Leveraging tumultuous profession innovations for aid conveying in Sub-Saharan continent – Information Important Web

Introduction

The Alma Ata Declaration of 1978 constituted direct aid as the groundwork of upbeat systems in most of Sub-Saharan chaste (SSA). Following the Declaration, SSA restructured the whole upbeat grouping within the hold of direct healthcare, instead of centering solely on the prototypal verify of care.^[3] However, primary-healthcare feat has suffered obstacles cod to semipolitical instability, structural changes, uncolored calamities and HIV/AIDS pandemics, impacting admittance to evenhanded and sustainable tending and the upbeat outcomes of the people.^[4]

Barriers to Effective Care in SSA

1. Insufficient admittance to direct care: Primary aid systems are governed by a ordered of policies regarding coupler upbeat news and direct care.^[5] In SSA, exclusive one-third of the location has admittance to inexpensive humble healthcare, and the men is a cypher of the amount filler required, feat binary upbeat challenges.^[6] The subregion’s unstoppered list does not sufficiently earmark hindrance and treatments. The location has old drastic changes in upbeat and disease patterns, and has a broad ascendance of contractable diseases, non-communicable diseases, and communicable and follower diseases.^[7],^[8],^[9] While the unstoppered upbeat grouping is pivotal in addressing the aid gap, there has been lowercase advancement over the years, cod to the postscript of colonial-era aid models that obligation pore on disease prevention, noesis components, men training, brawny oversight and managerial leadership.^[10]

2. Shortage of upbeat workforce: Community upbeat workers modify direct linkages to direct life-saving aid intervention. SSA consists of 11 proportionality of the world’s accumulation and bears 24 proportionality of the orbicular disease burden, but it is bag to exclusive threesome proportionality of the orbicular upbeat workforce.^[11] The World Health Organization (WHO) estimates that 57 countries worldwide grappling a grave insufficiency of upbeat workers, discover of which 36 countries are in SSA.^[12],^[13] The obligation of upbeat resources has perverse implications on unstoppered upbeat with attitude to accumulated mortality rates, motherlike and female upbeat and the act of AIDS, which boost limits the noesis of assorted interventions and the feat of polity upbeat policies, presented the bit of upbeat men disparity.^[14],^[15]

Figure 1: Current Density of Physicians, Nurses and Midwives, and the Required Rate of Workforce Growth According to Population Growth Rates, in 12 individualist Countries^[16]

Source: WHO, 2009.

3. Information profession for clinical use: Harnessing the noesis of aggregation profession crapper significantly meliorate the upbeat system’s noesis to streamline enduring database and wage meliorate clinical tending and verify management.^[17] However, cod to the disproportional calculate of diseases, SSA lags behindhand in the acceptation of original technology. A think reportable that the ingest of Electronic Health Records in SSA was advisable for the immunodeficiency Relief retrovirus programme, but limited machine skills and manlike resources hindered comely implementation.^[18],^[19] So far, profession has remained confining to administrative and non-clinical usage.

The ontogeny of clannish aid in Africa

The anaemic domestic upbeat systems in chaste sealed the artefact for clannish players to acquire newborn footholds in the continent. In countries with limited unstoppered resources, 60 proportionality of the aid finance is interdependent on clannish upbeat services and 50 proportionality of the amount disbursal goes to clannish upbeat providers.^[20] Most citizens—especially in agricultural communities— hit been underserved by the unstoppered sector, creating opportunities for clannish players to modify the notch with high-quality, lawful services and modern resources.

Renewed semipolitical stability, scheme reforms and crescendo cipher incomes hit swollen the aid gap, creating greater obligation for calibre care. In 2001, Africa’s period value ontogeny was at fivesome percent, faster than the orbicular cipher of 4.2 percent, with SSA’s per capita ontogeny prodigious fivesome proportionality in the terminal fivesome years.^[21] This allowed for reinforced per-capita disbursal on aid artefact and services. The maximal deal of assets has embellish from clannish aid sectors, much as scrutiny creation manufacturer, pharmaceutical, retail, insurance, scrutiny activity and technology-enabled aid initiatives.

India–Africa aid relations

Indian Pharmaceutical Businesses in SSA 

India is SSA’s second-largest caregiver trading partner, followed by China, which is ontogeny at a evaluate of 6.4 proportionality of the amount orbicular trade.^[22] Southern and Western Africa, in particular, are the maximal importers of Amerindic caregiver products. Amerindic manufacturers acquire mart deal primarily finished cost-effective pricing and by targeting assorted markets. For example, Ranbaxy, Cipla and Dr. Reddy hit a brawny proximity in East Africa^[23] and hit gained combative plus over another orbicular players in the location by desegregation topical talent in playing dealings and substance calibre medicines certificated by WHO.^[24]

Before 2001, exclusive digit in a cardinal had admittance to life-saving antiretroviral (ARV) medicines, grave for preventing the sending of HIV/AIDS. During that time, the large caregiver companies offered the penalization at a toll saucer of US$10,000–15,000 per enduring per year. Recognising the requirement for inexpensive medicines in the region, Amerindic caregiver companies, much as Cipla, disrupted the mart toll to substance the verify at US$350 per mortal per year, and later, Mylan and Aurobindo baritone the outlay to US$75 per mortal per year.^[25]

Table 1: attorney Pharmaceutical Companies in Sub-Saharan Africa

Source: RIS New Delhi, 2015.^[26]

After 2001, individualist Amerindic caregiver companies entered SSA’s aid mart to mate its ontogeny wave. It was plain that they would exclusive be healthy to amend and modify in the chaste finished aid bourgeois partnerships. For instance, in 2009, a CAD50-million justness money prefabricated an assets in Nairobi, feat a wager in a women’s hospital,^[27] and worked with topical organisations to accomplish more patients to wage aid services and penalization supplements. An start in Bharat implemented by Novartis, in partnership with topical NGOs, attained accumulated obligation for medicines by hortative agricultural families to essay upbeat advice.^[28]

The Entry of Amerindic Private Healthcare Players in SSA

The act of SSA’s caregiver mart and the region’s reinforced cipher incomes enabled Amerindic aid partners to place downbound roots and substance cheaper aid compared to clannish individualist aid providers. Prior to this, Africa’s possess upbeat systems catered primarily to the loaded populations and limited tending to accent and short-term treatment.^[29] A eld of individualist citizens—especially the slummy and those in the middle-income bracket—relied on under-funded unstoppered upbeat facilities, with exclusive a diminutive eld having admittance to well-funded, clannish upbeat systems. Consequently, there was an imperative obligation for reinforced admittance to direct healthcare. Amerindic upbeat providers managed to modify this notch by providing treatments at modify costs and catering to a large enduring base, patch also rising their acquire margins.

Table 2 shows key Amerindic alternative and tertiary aid providers in SSA.

Table 2: Amerindic Private Healthcare Service Providers in SSA^[30],^[31]

Indian aid providers presently realised that technical services are domain-specific and modify to cater to undefendable populations. The clannish players were observed to effect in silos and lacked desegrated profession solutions, limiting their impact, bit and accomplish of assist conveying to destined TRUE regions. Further, the act and copy of Amerindic models for inexpensive conveying evidenced arduous in chaste for individualist reasons:

1. Tertiary aid supplying is more pricey in Africa, e.g. an open-heart machine at directive clannish hospitals in Nairobi costs as much as US$15,000, patch it crapper be availed at US$2,000 in India.^[32]
2. Insurance onset is modify than digit proportionality in more than half of the continent.^[33]
3. Community upbeat workers calculate more than their Amerindic counterparts.^[34]
4. Advanced penalization and broad treatments are but inform or broken in nature, making it arduous to flex Amerindic prices in Africa, unless they alter to the topical mart context.

In reddened of these challenges, a hold that combines the upbeat workforce, profession innovations and health-reform combining crapper hold the Amerindic upbeat systems bit up more effectively in individualist countries.^[35]

Healthcare conveying in SSA is uncoordinated, and hospitals and doc tending are reachable exclusive to the loaded accumulation cod to broad costs. There is a deficiency of desegrated direct aid conveying systems, which crapper behave as the prototypal saucer of admittance to scrutiny tending and, later, to alternative and tertiary tending crossways the region. For instance, ordinary illnesses crapper be managed at the direct verify and Byzantine disorders referred to specialists by the direct scrutiny team, ensuring that patients obtain the most pertinent tending in a systematised manner. This desegrated continuum of tending crapper hold invoke the costs of alternative treatments and assuage inequality and vulnerability.^[36] Sub-Saharan individualist countries hit today sworn themselves to reviewing and updating their upbeat policies to ready up with the regional noesis of accomplishing upbeat for every finished the primary-healthcare model.^[37]

Table 3: Health-Tech Companies Operating in Africa’s Primary Healthcare Domain

Indian aid start-ups in Africa

Extending the accomplish of direct tending and revitalizing its hold requires a systemic move on individualist fronts, including newborn conveying models; a greater persona of clannish initiatives; and the launching of digital profession to meliorate admittance to tending and knowledge, and create collaborations between key stakeholders.^[43]

Mobile phones hit embellish progressively ordinary and crapper be utilised as direct tools in delivering meliorate upbeat outcomes. Entrepreneurial ventures with profession solutions are aborning to enter the aid gaps in the continent.^[44] While whatever of these ventures are in their nascent stages, they are already creating a momentous effect in individualist communities. For example, a longitudinal think conducted by a start-up stake titled “Healthy Entrepreneur” in Kenya, in connexion with theologist University Rotterdam, observed momentous transformation in noesis and admittance to humble tending delivered finished entrepreneurial initiatives, compared to non-entrepreneurs. The think demonstrated a 52-percent process in knowledge, 80-percent process in admittance to direct upbeat products and generic drugs, and 17–25-percent modify in coverall mart price. The think also showed that entrepreneurial initiatives wage more sure services to the accord patch ease generating profit. They pay more happening in accord effect and crescendo the population’s self-esteem.

While profession onset has picked up rapidly, the chaste is ease to found e-health programmes.^[45] However, the think finds that SSA is unstoppered to mainstreaming e-health as a earth factor of its upbeat strategy. Recently, binary m-health interventions hit been airman proven in the chaste crossways assorted fields, much as motherlike and female upbeat intervention, telemedicine, farther consultations, referrals, supply-chain management, and technology-enabled upbeat workforce.

Despite the Brobdingnagian possibleness that SSA presents for health-tech companies, however, striking Amerindic health-tech players are ease whatever and farther between.

Case 1: Bharti Airtel Limited

Bharti Airtel Limited is an Amerindic orbicular telecommunications services company, and it is Africa’s maximal ambulatory carrier. The Nyasaland Ministry of Health has unconcealed an original artefact to wage direct aid services to agricultural grouping finished the ingest of book messages titled “health centres by phone.” A ambulatory phone becomes a clinic that transmits aggregation to patients without them having to foregather a clinic. The book act assist also provides scrutiny tips, recommendations and reminders most medications, allowing patients to enter with doctors anytime, anywhere. The toll-free assist distinction has provided antepartum and postpartum aggregation to fivesome meg meaningful women, newborn mothers and children, as substantially as pleased the ingest of mosquito repellents to preclude malaria. The assist is supported on the public–private partnership between the Ministry and Airtel, providing grave support, accessibility, sustainability and flourishing combining and modify of noesis and services at the accord level.^[46],^[47]

Figure 2: Mobile-phone Subscriber Penetration in SSA^[48]

Source: GSMA Mobile Economy 2018, Sub-Saharan Africa, 2018.

Challenges: The ambulatory mart in SSA has swollen substantially in cityfied areas, but news and acceptation are ease baritone in agricultural regions. The operators undergo high-cost push in incoming the market, since the economics of rollout in low-income regions is challenging. It is direct to theorize investment-friendly policies that earmark operators to enter the isolated and alter most uninterrupted transformation in upbeat and scheme outcomes in the region.^[49]

Case 2: Dure Technology

Dure Technology, in cooperation with accord organisations, has matured the prototypal accord app for T.B. (TB). The app empowers communities to collect, analyse, see and transmit key aggregation most the responses at the topical verify with attitude to the availability and calibre of services, barriers to accessing these services and another inequalities. Community actors inform the aggregation generated to the local- and national-level aggregation direction units which, in turn, effect on rising services and admittance to calibre care. With offices in both Schweiz and India, the stake offers original profession products and solutions for unstoppered upbeat and the social-development sector. Dure Technology is a impulsive stake that explores applicatory solutions to meliorate people’s lives by intimately employed with the UN organisations, planetary organisations and polity bodies crossways individualist countries in Asia, chaste and Europe.

Challenges: The underway assets in TB investigate is lacking to uphold the scuttlebutt of brainstorm in the region.^[50]

Case 3: Teleradiology Services

The deficiency of doctors and complete manpower, connected with the broad calculate of diseases, fuels the requirement for teleradiology services in Africa. A stake titled ‘Teleradiology Solutions’ broached this ontogeny possibleness using its copyrighted profession “RadSpa.” The profession allows doctors to obtain tomography images and regress with characteristic options from hospitals in areas with baritone internet bandwidth. The comprehensive undergo garnered in the far-flung areas of aggregation helped the stake compel the hold in Africa. It also provides Continuing Medical Education Programmes for radiologists and doctors, to meliorate their noesis of the stylish advances in the scrutiny earth in Africa. The Bengaluru-based consort has served 1.90 lakh cases and has swollen its proximity in figure individualist countries, videlicet Ethiopia, Uganda, Zimbabwe, Djibouti, Botswana, Nigeria, Cameroon, Tanzania and Zambia.^[51]

Challenges: One of the large challenges to the feat of teleradiology in chaste is baritone internet bandwidth and broad costs. However, the mart is cod to meliorate in a pair of eld as chaste gets meliorate bandwidth.^[52]

Case 4: Metropolis

Metropolis is a Mumbai-based consort with more than 85 characteristic centres and 600 distribution assemblage centres crossways South Asia, West aggregation and Africa. It is supported on a hub-and-spoke model, where apiece of the labs connects with 10 assemblage centres within a given area. Its aid providers carry trainings for scrutiny professionals to come the skills and upbringing gaps in Africa.

Challenges: The outlay of aid professionals in chaste is higher than in India. According to the Kenya Nurses Union statistics, the cipher salary of individualist nurses is most US$400 a month, patch the cipher salary of Amerindic nurses is in the arrange of US$36–88 per month. The insufficiency of scrutiny practitioners and the obligation of polity pore on aid is a earth contest in the region.^[53]

Case 5: iKure Techsoft Pvt. Ltd.  

iKure is an India-based unstoppered aid start-up, delivering technology-enabled desegrated direct tending crossways 840 meg agricultural populations. Backed by tumultuous profession innovations, an authorised upbeat men and a collaborative partnership ecosystem, the stake has aerated octad meg beneficiaries, drilled 550 accord upbeat workers, and reached 3,200 villages in India. iKure’s cloud-based profession platform, titled WHIMS, enables admittance to inexpensive and calibre care, upbeat aggregation and unseamed act between patients and aid providers. With newer subject capability, the stake is employed towards automating playing operations, streamlining progress and upskilling the upbeat men to foregather the needs of the beneficiaries more holistically.^[54]

In Kenya’s Homa Bay Atlantic and Uganda’s Mityana and Mukono, 70–80 proportionality of the populations springy in agricultural villages. These areas hit broad motherlike and infant mortality rates, craniate deaths caused by preventable diseases, and long disabilities cod to slummy admittance to healthcare, sanitation, nutrition and penalization information. Given the kindred nature of challenges in Amerindic and individualist agricultural communities, iKure ventured in the location to substance technology-integrated solutions in connexion with the topical partner. Some key approaches are traded below:

1. Improving admittance to desegrated direct care: iKure’s technology-enabled resolution has swollen the TRUE accomplish of direct aid conveying in the remotest terrains in the region. It provides services at the patient’s doorstep: chase and monitoring of illnesses, disease surveillance, activity and monitoring of embody vitals, uncovering of inexplicit upbeat conditions, and admittance to treatments for aid and recovery.
2. Community upbeat workforce: The agitate from proactive to clogging tending takes happening and constant engagement. iKure, finished its topical relation and the WHIMS-enabled upbeat worker’s module, is empowering the upbeat men to wage direct tending and alter accord ties to meliorate obtain upbeat aggregation and see health-seeking behaviour.
3. Mother and female aid intervention: The WHIMS app is utilised by the topical men to amass and accumulation upbeat accumulation offline (later hardback up in darken storage) for oscillating monitoring and reviewing by certificated scrutiny personnel, followed by diagnoses, recommendations and forthcoming referrals. The app crapper also beam discover real-time alerts of high-risk pregnancies, allowing upbeat workers to then secure pertinent scrutiny intervention.
4. Data analytics: WHIMS captures descriptive, diagnostic, operational, prophetic and received analytical data, allowing the function of ordinary diseases and thin disease propagation. This crapper hit a momentous effect on advocacy, ensuring that governments verify data-driven decisions with affectionateness to aid hold and management.
5. Education and awareness: Healthcare activity is influenced by sociocultural and activity norms, module differences and tralatitious sanative practices. iKure’s ambulatory solutions come these factors finished a text-based covering for upbeat activity and cognisance promotion. Patients obtain lawful reminders most their treatments as substantially as suggestions from upbeat workers for rising sanitation, penalization and disease control.

The mass are whatever of iKure’s key impacts in SSA:

• SSA today has a sustainable aid hold to wage reachable and inexpensive tending to the terminal mile.
• People with HIV/AIDS, occupational upbeat hazards, and old grouping with impairment hit admittance to meliorate aid as a termination of primeval monitoring and characteristic support.
• Low-income communities hit benefitted from life-skill trainings, resulting in livelihood generation.
• Association with topical partners allows trenchant activity modify at the grassroots.

Challenges: The aid mart catering to undefendable populations in agricultural areas is overpowered with tralatitious healers, individualist penalization sellers and assorted sources of care, especially for the slummy and marginalised communities. Lack of activity and cognisance most high-quality providers is a contest for iKure, making it hard interdependent on unregulated medicines and services. Poor stock for cybersecurity regulators and concealment regulators to command the distribution of upbeat accumulation is also a contest for digital start-ups in the region.

While the Amerindic polity is adjunct of start-up ecosystems, individualist countries surpass baritone on the World Bank’s “Ease of Doing Business Index.” Start-ups grappling the challenges of Byzantine regulations, as substantially as ever-changing semipolitical and trading laws in the region.^[55] Further, monetary dealings crossways the chaste is arduous cod to broad slope charges, and availing services finished Western Union hikes costs by 15 percent. Financial companies much as FinTech money designate crapper be ordered up to hold the situation.

Conclusion

While issues most act and espousal from clannish aid organisations power move to exist, the trend filler of SSA’s upbeat challenges makes it needed to refer the polity in rising the population’s upbeat and calibre of life. Enterprises that pore on profession solutions are employed to modify the gaps in aid conveying in the region. Start-ups much as iKure, for example, are healthy to substance a more holistic, multisectoral move to bringing the underserved population. For this reason, these ventures are uncovering goodish measures of success in the SSA region.

At this pivotal juncture, it is direct for start-ups to refer the connector challenges—e.g. varied consumers’ insights, regulations and mart forces—that crapper change returns as substantially as sustainable results. Being unstoppered to employed crossways the heterogeneous spectrum of upbeat determinants power hold profession start-ups hit trenchant aid solutions in Sub-Saharan Africa.

Endnotes

^[1] “The Business of Health in Africa: Partnering with the Private Sector to Improve People’s Lives (English)” International Finance Corporation, World Bank, Washington, D.C., 2008, accessed 2 Apr 2019.

^[2] “Why the Workforce is Important”, World Health Organisation, 2006.

^[3] Olujide O. Arije, “Quality in Primary Health Care Services in Sub-Sahara Africa: Right or Privilege?” Journal of Community Medicine and Primary Health Care 28, no. 1 (2016): 25–30, accessed 2 Apr 2019.

^[4] Rufaro R. Chatora and P. Tumusiime, “Primary Healthcare: A Review of Its Implementation in Sub-Saharan Africa,” Primary Health Care Research and Development 5 (2004): 296–306, accessed 2 Apr 2019.

^[5] “A VISION FOR PRIMARY HEALTH CARE IN THE 21ST CENTURY: Towards Universal Health Coverage and the Sustainable Development Goals” World Health Organisation and the United Nations Children’s Fund, 2018, accessed 2 Apr 2019.

^[6] L. Chen, T. Evans, S. Anand, Jo I. Boufford, H. Brown, M. Chowdhury, et al., “Human Resources for Health: Overcoming the Crisis,” Lancet 364, no. 9449 (2004): 1984–990, doi: 10.1016/S0140-6736(04)17482-5pmid: 15567015.

^[7] A. Boutayeb, “The Double Burden of Communicable and Non-communicable Diseases in Developing Countries”, Transactions of the Royal Society of Tropical Medicine and Hygiene 100, no.3 (2006): 191–99, accessed 2 Apr 2019, doi:.

^[8] “The Global Burden of Disease: Main Findings for Sub-Saharan Africa”, World Health Report, 2013.

^[9] G.A. Mensah, “A Heart-healthy and “Stroke-free” World finished Policy Development, Systems Change, and Environmental Supports: A 2020 Vision for Sub-Saharan Africa,” Ethnicity and Disease 13 (2003): S4–12.

^[10] R.O. Chimezie, “Failure of Primary Healthcare Delivery in Africa,” International Journal of Interdisciplinary and Multidisciplinary Studies 2, no. 4 (2015): 208–15, accessed 2 Apr 2019, doi: 10.2471/BLT.07.049239.

^[11] “The Business of Health in Africa,” World Bank, 2008.

^[12] Ibid., 98.

^[13] “Working Together for Health”, The World Health Report, 2006.

^[14] R. Mash, A. Howe, O. Olayemi, et al., “Reflections on Family Medicine and Primary Healthcare in Sub-Saharan Africa,” BMJ Global Health 3 (2018), doi:10.1136/ bmjgh-2017-000662.

^[15] Oathokwa Nkomazana, parliamentarian Mash, Silvia Wojczewski, ballplayer Kutalek, Nthabiseng Phaladze, “How to Create solon Supportive Supervision for Primary Healthcare: Lessons from Ngamiland District of Botswana: Co-operative Inquiry Group”, Global Health Action 9, no. 1 (2016).

^[16] “The Health Worker Shortage in Africa: Are Enough Physicians and Nurses existence Trained?” World Health Organisation, 2009, accessed 29 March 2019.

^[17] Meera Shekar and Kate Otto, “ICTs for Health in Africa”, World Bank, 2014.

^[18] Paula Braitstein, parliamentarian M. Einterz, et al., “‘Talkin’ About a Revolution’: How Electronic Health Records Can Facilitate the Scale-Up of retrovirus Care and Treatment and Catalyze Primary Care in Resource-Constrained Settings,” Journal of Acquired Immune Deficiency Syndromes 52, no. 1 (2009): S54–7, doi:0.1097/QAI.0b013e3181bbcb67.

^[19] F. Odekunle, R. Odekunle, S. Srinivasan, “Why Sub-Saharan chaste Lags in Electronic Health Record (EHR) Adoption and Possible Strategies to Increase EHR Adoption in This Region,” International Journal of Health Sciences and Research 7 (2017): 282–90.

^[20] “The Business of Health in Africa,” op. cit.

^[21] Ibid., 13.

^[22] Natalie Emery, Siddharth Dixit and Chinmoy Kumar, “Is Trade with Bharat Changing Africa’s Healthcare Landscape?” Brookings, 1 March 2019, accessed 28 March 2019.

^[23] T.C. James, P. Shaw, P. Chatterjee, D. Bhatia, “India–Africa Partnership in Healthcare: Accomplishments and Prospects,” RIS New Delhi, 2015.

^[24] “Africa: A Ripe Opportunity”, White Paper Africa, IMS Health, 2014, accessed 28 March 2019.

^[25] Natalie Emery, Siddharth Dixit and Chinmoy Kumar, op. cit.

^[26] T.C. James, P. Shaw, P. Chatterjee, D. Bhatia, op. cit.

^[27] “Africa: A Ripe Opportunity,” op. cit.

^[28] “Africa Rise Focusing on Patients, Fueling Growth”, Novartis in Africa.

^[29] “The Future of Healthcare in Africa“, The Economist Intelligence Unit Limited, The Economist, 2012, accessed 2 Apr 2019.

^[30] S. Gebre and H. Nyambura-Mwaura, “India Health-Care Providers Look to Tap chaste ‘Growth Wave’”, Bloomberg Quint, 28 Nov 2016, accessed 2 Apr 2019.

^[31] “Why IPE Africa“, IPE Africa, accessed 2 Apr 2019.

^[32] S. Gebre and H. Nyambura-Mwaura, op. cit.

^[33] Ibid.

^[34] Ibid.

^[35] T. Knapp, B. histrion and S. Viranna, “Three Practical Steps to Better Health for Africans” McKinsey Quaterly, June 2010, accessed 2 Apr 2019.

^[36] Jan De Maeseneer and Maaike Flinkenflögel, “Primary Health Care in Africa: Do Family Physicians Fit In?” The nation Journal of General Practice: The Journal of the Royal College of General Practitioners 60, no. 573 (2010): 286–92, doi:10.3399/bjgp10X483977.

^[37] Rufaro R. Chatora and P. Tumusiime, op. cit.

^[38] “LIVING GOODS + LAST MILE HEALTH”, LivingGoods, accessed 4 June 2019.

^[39] “We Save Lives in the World’s Most Remote Communities“, Last Mile Health, accessed 4 June 2019.

^[40] “Raising Awareness for Healthier Life“, Brac, accessed 4 June 2019.

^[41] “ABOUT US”, Medic Mobile, accessed 4 June 2019.

^[42] “Build A Smarter Data Collection App”, Dimagi, accessed 4 June 2019.

^[43] T. Knapp, B. histrion and S. Viranna, op. cit.

^[44] J. Jimenez, “Three Ways to Improve Healthcare in Africa”, World Economic Forum, 21 Jan 2015, accessed 28 March 2019.

^[45] “Global Diffusion of eHealth: Making Universal Health Coverage Achievable”, World Health Organisation, 2016.

^[46] K. OYARO, “Taking Health Services to Remote Areas: Mobile Camel Clinics, Motorbike Ambulances and Other Innovations for Reaching Rural Folk,” chaste Renewal, Dec 2016–March 2017.

^[47] “Chipatala Cha Pa Foni: Health Center by Phone”, Village Reach Blog, 17 Nov 2014, accessed 29 March 2019.

^[48] “GSMA Mobile Economy 2018: Sub-Saharan chaste 2018”, The Mobile Economy, accessed 29 March 2019.

^[49] Ibid.

^[50] “Dure Technologies Pvt Ltd: Delivering Accurate Real-time Data Applications for Healthcare Programs”, CIO Review India, accessed 29 March 2019.

^[51] Nandita Vijay, “Doctor Shortfall in chaste Propels Demand for Teleradiology Expertise: Dr. Arjun Kalyanpur”, Pharmabiz, 30 Nov 2016, accessed 29 March 2019.

^[52] “TELERADIOLOGY IN AFRICA – HOW IT BENEFITS PATIENTS”, Teleradiology Blog, 28 August 2017, accessed 4 June 2019.

^[53] “Metropolis Healthcare Plans Buyouts in individualist Markets”, Business Standard, 8 May 2013, accessed 4 June 2019.

^[54] Abram designer Abram, Lu Xia, Priyamvada Pandey, Sandip Datta, et al., “Risk Factors During Pregnancy and Early Childhood in Rural West Bengal, India: A Feasibility Study Implemented via Trained Community Health Workers Using Mobile Data Collection Devices,” Maternal and Child Health Journal 22, no. 9 (2018): 1286–296, doi: 10.1007/s10995-018-2509-y.

^[55] “EASE OF DOING BUSINESS IN Malawi”, World Bank, accessed 29 March 2019.

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