ICTworks

Uganda is one of the youngest countries in the world with 81% of Uganda’s population under age 35. Public health programs in Uganda are constantly faced with the challenge of identifying relevant communication and engagement platforms that are suitable for youths and hard to reach groups of people.

This becomes even more complex within a rapidly changing ecosystem of communication options and technological advances such as smartphones and mobile-first internet connectivity, whose uptake is highest among young people.

As a result, healthcare initiatives that leverage the current mobile and messaging trends provide the most feasible way for breaking barriers to healthcare access. A large percentage of medical queries and issues can be resolved remotely over a mobile phone, saving time and money that would ordinarily be spent going to a traditional physical hospital or clinic visit.

One Approach: The Multi-modal Multi-Channel Call Center

At the Medical Concierge Group, we operate a call centre that provides free access to health professionals 24 hours a day, 7 days a week, for anyone seeking health consultation and information.

But this isn’t your typical call centre.

We provide free medical consultations with primary care doctors and pharmacists via voice calls, SMS, Facebook, Twitter and WhatsApp, with a focus on live interactions to provide the unique personal value of individualizing responses in every interaction.

We most commonly support sexual and reproductive health services, coordinate care for chronic illnesses, assist HIV care retention, antiretroviral treatment adherence, follow up for antenatal care visits, and contribute to pharmacovigilance.

Technology platforms like our medical call centre that use voice and messaging platforms provide affordable, actionable and timely messaging among youth and high-risk populations.

What We’ve Learned About Our Users

With inbuilt social media and call centre platform analytics, real time data summaries and visualizations have provided us with key insights into who uses these services and why.

Four years into the launch of the service, we have an average of 30,000 monthly active users on TMCG’s platforms:

• 80% of our users are aged 18 to 35 years
• The gender distribution of males to females among users was 60% to 40%
• 97% of our users own mobile phones, and 92% of them agree to routinely receive health/HIV information via their mobile.
• Whatsapp and Facebook are the most popular messaging platforms because of the low data costs, sustained engagement over long periods of time and the ability to archive chat history.
• 61% of the users have used at least one of Facebook, SMS or Whatsapp platforms to access the service.
• Currently, 38% use Whatsapp, 29% use SMS, and 19% use Facebook.
• Most interactions relate to acute emergencies, condom use, sexually transmitted infections, skin conditions, emergency contraception, HIV post-exposure prophylaxis, information on health services including their costs and their locations.
• Over the course of 2016, 21,000 SMS interactions have facilitated engagement concerning male circumcision, antenatal care and hospital appointment compliance.
• Vulnerable populations, like men having sex with men and commercial sex workers, are increasingly using the service for their medical queries because of its confidentiality and privacy.

We are now experimenting with emerging technologies such as Natural Language Processing, machine learning and chatbots for the more routine healthcare questions and responses in defined knowledge domains we support such as immunization, HIV/AIDS, and TB. This will help us scale and provide services to an even wider audience in Uganda and beyond.

The Role of SMS Text Messaging

While we operate a multimodal call centre on the forefront of using new social media and instant messaging technologies, we still do believe in the use of SMS text messaging for health services.

SMS text messaging is still a universal medium of communication, accessible by all kinds of ‘basic feature’ phones as well as smart phones across more locations since it only needs 2G network access.

SMS text messages are also easily programmable. However, we have learnt that they are optimally successful when programs use two-way live engagement to allow for further clarification on their issues.

Interestingly, users do not report significant privacy concerns with SMS since they have the choice to voluntarily opt out with a key word and register back in or delete the SMS after reading it.

Unique Perspectives on Confidentiality and Privacy

The increased uptake of the services by men and commercial sex workers can be attributed to the confidentiality and privacy provided by our service. Calls and texts with a remote health professional allows free expression by the users about medical issues that they would otherwise be too shy to confront with in-person clinic visits.

Importantly, Facebook Messenger and WhatsApp are perceived to be more secure healthcare communication channels than SMS text messaging.

The end-to-end of encryption with WhatsApp increased its credibility to guarantee the data privacy of user conversations, as opposed to SMS history records that could be accessed by a Mobile Network Operator. Still screenshots, which can easily be captured and shared, are one of the most common concerns voiced by the users.

At TMCG, we take security precautions to guarantee the privacy of the users through internal information security policies, security controls and internal audits. For example, social media pages have different permissions and access rights for authorized persons.

Personally identifiable information stored locally is abstracted, and SMS databases are encrypted and transmission secured by the local mobile network security.

Mobile Technology will Continue to Break Barriers

In summary, current healthcare delivery systems in Uganda fall short of meeting public health expectations due to limited human resource such as doctors as well as inequitable distribution between rural and urban areas.

Technology platforms like medical call centres and messaging platforms break such barriers by maximizing the output of the limited health worker force for a wider audience cost effectively.

Such real time communication portals are critical in averting HIV and sexual reproductive health related emergencies, including post-exposure prophylaxis and emergency contraception among others.

Call centres and social media platforms provide affordable, actionable and timely messaging among youth and high-risk populations, and we are excited about what the future holds as we harness technology for health in our region.

Written by Dr. John Mark Bwanika and Dr. Davis Musinguzi of The Medical Concierge Group, Uganda