www.eib.org/en/publications/african-digital-best-practice-to-tackle-covid-19

[2] Desclaux A, 2021, « Covid-19: En Afrique de l’Ouest, le vaccin n’est pas le nouveau « magic bullet », available at: https://vih.org/20210202/la-mondialisation-des-informations-et-la-fabrique-des-opinions-sur-les-traitements-du-covid-en-afrique/

 

The community health check in Japan

Laura Haapio-Kirk4 December 2020

 

One of the biggest challenges facing the healthcare system in Japan today is a rapidly ageing, rapidly shrinking, population. One-quarter of the population of 127 million are over the age of 65 – the world’s highest proportion – and this is predicted to rise to 30% by 2025 (National Institute of Population & Social Security Research [NIPSSR], 2012). According to the World Health Organization, Japan ranks first in the world for the highest age to which a person can expect to enjoy good health: 74.5 years old. Only about 12% of the elderly (those aged 75+) population require long-term care, of which about 4.3% are institutionalised, while the rest live at home and receive care from family and health professionals (Thang, 2011). The healthcare system in Japan is covered by a national health insurance plan focused on preventative medicine through the practice of annual health check-ups. Since the early 2000s, health checks have been delivered for all age groups, and age-appropriate tests are performed for each age category.

In my ethnography of a rural health check in Tosa-cho, Kōchi Prefecture, the patients were generally very positive about their experience of coming to the health check every year, and said that it helped them feel motivated to stay healthy by giving them goals. Each patient brought with them a personal booklet which the doctor would write their notes in, as well as affixing a photograph of the patient with the doctor (which you can see in the video above). These booklets helped the patients to track any differences in their test results year on year, and to help them know which areas they had to work harder to improve such as though dietary modifications. Self-tracking in this case was low-tech, but its motivational power was clear.

The video above is narrated by Dr Kimura Yumi from Osaka University, one of the doctors who co-ordinate this health check for over 75s which has been running for 15 years. The health check was established when the town’s head councillor wanted to improve the health of ageing residents through preventative medicine. He invited doctors and researchers from different universities around Japan with the aim to identify key factors affecting the health of elderly people. This type of community “field medicine” (フィールド医学) is a relatively new practice in Japan, and inviting researchers to the Kochi health check up was the first such attempt among geriatric people both domestically and internationally (Matsubayashi and Okumiya, 2010). The annual community-based health check in Tosa-cho appears to have been successful in terms of reducing medical costs for geriatric care. The medical expenses for the elderly there between 2004 and 2007 were reduced, compared with Motoyama-cho, a neighbouring, similar sized and similar environmental control town, as well as compared with Kochi City and with the average medical expenses of 35 towns in Kochi Prefecture.

After my participation in the health check I returned to this community regularly over the subsequent eight months in order to get a better understanding of people’s lives and wider attitudes to health and wellbeing. My long-term ethnographic research in the community found that people continually emphasised the importance of food and social connection for maintaining health. Indeed many said that they came to the health check each year precisely because of the opportunity to catch up with friends. This finding led to the development of a digital health project in partnership with Dr Kimura and Sasaki Lise which is still ongoing. This project was designed to see if participating in chat groups via the messaging application LINE could improve quality of life among elderly participants.

Because of the coronavirus pandemic, the health check did not run in 2020. However, the crisis prompted innovation: the local town hall were inspired by our digital health project to create their own version in which they connected residents via LINE (the most popular messaging app in Japan). Residents who signed up to the buddy scheme via LINE were then rewarded with a meal at the town hall with their chosen ‘buddy’ – all in a socially distanced and covid-safe manner. Even though digital forms of care are only just emerging among elderly people in this rural town, it is already clear that they are going to be integral to how care is organised in the future, well beyond the pandemic.

 

National Institute of Population and Social Security Research [NIPSSR], (2012). Nihon no shorai suitei jinko [Population projection for Japan] Accessed 01.08.2018 <http://www.ipss.go.jp/site-ad/index_english/esuikei/gh2401e.asp>

Matsubayashi, K., & Okumiya, K. (2012). Field medicine: a new paradigm of geriatric medicine. Geriatrics & gerontology international, 12(1), 5-15.

Thang, L. L. (2011). Aging and social welfare in Japan. Routledge handbook of Japanese culture and society, 172-85.