A Practical Solution: Ghana-style

This blog is inspired by my time in Ghana.

 I distinctly remember being in a beat-up taxi in Accra, having just arrived in the country and thinking...."it's different, but not that different." The next day, in a beat-up tro-tro, I remember thinking, "it's different, but so similar." and then wondering if this would really be a life changing experience. After all, I thought, it wasn't that different. As time rolls on, I find myself increasingly mentioning my experiences in conversation, piping up about how service delivery is significantly altered in a country where democracy is only mildly functional, where there aren't enough funds to deliver all services because the infrastructure can't support it, creating a vicious cycle where the job market remains mostly agricultural and industry-based rather than moving to a knowledge-based economy. While this is a very simplistic breakdown of an incredibly complex economic situation, it paints an understandable picture for those of us with little if any training in international politics and economics.

I'm not very good at staying still. My personal motto, some might say mantra, is "never static" because I strive to always learn something new, to try different things, to challenge myself. Early on in my trip to Ghana, I noticed just how much I missed having the Internet. I missed knowing what was going on in the world of Medicine, I missed being able to look up random facts that came up in conversation on Wikipedia (because when it's relatively trivial, you don't need a world-renowned journal). I missed constant access to my email. Equally, it was painful to receive 200 emails in one go when I did finally get access to the Internet. I became acutely aware of how much the Internet was a crutch in my understanding of the world. I felt like this change, though it felt like I was standing still, was giving me a chance to immerse myself in real-time. At the same time, I noticed that many people in Ghana have access to mobile phones of some sort (there is approximately 50% penetrance of the market and this would probably be higher if the more rural areas were serviced) and are avid users. In Ghana, a cafe is somewhere you go to use the Internet, not somewhere you go to buy coffee. On one occasion, this was a particular disappointment for me. Having overcome the immense longing for reliable Internet (reliable and Internet don't really belong in the same sentence there, from what I experienced), I was hanging out for some banana bread and a chai latte. A small comfort of homewon longer required once a hot shower was experienced. Anyhow, in dwelling so long on the use of phones and the Internet I was struck by an idea.

Why don't we create value for this huge portion of the population using mobile phones by delivering health education?

It's such a simple solution on the surface. There are myriad issues - a relatively high illiteracy rate, the huge numbers of languages in Ghana and the fact that many people do not speak English at all, delivering health education messages in 140-160 characters that are achievable by the majority of the population, tackling the divide between traditional and Western medicine. At the same time, I feel that delivery of practical messages in English (or selected translations) could be spread virally (if you pardon the pun) through a community thanks to the passion in the younger generations for learning English and becoming part of a global society. If you can get through to one person in each family, you have a chance of changing practices for the better.

Why do Ghanaians need health tips? If you look solely at Millenium Development Goals (MDGs), Ghana still has a lot of work to do in terms of maternal and child health. The maternal mortality rate leaves a lot to be desired, especially in a culture where it seems that child rearing is mostly left to the mothers. Children equally suffer from poor health. And many children miss out on important traditional education, which incorporates some level of health education, because their parents cannot afford the co-payment. If you can provide simple tips on hygiene, you can reduce a number of illnesses that are avoided or easily managed in the Western world, things like diarrhoea and the flu. If you can encourage techniques to reduce mosquito populations and their bites, you have the opportunity to change attitudes around malaria from "as common as a cold" that you get "when you're a little stressed" to a serious condition that needs medical treatment. Of course, that sort of attitude change only happens when you significantly reduce the incidence of the disease. And in Ghana, where the most common strain of malaria is P. falciparum, the most deadly strain, this is an incredibly important change in attitude.

And the great thing is that you can make inroads with simple text messaging services. Vodafone, one of the biggest mobile service providers, already supports health initiatives through a TV program that also incorporates health lessons. Imagine how much more impact this could have on a population level. Especially on a population where there just aren't enough health care professionals to go around.

The possibilities continue. Imagine if there were health care professionals in Ghana (or anywhere else, really) who were interested in upgrading their skills but unable to afford or access further training. You could create a program that could be delivered in a series of text messages. Tests could be delivered by SMS with a response message containing answers. While many new skills may require hands-on training and images, this provides a way of getting information to professionals in the field. When training occurs away from the practice, an important community resource disappears. This may extend the periods of time in which professionals can remain at home.

Until Internet services on mobiles becomes more reliable and more widely accessible, delivering health education via mobile applications is a less viable option. Certainly, it would be considered in the future.

The answer to health, like so many other goals for developing countries, lies in empowering those who are already there to lead solutions. From the outside, we can provide ideas and support. But by being the mainstay of provisions, there is perpetuation of an idea that Western physicians are better, which reduces the ability of the incredibly well-trained and capable locals to do their job.

This is an idea I had in Ghana. This is an idea I shared with a friend who works in the Ghanaian Health Department. This is an idea I am sharing with the world. Healthcare should be inspired, flexible and never static.


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