14 Jul Connected Diagnostics: The Mobile Future of Disease Detection, Treatment, and Health Financing

On 3 June 2021, AIGHD researcher and PharmAccess Research Director, Prof. Tobias Rinke de Wit spoke at WEON 2021―the premier Dutch epidemiological symposium. This conference, held virtually due to the COVID-19 pandemic, had the timely theme of the influence of the World Wide Web on healthcare and research, aptly titled, ‘Science in an Online Society.’ Commenting on the significance of presenting at this conference, Prof. Rinke de Wit states, “it is an excellent forum to share innovative epidemiological research amongst a large network of Dutch colleagues. It was nice to be a keynote speaker.”

Prof. Rinke de Wit presented on his work in the area of ‘Connected Diagnostics’ (ConnDx). This innovative school of thought refers to the digitalization of rapid diagnostic test results and linking these to digital payment channels through mobile phones in resource-poor settings. In synthesizing several technological innovations―chiefly digital diagnostic tools with mobile money streams―proper diagnoses can be used to ratify treatments for specific conditions as well as to qualify patients and healthcare workers to receive digital entitlements for treatment.

Prof. Tobias Rinke de Wit cites digital diagnostic tools as the first revolution behind this initiative: “Digital data collection on human health indicators is going to happen more and more. It’s the future. Sooner or later, we will all have our medical avatar.” Alongside digital diagnostic tools, the Kenyan mobile banking revolution is a crucial piece in this puzzle, namely M-pesa (‘m’ meaning “mobile” and pesa, which is money in Swahili), a mobile phone-based money transfer service. ConnDx evolved naturally out of mobile banking, as Prof. Rinke de Wit explains: “Obviously Kenya was our starting country because of the whole mobile money development there. PharmAccess has been intimately involved and created its spin-off M-tiba (tiba meaning cure in Swahili) that manages earmarked mobile health wallets.” There have already been two pilot studies for ConnDx in Kenya, namely in Samburu and Kisumu.

In Samburu, ConnDx was used by community health workers amongst nomadic, pastoral peoples in the region to detect brucellosis, a febrile illness spread from cattle to humans that is often mistaken for malaria. This study successfully proved that a relatively rare disease could still effectively be identified―and, in turn, treated―amongst a very mobile population using ConnDx. Additionally, through this pilot study, surveyors could detect a brucellosis hotspot near a slaughterhouse, which helped the local vet to prioritize cattle vaccination. In a subsequent ConnDx study in Kisumu involving nearly 12,000 participants, researchers found an average over-prescription rate for antimalarial medication of 28%―a significant number―which was as high as 63% amongst some providers. Additionally, this study helped identify malaria hotspots, from which thousands of poor patients who could not access treatment benefitted. Both of these pilot studies illustrate some of the many advantages that ConnDx yields for various parties.

ConnDx allows for expedient treatment because money goes directly to a patient, physician, or facility to treat a disease, meaning the bureaucracy of top-down, paper-based funding can be avoided. Prof. Tobias Rinke de Wit elaborates: “For many people, the money streams of healthcare are quite unclear. The usual funding mechanisms are top-down, with money from international donors, taxes, or governments trickling into systems, which should end up with patients and clinics. There are lots of steps involving bureaucracies, delays, overhead costs, and other things.” By piggybacking on the mobile banking revolution, Prof. Rinke de Wit posits ConnDx as a bottom-up approach to health financing, reducing steps by decentralizing healthcare networks.

In addition to efficient testing and treatment, ConnDx also promises efficacious care, yielding health advantages at both individual and population levels. ConnDx incorporates National Malaria Treatment Guidelines and allows for remote quality control of malaria tests performed. This accelerates provision of decent healthcare, something which has crucial implications in settings like Kenya, particularly in times of COVID-19. ConnDx ensures that patients receive targeted care with proper prescriptions given according to diagnoses, which, in turn, allow for performance-based financing. Misdiagnosis and inappropriate treatment are particularly common with febrile complications (like brucellosis), as fever is the most prevalent reason one will visit a drug shop. “It’s human,” says Prof. Rinke de Wit, indicating that small drug retailers are often the first point of consultation when one has a fever, placing treatment responsibility on relatively unqualified healthcare workers. Parents, for example, concerned that their young children with high fevers have malaria, may go directly to the closest provider to get the most seemingly applicable medicine. Frequent incorrect prescription can lead to inefficacious treatment outcomes for the patient and drug resistance for the population. ConnDx can correct this issue, as negative diagnoses will prompt clinics to more reliably sift through potential disease candidates, making sure that febrile complications are better addressed.

However, decent care provision is not only advantageous to patient health; various other parties can also benefit from this technology. Placing ConnDx in drug shops can serve as a quality control gateway, empowering small pharmacies to address illnesses precisely and methodically, therefore, improving their performance and reputations. Additionally, the real-time collection of data via the ConnDx interface―from demographic information on infections to drugs administered―will be relevant for policy makers. Lastly, the fiscal transparency within ConnDx will ensure that funders’ money effectively treats a particular disease. Essentially, all parties who are implicated in this network will benefit.

The synthesized ConnDx system can have important implications for the future of healthcare provision, research, and policies. “It will allow for democratizing health in Africa by empowering individual patients and doctors.” Prof. Tobias Rinke de Wit focuses on the value of transparency as paramount for all parties involved, citing it as a “true value creator for M-tiba.” As more parties trust the system―patients, providers, funders and policy makers―the network will expand, becoming more useful. The ultimate goal is to incorporate ConnDx into local risk pools so health insurance providers can work towards universal health coverage (UHC). Kenya is merely the peak of this iceberg, as ConnDx can be linked to any emerging healthcare exchange platforms such as those in Nigeria, Ghana and Tanzania. Healthcare costs are increasing globally, and there is a need for clever means of decreasing expenses through data management, decentralization and transparency. “I think what we do in Africa can be translated to Europe again. We can learn from Africa.” The implications of this novel, integrated health network are crucial, whether in Kenya, Africa, or the entire world.