Stories and podcasts WBW Stories Revolutionising Sexual and Reproductive Health through Digital Technology Being a woman in sub-Saharan Africa comes with a lot of challenges which include gender inequality, social exclusion and health issues, the latter of which is particularly profound with regard to sexual and reproductive health and rights (SRHR). Africa has some of the highest burdens of maternal and child health, poor knowledge in SRHR and a high unmet need for family planning services. There is a pervading dearth of SRHR knowledge across many sub-Saharan African countries, which is correlated with insufficient knowledge and protection against HIV/AIDS, maternal and child health, communicable and non-communicable diseases at all levels of society. The Sustainable Development Goal (SDG) 5 clearly highlights a linkage between technology, gender equality and empowerment of women. Mobilising technology to educate, empower and provide opportunity is integral to the achievement of all the SDGs. Low inventive technologies are integral to making changes in the vast health deserts that exist across the continent. According to a PATH publication, digital health has the potential to save about 200 billion dollars by 2030. A research by Pew showed mobile phones are ubiquitous with over 900 million people having access to a mobile phone, and this obviously shows an available market for low inventive tech solutions. These low inventive technologies offer solutions from text messages educating mothers on what to expect when they are pregnant, to how they make health decisions for their children, to apps that help educate young women about their reproductive health, even extending to solutions that help healthcare workers in remote places offer quality care. For example in Zambia, a health product was developed to help young women and men have access to information on SRHR; in Nigeria, Safermom is an award-winning tech solution that helps pregnant women and nursing mothers raise healthier children by accessing health education via SMS message. A similar product is also active in Malawi, called VillageReach which has a hotline – known in the local language as Chipatala cha pa Foni (CCPF) – which provides direct access to information, advice and health promotion regarding maternal, neonatal and child health issues to callers who may be out of reach of the health system. Hotline callers also have the option to enrol in an SMS-based tips and reminders service to receive personalised health education messages regarding pregnancy or child health. Pilot studies of some of these digital technology-leveraged health interventions in different areas of Africa have shown great promise. The evaluation of a pilot of Mobile for Reproductive Health (m4RH), a menu-based SMS system that provides automated information about eight different Family Planning methods, showed that it has the potential to positively impact reproductive health services usage behaviour. There are still existing challenges in the African digital health landscape, most significant of which is the challenge of sustainability and scalability of digital projects. Digital health projects in Africa are suffering from what has been described by some as “Pilotitis”, with a large proportion of digital projects executed being unsustainable and often expiring once initial funding is exhausted. For example, in Uganda alone there were 23 million health initiatives in 2008 and 2009 that did not scale up after their pilot phase. Despite the increased mobile penetration in Africa, there are still disparities in ownership among the genders: Most mobile phone owners in Africa are dominantly male, though these phones are shared in some cases, which represents a challenge to ensuring privacy and uninterrupted access to relevant information. Additionally, quite a number of interventions are being designed for smartphones and the internet, which not so many people own or have access to. In moving forward, innovators, entrepreneurs and the government need to focus more on interventions leveraged on SMS or USSD as this is more accessible to every phone owner, no matter the grade of phone used. This is important as less than 30% of Nigerians own smartphones. Digital health pioneers, innovators and entrepreneurs need to publish or make available information regarding their programme costs. This will help current and future programme implementers or funders to understand cost structures and to explore pathways to financial sustainability. Most importantly, design and development must be user-centered; the end users should be integrally carried along in every phase of the product development. We need to have more women involved in aspects of digital product development and even be more actively engaged (and empowered) to create and launch the solutions that cater to their health. Lastly African countries need to develop and implement a National Digital Strategy, this strategy outlines a country’s digital health priorities, and the regulations, policies, and systems needed to realise them. To ensure the success of this strategy, governments need to align activities and investments behind a country’s national digital health strategy. This means effectively coordinating with partners, donors and organisations that are making investments, whilst taking responsibility for the development of local capacity to engage with these technologies. A good example is the collaboration between the health ministry of Tanzania and Villagereach also known as Chipatala cha pa Foni (CCPF) in scaling the project nationally and make it a national Mobile Health Hotline. Achieving the Sustainable Development Goals is a huge possibility, and ensuring that the wellbeing of women especially in sub-Saharan Africa is secured and improved is integral to this achievement. Digital technology has a significant role to play in this regard. [ BIBLIOGRAPHY NW 1615 L. St, Washington S 800, Inquiries D 20036 U-419-4300 | M-419-4349 | F-419-4372 | M. Cell Phones in Africa: Communication Lifeline [Internet]. Pew Research Center’s Global Attitudes Project. 2015 [cited 2018 Mar 3]. 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Folaranmi T. mHealth in Africa: challenges and opportunities [Internet]. blogs.bsg.ox.ac.uk. 2014 [cited 2018 Mar 3]. Available from: https://blogs.bsg.ox.ac.uk/2014/01/30/mhealth-in-africa-challenges-and-opportunities/ About the Author.