How health platforms can improve healthcare in the Global South

More than half of Africa’s population – around 615 million people – do not have access to the healthcare services they need.

“Healthcare systems in Africa suffer from neglect and underfunding, leading to severe challenges across the six World Health Organization (WHO) pillars of healthcare delivery,” explain physician and public health specialist Obinna Oleribe and his co-authors in their paper, suggesting training and capacity building for health workers as the leading potential solution.

Platforms constitute an efficient and effective way of disseminating knowledge and offering opportunities for upskilling the workforce, including remote or vulnerable communities in the Global South. There is an urgent need to provide continuous education and skills to the most socio-economically underprivileged to equalize access to knowledge. But what kind of knowledge is being transferred through platforms and what could their unintended effects be?

To determine this, we studied MedicineAfrica, a non-profit platform that connects UK physicians with medical students and healthcare workers in under-resourced, post-conflict low- and middle-income countries (LMIC) such as Somaliland, the focus of our research. The platform aims to provide free medical education and create social value in local communities by upskilling healthcare professionals, equipping medical students with up-to-date clinical knowledge and, ultimately, improving healthcare outcomes.

MedicineAfrica, which won a Tech4Good for Africa Award in 2020, offers a range of courses to medical students at universities in Somaliland and qualified clinicians and healthcare workers. Although these are mainly in English, MedicineAfrica has also offered bilingual (English and Somali) courses, such as a recent continuing professional development course on COVID-19 prevention and treatment.

We aimed to capture the platform’s impact on developing medical skills and knowledge in Somaliland and improving clinical practice. Our findings confirm the platform’s potential to build capacity by transferring medical knowledge. However, this knowledge did not come without problems. Our research participants considered it, to a degree, limited in terms of its relevance to Somaliland’s context, as well as alienating because of its disconnection from local health workers’ practices.

MedicineAfrica managed to transfer clinical knowledge to participants, filling critical gaps in existing medical curricula. It also exposed students to Western best clinical practices, such as taking patients’ medical history, which they could adopt to improve local practices. Further, through online, real-time tutorials, medical students would receive instant advice on specific clinical cases they encountered in local hospitals, such as how to treat trauma in the head.

Somaliland-based participants could also compare their clinical case management with a Western peer through discussions with UK-based clinicians, leading to significant learning through comparison. For example, in one of the discussions, a participant recounted how a postpartum haemorrhage was treated and “saw some mistakes that we [made…]. Now we can do much better.”

The knowledge medical students got through the platform motivated them to further disseminate it to their peers who did not experience learning through the MedicineAfrica platform.

One participant represented this well when they said: “These doctors and nurses from the MedicineAfrica team are giving you lessons for free. So, this tells you that when you have the knowledge and skill, you also need to do some volunteering. You need to convey, transmit or transform or do your best to teach others, to help others.”

This, and other testimonies, show that MedicineAfrica provided useful knowledge to its students, truly transforming their practice and leading to improved learning.

Our study also highlights that the platform was unintentionally assuming knowledge that was of less relevance and significance to participants. Specifically, participants described that some of the knowledge they would get through the platform was inapplicable because it relied on locally unavailable equipment and medicines.

As a participant told us, “We, in Africa, sometimes use what we have. We cannot access many drugs that you guys use, so sometimes you might hear that that drug is no longer used […] or these are the new guidelines…”

In their daily work, clinicians would make do with whatever equipment is available. Because the medical equipment’s availability is dismissed from the platform’s design, participants’ professional identity is devalued. That raises a question about the adaptability of global health platforms to local conditions of work.

Also, participants highlighted the significance of participating in a platform in which participants’ language is used. This issue is independent of individuals’ fluency in English. Our interviews show that the subtleties and rapport are lost when using another language.

As one participant shared: “When it is in Somali, you feel that you can ask more questions. If you ask a White person a question, the understanding isn’t there.” The linguistic rapport, therefore, conditions the depth of engagement, indicating the significance of local languages and idioms in creating a shared learning context.

Finally, platforms based in the Global North often overlook the specific challenges and needs of the local context, which hampers their usefulness and value. For example, participants explained the need to develop a medical knowledge base about medical conditions in Somaliland and tailor clinical knowledge to target those conditions.

However, the medical knowledge they get relates to conditions identified in other countries where medical research is carried out. The platform does not currently offer the research skills needed to collect these types of health data. That is partly because platforms are developed in the West, reflecting curricula and best practices of Western societies while aiming to meet return-on-investment expectations. As the platforms are developed from the supply side, it is important to question whose priorities platforms need to espouse.

These issues, taken together, represent what we call “epistemic colonialism,” the process by which platforms aiming to transfer knowledge to countries of the Global South end up displacing and suppressing local knowledge and identities. Consequently, useful local knowledge is devalued and these platforms’ potential value is questioned.

The risk of epistemic colonialism may always be present but it does not mean it cannot be managed and alleviated. Our findings indicate that medical professionals on the MedicineAfrica platform were active, not passive recipients, of the knowledge transferred to them and could make choices about the knowledge that can (and cannot) be applied to their practice.

We argue that if health platforms intended to transfer knowledge, like MedicineAfrica, aim to equalize access to knowledge and offer continuous opportunities for reskilling and upskilling, then they must be attentive to their design and development.