The last decade has seen improvements in a number of African health indicators including child and maternal mortality rates. However, despite being home to over a quarter of the global disease burden, Africa has only 2% of the world’s doctors. Technology and innovation are essential in efforts to rapidly meet its healthcare needs, including improving life expectancy across the continent – currently 61.2 years in Sub-Saharan Africa versus 77.5 years in Europe. These numbers are, in part, driven by low levels of investment in healthcare facilities and human resources. Poor health indicators such as these have a negative impact on the labour force which stifles economic growth across the continent.
The incredible success of Africa’s ‘Mobile Phone Revolution’ which brought commercial banking services to over 60% of Africans with no access to banks has been widely touted. It is easy to imagine how a ‘Healthcare Revolution’ supported by space-based systems could transform healthcare in Africa, where ground-based infrastructure is often limited, substandard or absent.
The majority of medical professionals in Africa live and work in urban areas, resulting in a deficiency of care in rural areas, where the majority of Africans still live. This is further exacerbated by poor transport networks which make access to healthcare, particularly emergency medical services, difficult. The use of fast and reliable space-based telemedicine platforms by medical personnel to prevent, diagnose and treat patients in geographically distinct locations could be transformative for Africa. Imagery from Earth observation satellites can be used to monitor the numbers and movements of mosquitoes carrying malaria parasites and other disease vectors to help prevent disease outbreaks. Earth observation imagery can predict crop failure due to floods, and thus help prevent or prepare for droughts and their sequelae of malnutrition and mass starvation. Access to, and control of, space-based technologies, which often operate through satellites, are therefore important to modern healthcare development efforts on the continent.
Article 16 of the African Charter on Human and Peoples’ Rights obliges African states to protect the health of their people. Both the African Union Agenda 2063 and African Space Strategy refer to telemedicine but stop short of a comprehensive strategy to extend its use on the continent. The Continental Africa Telemedicine Alliance was established in February 2019 to engage with regulatory agencies in an effort to increase and support telemedicine initiatives. This makes the AU-backed Pan-African E-network on Tele-education and Tele-medicine (‘PAeN’) especially relevant. PAeN is a multi-modal space-based satellite platform capable of delivering tele-education and telemedicine services throughout the African continent. Unfortunately, its telemedicine operations have failed to make an impact and require restructuring and refinancing to meet this critical need.
Just as space-based healthcare services are useful in day-to-day medical delivery, it is equally important for the effective delivery of health services in the midst of a global pandemic. The third United Nations Conference on the Exploration and Peaceful Uses of Outer Space (‘UNISPACE III’), resulted in the Vienna Declaration which recognised the significance of space science and space applications to health and recommended that steps be taken to ‘improve public health services by expanding and coordinating space-based services for telemedicine and for controlling infectious diseases’ in the interest of human security and welfare. Additionally, the African Health Strategy 2016–2030 emphasizes the need to implement effective measures for disease surveillance. These recommendations have been underscored by the recent global spread of the Coronavirus (Covid-19).
Infectious diseases such as Covid-19, which spread rapidly and have the capacity to lead to high mortality rates in vulnerable groups, present both a public health and acute services emergency. Space-based systems can help in reducing or containing the spread in a number of ways. Global positioning systems (GPS), for instance, can be used to monitor infected patients and transportation of medical supplies in real-time. Similarly, global navigation satellite systems can be used for large-scale disinfection efforts through autonomous drones. China utilised the BeiDou Navigation Satellite System for these purposes to great effect in this Covid-19 pandemic.
The use of telemedicine during a pandemic is not only helpful for the assessment and treatment of the ill, but also for minimising the number of people unnecessarily exposed to disease by physical attendance at medical facilities. Additionally, the use of telemedicine systems can also protect medical personnel. The Ebola crisis exposed the lack of adequate infrastructure which contributed to the infection and death of high numbers of medical staff, hindering the survival of patients. Health applications supported by space-based systems are, therefore, particularly vital in Africa given its low doctor-patient ratio and lower numbers of medical facilities.
Our recent paper, ‘Health from Above: Space-Based Healthcare Services in Africa’, published in the book, “Space Fostering African Societies”, makes a case for the establishment of a better resourced PAeN to, amongst other things, increase awareness of the use of space-based services to widen access to high-quality healthcare across Sub-Saharan Africa. The absence and/or inadequacy of national and AU laws on telemedicine services as well as issues concerning licensing of health personnel to use telemedicine and reimbursement policies for telemedicine services have, along with other factors, prevented the widespread use of the service on the continent. Some African countries, South Africa, Ivory Coast and Tanzania for example, have regulations or laws covering certain aspects of telemedicine. However, these have been subject to criticism including claims of inadequate data protection. This problem is compounded by the fact that there is currently no international treaty which specifically governs the global use of telemedicine.
The impact made in commerce and banking by the growth of the mobile telecommunications sector in Africa is phenomenal. Space-based telemedicine services across national borders have the potential to drive similar transformational change in healthcare across Africa and must be diligently pursued through a comprehensive plan. But first, legal concerns including consent, liability and confidentiality related to telemedicine must be tackled as must the ethical, technical and financial challenges facing the continental implementation of telemedicine platforms.
About the authors:
Harold Ayetey is a Senior Lecturer and the immediate past Head of the Department of Medicine and Therapeutics at the University of Cape Coast. He is also a Consultant Physician and Cardiologist at the Cape Coast Teaching Hospital. His clinical and research interests include cardiovascular imaging, digital medicine and artificial intelligence in healthcare.
Julia Selman Ayetey is a lawyer qualified to practice in Ghana, England and Wales. She is a Senior Lecturer at the Faculty of Law, University of Cape Coast and has a longstanding interest in the intersection between law, ethics, science and technology. Currently, Julia is pursuing her doctorate at the Institute of Air and Space Law, McGill University.