As COVID-19 continues to have devastating impacts on the health of the global population, public health systems that were already under-resourced before the pandemic will likely suffer the worst outcomes.

In a [recent paper](https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20%2930229-1/fulltext) published in The Lancet medical journal, doctors from Johns Hopkins University reveal that groups least likely to die from Covid-19, such as children, will be disproportionately impacted by the suspension of routine medical services, particularly in countries with fragile medical systems.

In Uganda, for instance, they estimate that there could be between 640–2630 deaths of children under five years old for each month that treatment and prevention of COVID-19 takes priority.

The true number of deaths from the virus will depend on the degree of the disruption to essential care in these areas, most notably reproductive, maternal, newborn and child health (RMNCH) services.

The NGO Living Goods, which works in Kenya and Uganda, as well as other countries in Africa, is doubling down on its pre-virus message to these governments: mobile technology and data connectivity save lives.

Often relying on decentralised paper-based systems across different rural areas, these health ministries find themselves unable to get a handle on community transmission of COVID-19.

Without a nation-wide technology platform and trained health workers who can reach patients in their communities, governments won’t be able to deliver crucial non-coronavirus health services, leading to a devastating number of preventable deaths, particularly among women and children.

Technology is make or break

Founded in 2007, Living Goods equips government community health workers (CHWs) across Uganda and Kenya with smart phones. Using a diagnostic app, the phones allow them to identify and treat preventable diseases– such as diarrhoea, malaria and pneumonia – in patients’ homes. CHWs also provide family planning education and pre- and postnatal visits for pregnant women and mothers.

Health workers capture and compile data from patients, which is then used by health departments to monitor disease patterns, track immunisations, and determine which supplies and medicines to stockpile.

Since the onset of the COVID-19 outbreak, the organisation has redoubled its work with the Kenyan and Ugandan health ministries, by helping them produce a nationwide technology solution that will enable sentinel surveillance, communication with patients, and planning and budgeting for medical supplies.

“I really believe that technology changes the game when you talk about how to maximise limited health system resources to fight a pandemic,” said Jennifer Hyman, director of communications for Living Goods.

Living Goods’ Smart Health app – which helps CHWs diagnose their patients and establish a record of the care they provide –  became even more valuable when COVID-19 began to spread in the region.

The nonprofit had its internal teams think through how each workflow in the Smart Health app would be impacted by COVID-19. Efforts to train new health workers and expand into different areas had to stop, for example, because public transportation is currently banned in Uganda, and Kenya has imposed a strict curfew.

In other cases, the working groups decided that they could continue care, but modified protocols to protect the health workers and prevent the spread of the virus.

CHWs are now using their mobile phones to hold telemedicine appointments with patients in their community. The phones have been given more data to facilitate the rise in calls, both between health workers and their patients and between supervisors as they figure out a new way of working.

When it comes to giving out medicines and birth control, CHWs are now doing contactless medicine delivery outside homes. Living Goods has made these medications free for the foreseeable future while also increasing monthly compensation for their community health workers by about 25% to account for the new realities.

This decision was taken knowing that for many government health workers, other sources of income have likely been diminished due to movement restrictions and economic contraction.

COVID-19 is a gendered crisis

Technology and data are also vital in combating the disproportionate effect that COVID-19 will have on women and children in these regions.

“There’s no doubt that there will be gendered dynamics in how this pandemic affects women. We’re already seeing cases of women dying at home unable to give birth in facilities, and domestic violence is likely to rise,” said Hyman.

Using the network of CHWs and their smartphones, Living Goods will soon run an experiment on self-injection of Sayana Press — a subcutaneous shot that provides 3 months of birth control protection, which is one of the most popular forms of birth control in the region.

Normally administered by a health worker in a patient’s home, self-injection would allow women to continue their treatment without putting themselves or community health workers at risk.

Sayana Press comes in a form that is intended for self-injection, and Living Goods is also working on training videos to help women learn how to use it.

Equipping women with these resources and knowledge will give them independence over their families and bodies at a time when maternity and birth services will be particularly strained.

Making a decision

Ultimately, Living Goods sees its most significant role as helping to create a sustainable health service that the government can run without help from outside organisations like itself.

“We have long seen our direct operations as a testbed for innovation and scale. We never thought that we could succeed by being in every county in Kenya. That's not the goal,” explained Hyman.

Persuading the governments in Kenya and Uganda to choose nationwide technology systems that aggregate health data and replace analogue processes is where Hyman thinks Living Goods can make the biggest difference.

In Kenya alone, there are 140 digital tools used by different “implementers”, meaning other NGOs and health programmes.

“The Kenyan government is evaluating and planning to scale nationally, in a phased approach, some kind of technology solution. We've pitched our technology solution, as have others, and we don't even care at the end of the day whether they choose ours or something else. But they need to choose something,” said Hyman.  –– Megan Dent

(Picture credit: Pixabay)

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