Real-time monitoring of reported COVID infections has been key to the global response to the pandemic. Many tools, devices and applications have been used to support monitoring. China, South Korea and Malaysia developed some at the start of the pandemic and many more were created by other countries later.
Some of these platforms will also have a role to play in a post-pandemic world. Improvements in digital technology, mobile phone networks and the potential of telehealth systems could help reshape the appearance of health care in resource-poor settings.
Dashboards at national and subnational levels are already commonplace. In the UK, for example, the government portal covers the latest daily statistics on cases, hospitalizations and deaths. Countries like South Korea have used mobile phone technology to develop applications that support their test programs.
Beyond the pandemic, the use of mobile phones to support healthcare is an emerging trend in sub-Saharan Africa. Examples include the CDC Foundation which funds the Mobile Exposure Prophylaxis (mPEP) initiative in Kenya. This uses mobile phone communications to track the progress and adherence to treatment by healthcare workers who have potentially been exposed to HIV. And in Benin, applications are being evaluated to make an appointment with a doctor.
In a recent article, we looked at how a Ghanaian software company, Cognate Systems, adapted one of its data platforms to help report and track symptoms of COVID across the country.
We have reviewed the project and analyzed the platform, its functionality and usage. Our main findings were that self-reporting of COVID-like symptoms via a mobile platform is feasible, and that it could detect outbreaks faster than routine surveillance.
Based on our findings, we made some recommendations on how the technology could be used in public health emergencies in a developing country like Ghana.
What we found
The data platform, called Opine, was designed to collect disease information from various sources and provide information in real time. Our project aimed to determine whether users would interact with the system and report symptoms that could be due to COVID-19, and whether healthcare workers would appreciate the information transmitted.
The feasibility study took place in four districts; the peri-urban sites of Ashaiman and Kpone-Katamanso, Greater Accra, and the rural areas of Nkwanta South and Nkwanta North, Oti region.
Added: The system is easy to use. A user simply needs to dial a speed dial number (called Unstructured Additional Service Data or USSD) on their mobile phone to start interacting with Opine and a series of questions will appear.
The aim was to ensure that everyone in the country could participate in disease surveillance. The technology has therefore been adapted to ensure its use in places where Internet connectivity is unreliable or lacking.
It had to work on all cell phones, not just smartphones, and without internet access. The abbreviated number could be dialed for free and did not require any credit on the phone to make the call. Because the platform was not tied to a particular user account, it was suitable for communities where cell phones are shared among residents.
We saw that over 1,200 users dialed the number during the four month testing period. Feedback from users and healthcare workers was that the platform had the potential to offer timely information on the spread of the virus within communities.
It has the potential to be integrated into routine surveillance infrastructure, but communities should be reminded to use it.
The project has highlighted a possible avenue for regular and early notification of COVID-19 symptoms to help identify new cases. For example, several potential cases reported in an area could indicate a “hot spot” of an outbreak.
Technology in health crises
Managing public health emergencies with digital and mobile devices has grown in leaps and bounds over the past decade. One example is the use of portable sequencing devices to study the genomics of the Ebola virus in infected patients. This made it possible to follow the sequence and direction of an epidemic.
Real-time data platforms such as Opine have the potential to improve surveillance and support early notification of other public health emergencies. For example, they might answer questions about a meningitis epidemic, earthquake, flood, or an urgent need for food or clean water.
A post-pandemic health care service in Ghana and beyond could usefully integrate more elements of mobile health programs. It could collect more electronic data and interact more with community health centers and local pharmacies.
The Ministry of Health and Ghana Health Service have extensive experience in using mobile apps and mobile devices to improve real-time data collection for immunization and logistics management. COVID-19 contact tracing and vaccine administration were performed using mobile apps and mobile devices. As internet coverage and network quality improve, telemedicine (remote consultations by video call or phone call) will increasingly become an option.
There are also potential fundraising avenues to explore. New uses of technology and devices in sub-Saharan Africa could be driven by donations from the north of the world. But caution is in order. About 40-70% of donations are not useful because the technology does not work well or is inappropriate in the local context, or staff are not trained in its use.
The use of any new technology should be guided by the local context and its acceptability. Country-led initiatives are more likely to be successful and sustainable.