4.4 Digitalization in East Africa
4.4.1. Digitalization in Kenya
Kenya has made significant strides in technological infrastructure. The Kenya National Digital Master Plan 2022-2032 is a blueprint for leveraging and deepening the contribution of ICT to accelerate economic growth. It provides a digital infrastructure for equitable access to service through a pervasive and ubiquitous national ICT infrastructure. In addition, it ensures digital skills for the development of a digitally skilled workforce and citizenry that is grounded on ethical practices and social cultural values. With this in place, Kenyan government has taken steps to promote telemedicine and digital healthcare services, which includes exploring the integration of Digital Rehabilitation into its healthcare system to improve accessibility and the quality of care. This initiative has accelerated the awareness and adoption of such services among healthcare providers and clients.
Likewise, the Kenya's growing economy has also enabled greater affordability and accessibility to digital devices, which can be instrumental in delivering Digital Rehabilitation solutions to a broader population.
The vibrant tech ecosystem has given rise to digital health startups and innovative solutions in healthcare, including Digital Rehabilitation platforms. This entrepreneurial spirit has the potential to drive accessibility. Additionally, collaboration with international healthcare organizations and NGOs can provide valuable expertise and resources to enhance the accessibility of Digital Rehabilitation in Kenya.
While internet and mobile phone penetration is steadily growing in Kenya, disparities in access remain, with urban areas enjoying better connectivity compared to rural and underserved regions. Moreover, there exists a significant variance in digital literacy and awareness of Digital Rehabilitation services among the Kenyan population.
Kenya is currently in the process of developing a regulatory framework for telemedicine and digital healthcare [7]. As the regulatory environment continues to grow, ensuring clarity and consistency in regulations becomes a vital consideration. A well-defined regulatory framework will substantially contribute to the safety and effectiveness of Digital Rehabilitation services, promoting confidence among providers and clients alike.
Training rehabilitation professionals to competently deliver Digital Rehabilitation services stands as an ongoing challenge. A deficiency of experts in this field may limit the availability and accessibility of these services. Addressing this gap necessitates investments in specialized training programs and capacity-building initiatives to cultivate a skilled workforce capable of delivering high-quality Digital Rehabilitation. Relatively high cost of data in Kenya can serve as a deterrent, preventing individuals from accessing Digital Rehabilitation services. To make these services more accessible, one effective strategy is reducing data costs or providing free access in specific contexts. This approach is instrumental in dismantling this data cost barrier and facilitating broad adoption.
In concert, addressing these multifaceted challenges is a collective effort, necessitating cooperation among government bodies, healthcare organizations, technology providers, and advocacy groups. By surmounting these barriers, Kenya can lay the groundwork for a more inclusive and accessible digital healthcare ecosystem, ultimately enhancing the quality of care for individuals across the country.
4.4.2. Digitalization in Tanzania
Tanzania is making its mark in the field of IT, positioning itself as a significant player on the African continent. With an estimated GDP growth of 6.3% in 2024, the country is undergoing an ICT digital transformation that promises to drive further economic growth [8].
The expansion of network coverage, the introduction of high-speed internet services, and the establishment of a National ICT Broadband Backbone have laid a solid foundation for the country’s digital future. The Ministry of Information and Technology in Tanzania, offers to make Tanzania a technological powerhouse in Africa.
Tanzania has undergone a digital transformation, reflected by the growing number of people connected to communications and internet services. This is having a profound impact on the country’s social, cultural and economic frameworks, through enhanced access to key services and improved productivity and efficiency across economic sectors.
Tanzania is currently finalizing its Digital Economy Strategic Framework 2023-2033, which is due for implementation in early 2024 [9]. A panel of digital experts has given permission to proceed with the suggestions and recommendations for the proposed national digital economy program. According to local media reports, the program will serve as a roadmap for the country's day-to-day economic activities, guiding the processing and management of electronic messages and documents.
Mobile technology is at the center of Tanzania’s digital transformation. Mobile services today connect more people in the country than any other communications technology, with around 42% of the population subscribing to a mobile service in 2018. Mobile internet penetration has nearly quadrupled since 2010 to 18.5%, with more than 8 million new mobile internet subscribers added over that period [8].
With these advancement in digital technology Tanzania has improved payment system through mobile phones. The most popular payment option in Tanzania is now available for Payment wall merchants. Payment wall has added a new payment option in Tanzania. Customers in the country can now accept payments via mobile banking – the most popular financial service in Tanzania. Mobile banking services allow users to pay for online purchases using e-wallet accounts – like TigoPesa or Airtel Money. They can also use Mastercard QR-code payments via M-Pesa, TigoPesa, Airtel Money, HaloPesa, EzyPesa, or TTCLPesa (these are popular Tanzanian digital wallets). All payments especially government payments are done electronically including all public services. Locals frequently use mobile money to pay the bills, shopping, fees, transport, bank-to-wallet and wallet-to-bank transfers, POS, etc.
Tanzania through the Ministry of Health is committed to the effective application of digital technologies to improve population and individual health outcomes by facilitating evidence-based actions at all levels of the health system. The National Digital Health Strategy 2019–2024 outlines how Tanzania intends to leverage digital health technologies, build on the achievements, and experience from the implementation of the National eHealth Strategy 2013–2018 [10, 11]. This strategy outlines what needs to be done from 2019 to 2024, to fast-track progress towards attainment of universal health coverage and the health-specific sustainable development goals. The strategy will also address challenges encountered in the digitalization of the health sector in Tanzania.
Moreover, the government of Tanzania is striving to move the country to middle-income status and achieve the Sustainable Development Goals. Tanzania was able to achieve several health-related Millennium Development Goals (e.g., under-five mortality, measles-immunization coverage, incidence of HIV/AIDS, tuberculosis mortality), but others persist unattained (e.g., maternal mortality, antenatal coverage, births with a skilled birth attendant, family planning, antiretroviral-therapy coverage, malaria incidence).
To achieve these goals, the government is committed to expanding and improving the use of ICTs to strengthen the efficiency and effectiveness of its public health services. Trends in ICT availability, affordability, and usage are creating an increasingly promising context for expanding the use of ICTs for development in Tanzania. There are 39 million mobile connections (21.7 %), this number is growing as mobile service, and connectivity is expanding nationwide.
Tanzania is the landing point for East Africa fibre-optic cable. There are public and private investments in ICT infrastructure and increasing availability of hardware, including smartphones and tablets, at lower costs. More investments are required to leverage the ICT infrastructure for effective data systems and use for health impact.
Although an appetite for digital technology is growing in many countries, it seems to be particularly strong among Tanzanians. The publication of the country's new policy document demonstrates that, even in the poorer regions of the globe, digital approaches to health planning and provision are no longer a complete novelty. Equally encouraging is that Tanzania is now eager to adapt and deploy these technologies in the way that best suits them. Digital health and digital is firmly on the country's agenda.
The Tanzanian Act No. 9 of 2010 (12) for the health care, social support, accessibility, rehabilitation, education, vocational training, promotion of basic right for people with disability as outlined by the United Nation Convention on the Rights of Persons with Disabilities (UNCRPD) went even further in underlining under Part V, Para 26 (1) of the act that:
- Every person with disability shall have the right to enjoy the attainable standard of health care services without any discrimination.
- Every health facility whether public or private shall not deprive a person with disability the right to health care service and shall take all reasonable and necessary measures to ensure access for such person to health services.
Since such an act is in place then, the incorporation of Digital Rehabilitation services will be complementing the government initiatives of providing such services. In the process of the ongoing projections, the government needs to ensure that a policy of subsidizing/supporting these services is in place.
4.4.3. Digitalization in Rwanda
Rwanda’s Health Sector Strategic Plan (HSSP 2018-2024) [13] aims at achieving Universal Health Coverage. However, Rwanda’s hilly terrain and inefficient transport infrastructure makes it difficult to access health facilities especially for the rural population that constitutes more than 80% of the population [14]. The Rwandan government intends to use Information Communication Technologies (ICT) to transform the health sector to overcome this challenge. Rwanda’s Digital Health Strategic plan 2018–2023 [15] set a decisive goal to improve health service delivery and accessibility through Digital Health. The Ministry of Health’s strategic plan aligns with the Smart Rwanda Masterplan under the Ministry of ICT in prioritizing the use of telemedicine technologies to increase accessibility to health services.
Rwanda is already a well-known tech hub in Africa and the Rwandan government has given priority to the health sector enabling innovative technology solutions such as robotics contact tracing, symptom surveillance, robot-monitoring and data visualization which were used in the management COVID-19. In addition, the government of Rwanda introduced AI-powered chatbots in health care to help Rwandans have easier access to consultations with doctors or nurses. Clients can complete consultations from any location in the country with just a mobile device. This is made possible due to increased mobile penetration in the country with over 10 million active mobile subscribers (14). Currently, there are over ten internet service providers, including MTN, TIGO, Altech Stream, Rwandatel, among others.
More Rwandan public services are also going digital for instance, “irembo” platform (Government’s e-service portal) whereby, Rwandans can access government services online via mobile devices and/or PCs. In addition, there is digitalization of other services, including financial (mobile money, mobile banking services), agriculture (e-Soko) and health (Mobile e-Health) [14]. To enable smooth operations of digital services, the government has enacted laws to govern electronic messages, signatures, transactions, data protection, cyber-security and ICT usage. It established the Rwanda Utilities and Regulatory Agency which adopted the International Telecommunications Union (ITU) ICT industry standards.
Sound ICT infrastructure is fundamental for an inclusive and accessible digital development which overcomes social, spatial and economic gaps. A big challenge for telehealth solutions in Rwanda is the lack of access to digital infrastructure. Although majority of the population in Rwanda have access to electricity, progress in access to electricity remains far below the universal access target of 100% by 2024. Furthermore, disparities in access still exist with urban access being higher than rural areas. In addition, gender disparities persist, with more male headed households accessing electricity more than female headed households [16].
Internet penetration and digital literacy is still very low in Rwanda which is fundamental in the delivery of digital technologies. Another relevant challenge is the ability to source a skilled, local workforce. However, given the interest and advocacy from the government and the support of non-governmental organizations, Rwanda will make significant strides in establishing an accessible and more inclusive digital health care systems which will enable the delivery of Digital Rehabilitation possible.