William (Bill) Opoku Effah

Brown School: Public Health, MPH

William (Bill) Effah is a general practice physician-administrator with experience in patient care and leading healthcare teams in West Africa. He obtained both his bachelor’s and medical degree from the University of Ghana. He is currently a MPH student with interests in Global Health and Epidemiology at the Brown School. Bill is generally interested in questions and therefore has broad interests in areas such as dissemination and implementation science as it relates to infectious diseases in sub-Saharan Africa, maternal and child health, neglected tropical diseases, leveraging technology to improve health and health outcomes research.

He is currently helping the City of St Louis Department of Health develop a comprehensive foodborne illness surveillance system that incorporates social media and helping to also revise the City’s Food Code. He is the chair of the Global Health Student Advisory Committee at the Global Health Center of the Institute for Public Health.

Bill enjoys playing music and is a skilled bass player.

McDonnell Academy Global Leadership Visions | OPINION

Using Innovation To Advance Health In Low Resource Settings In Today’s Pandemic Prone World

COVID-19 has brought to the fore more glaringly the challenges and deficiencies in our quest to improve global health and health security. In March of  2020, as the COVID-19 pandemic surged, and cases emerged in record numbers, it became quite apparent that more public health measures were needed at a much greater scale to mitigate the effects of this unrelenting disease. Physical distancing measures, quarantines, and isolation practices became pervasive stopgap measures in many jurisdictions not just here in the US, but across continents.  Mandatory lockdowns which some critics viewed as drastic and even somewhat draconian became the order of the day.

As cases have continued to rise over the months, coupled with the finitude of available health care resources like personnel and consumables, there has been the overstretching of the health care system to the point where it is bursting at the seams all over the world. This has led to unfortunate events, like that witnessed in Italy, where the health system was so overburdened at a point that health care providers especially physicians had to literally prioritize who to save and who to let die! 

 While this was ongoing, the provision of non-emergent but equally important care for the management of chronic conditions such as diabetes, hypertension, gynecological and mental health services appeared to be put on the back burner. A devastating corollary effect of all available resources being directed towards the pandemic. Also, even if the resources to provide care were available, the positive health-seeking behavior of individuals was also affected as people were often too afraid to visit healthcare centers for fear of contracting the virus. As a result, as the pandemic created another trail of morbidities and mortalities that could have otherwise been prevented altogether.

Telemedicine or Telehealth provides a practical solution. Telehealth is a means of providing medical care and clinical information remotely, using information communication technology like computers and smartphones. Three modalities of use of telemedicine are clearly identified. These are synchronous, where care is delivered face-to-face via videoconferencing or text in real-time. Asynchronous modalities are not delivered in real-time but utilize tools like emails, text to monitor and deliver feedback to clients. A third modality combines both.

I believe such tools are useful in delivering critical healthcare services and improving health outcomes. Potentially, it can increase access to healthcare for many people who otherwise previously would not have access. A report by McKinsey & Co states that doctors in the US with access to telehealth saw between 50 to 150 more patients than prior to the pandemic. In many low to middle-income countries (LMICs) such as Ghana where the doctor to patient ratio is low (10/100,000population), this can potentially be a game-changer for healthcare. By leveraging technology, the few available healthcare workers can reach more people than before. Telemedicine can also markedly reduce the risk of disease transmission to health staff while relieving pressure on the use of personal protective equipment since it cuts down on person-person contact.

The idea and use of telemedicine are not new in the global north, but in places like Sub-Saharan West Africa, its presence and adoption are relatively new. One may argue that this is so because the technological infrastructure and capital investments needed for such an undertaking is almost nonexistent. This assertion may have been true a decade or so ago, but not so much currently. Data shows that across the continent well over 80% of people have mobile phones now and this number has been increasing since 2013. Internet penetration was estimated to be about 40% in 2018 and is expected to increase by about more than 10% by 2025. Averagely it is currently 58.8% worldwide. The infrastructure exists, just underutilized!

Building hospitals are good investments, but are quite capital intensive, and may not be enough to address the problem of lack of access. For instance, in Ghana, 50% of all doctors are in the capital, Accra and the second biggest city, Kumasi. Many healthcare workers want to enjoy the comforts of the city, like good schools for their children and motorable roads. As one moves further North there is a paucity of doctors. Siting a hospital up north may not solve the problem of lack of access etc. Telemedicine can remotely bridge the gap.

As the world moves through what I term a “reverse epidemiological transition” the double burden of infectious and chronic diseases which is fast becoming a problem in LMICs can be addressed with telemedicine.

It is imperative that governments in Sub-Saharan Africa continue to increase their investments in technological infrastructure, clearly delineate the policy space on issues such on protected health information, incentivize the production and use of telehealth products, create private sector- government partnerships to drive tele health as government is a big supplier  and stakeholder of health care in most African countries. These will go a long way to make access and use of innovation, especially a reality.