Can a robot provide helpful answers to your health concerns? Like, "I'm 39 weeks pregnant and I have a slightly pink discharge." Or "what should I pack in my hospital bag?"
That's the goal of Reach Digital Health, an organization that uses mobile technologies — SMS and WhatsApp messaging — to provide helpful health-care information and guidance to people across sub-Saharan Africa who can't easily reach a health-care provider. As a testament to their success, the 15-year-old group just received one of this year's five Skoll Awards for Social Innovation of $2.25 million, presented this week in Oxford, England.
The Skoll Foundation, which invests in and honors social change, selects a group of social innovators each year "whose work targets the root causes of societal problems that are ripe for transformational social change." Other awardees this year included groups tackling the climate crisis, strengthening democracy and promoting economic growth for all.
"Reach Digital Health is working toward a world where marginalized people are safe from disproportionate impacts of disease outbreaks [and] disparities in health outcomes among the most marginalized are eliminated," is the Foundation's rationale for giving the group the award.
Obstacles to getting health-care help
The need for some kind of health-care intervention in Africa is evident. The continent has 17% of the world's population, 23% of the diseases that disable and kill, and only a small fraction of the world's health workers. All too often, says Debbie Rogers, CEO of Reach Digital Health, people travel long distances to reach the closest health facility and wait hours to briefly see a medical professional before making the long return journey home — if they seek out care at all.
"So the problem is that [these individuals] do not have access to the health care that they need and they deserve," says Rogers. Her organization works to bridge that gap to "empower people when they don't have access to somebody they can talk to about their health."
The group reports that its MomConnect Africa project has enrolled 70% of all pregnant women in the public health-care system in South Africa. The program provides maternal and child health information in numerous languages, including those of indigenous communities. And more than 14 million people in the country engaged with the COVID-19 service the team built in the midst of the pandemic. Both programs are in partnership with the South African National Department of Health.
The organization isn't just in South Africa. It's scaled up to work in eight other countries in sub-Saharan Africa. In addition, through a collaboration with the World Health Organization starting in 2020, they've expanded their services across the globe and set up programs in Bangladesh, Timor-Leste and Indonesia.
Tapping the power of mobile phones
The key to the empowerment that Reach Digital Health seeks to create is the mobile phone, which for many in sub-Saharan Africa is the only technology they use to communicate electronically (since landlines and computers are uncommon in many communities). So the organization relies on text messaging and WhatsApp — no user manual required!, says Rogers — to have ongoing exchanges with people about their physical, mental, and reproductive health.
Individuals sign up in one of two ways. The first is through a clinical setting. For instance, at their first prenatal visit, all expecting mothers in South Africa's public health care system are invited by a medical professional to join MomConnect Africa. When a woman agrees to participate, she begins to receive automated updates about scheduling future prenatal appointments and how best to nourish and care for her developing baby.
In an independent analysis of the program, a South African research team headed by Donald Skinner of the Human Sciences Research Council found there were some problems with translation quality and network coverage but concluded that overall, "The women were consistently positive about MomConnect, attaching high value to the content of the messages and the medium in which they were delivered."
To contact those who don't participate in the health-care system, Reach Digital Health uses mass media, advertising and community-based organizations to encourage people to enroll. These invitations come in the form of specific calls to action, like: "Need to register for a vaccination?" or "Are you worried that you might have COVID-19?" followed by a prompt to dial a number. Once people are in the system, Rogers says they're exposed to the breadth of Reach Digital Health's offerings. This includes being invited to ask open-ended questions about their health and responding to automated inquiries about how they're feeling.
How the robots answer questions
Reach Digital Health fields millions of questions and dispatches millions of mostly automated, computerized answers per day. That is, "we first try to respond automatically to any question that they might have," says Rogers, "because we want to be able to give them an answer as quickly as possible."
Milton Madanda, director of platform at Reach Digital Health, says they've built a system that uses both simple question-and-answer algorithms and more complex machine learning approaches to scan the incoming inquiries for keywords. Like "pregnancy" and "vaccine" during the height of the COVID-19 pandemic when people were asking questions around immunization safety.
Other words or responses trigger additional interventions. If someone includes a word like "bleeding" in their message, for example, the system will either instruct them to visit their nearest clinic as soon as possible or facilitate putting them in touch with a health-care facility. Same thing for that comment from the person who wrote that she was 39 weeks pregnant and noticed a pink discharge. The system responded: "It sounds like this might be serious. In an emergency, please go to your health provider immediately, or call one of the below Emergency Numbers."
There are circumstances that elicit a different kind of response. Take their Young Africa Live program. "If there are any messages related to needing help, being suicidal or being depressed," explains Madanda, "we are able to pick out certain words that we can then escalate from a mental health perspective." That escalation may involve a more urgent suggestion to seek medical help and the opportunity to speak directly with a counselor through a government hotline if they choose.
According to Rogers, a fraction of the time, an individual will ask to connect with a real person or they'll ask a question the system doesn't recognize. They're then routed to an actual human being — "trained nurses who are able to respond and engage in a much more personal way," says Rogers. "So it's a mixture of automated and personal." All responses are vetted by health authorities and medical professionals.
Reach Digital Health also uses the information they collect to improve the health offerings of a facility, district or even entire country. After a woman's first prenatal visit, for example, she'll be asked via text or WhatsApp about what did and didn't happen. Was her urine taken? Was she prescribed any medications? Was she told about worrying danger signs? These answers are gathered from millions of women, which allows for shortcomings in training or medical supplies to be identified and corrected by providers and governmental health agencies.
In addition, symptoms and diagnoses reported through Reach Digital Health can be relayed to governments in real-time to allow for informed public health decisions to be made quickly and responsibly.
The Skoll Award's financial prize is offered as unrestricted funding and flexible support. Rogers says Reach Digital Health plans to use this influx of funds to teach other organizations and institutions across the world to replicate their work. "The goal is not world domination," she says. "We've built up a model now that we know is impactful. It saves lives. We know that it's scalable."
Now, Rogers says, "We have to be able to empower other organizations to do what we've been doing."
