Africa is rolling out digital health IDs

Health systems across the continent of Africa are implementing digital identification initiatives to improve access to health care, strengthen the delivery of care, and reduce costs. Over the past few years alone, Senegal, Cameroon, and Ethiopia, among others, have launched digital identification for health programs.

“It is not a matter of if, but when,” said Dr. Joseph Atick, CEO of the nonprofit ID4Africa, which is supporting ministries of health and governments as they adopt digital identification systems and explore use cases. “Digital identification is serving as the cornerstone for the modernization of health delivery systems across the continent.”

The effort addresses an Achilles heel in many low- and middle-income country health systems – fragmented and paper- based health records that are often inaccessible to health providers and decision makers.

Digital health identifications have the potential to help fix this by strengthening record keeping and data quality. They can also improve continuity and coordination of care and patient tracking, boost access to care, give health care providers better information and increase their efficiency, allow for real-time health risk monitoring, and generate more robust and timely data, including for disease outbreak surveillance.

The benefits may be particularly significant for patients with chronic conditions such as diabetes or HIV. For those patients, health care providers would have access to that patient’s most recent laboratory results, no matter where the patient presented for care, and could trouble shoot or adjust treatment quickly without running new tests. Digital health identification also allows for a more team-based care approach for complex and chronic cases with information being shared among a group of providers.

But such efforts require a huge investment in infrastructure and safeguards to work.

Ethiopia’s journey illustrates the potential and challenges of these programs. Its population of 120 million is currently served by more than 400 hospitals, 4,000 health centers, and more than 17,500 health posts. Previously, patient information was not shared among these facilities.

“Implementing an accurate and inclusive digital patient identification system is a key strategy of the ministry of health in its information revolution to achieve health sector transformation,” said Gemechis Melkamu Gobena, the digital health lead executive at Ethiopia’s Ministry of Health. “As outlined in the country’s digital health blueprint, Ethiopia’s health leaders envision a future where every Ethiopian has a national health identification connected to the country’s national digital biometric identification platform called Fayda.”

During the COVID-19 pandemic, health leaders saw an opportunity to move closer to that vision. They wanted to track COVID vaccinations to ensure that people received their booster shot at the appropriate time. But if a patient went to a different health facility for their booster, the facility was unable to access the patient’s immunization status.

Health leaders determined this was the perfect opportunity to pilot health identification cards. The cards are unique and interoperable health care credentials that patients can carry with them wherever they go. For a health care facility to make use of these cards, they only need an Android NFC-enabled device and internet connectivity for data synchronization with the central server.

As part of the pilot, more than 48,000 Ethiopians received these cards at the same time that they received their COVID vaccination in more than 700 health facilities that participated in the pilot. Their immunization information was stored on the cards, which could be read by tablets at every facility.

Initially focused on COVID vaccinations, the health identification cards initiative later expanded to include routine vaccinations for children under two. Health leaders are planning additional use cases such as health insurance, follow-ups for chronic patients, and drug refills, among others. Ultimately, the cards will incorporate Fayda numbers as the national health identification system integrates with the national biometric identification system.

“It is a new technology,” said Melkamu. “We are learning a lot. Including the need for capacity building.”

Researchers have found some health providers are unwilling or unable to competently use the tablets that both extract and information from and add it to the cards. This can result in parallel or duplicated data entries and incomplete health records, which is particularly problematic when there are no paper backups. To address this and other concerns, Ethiopia is moving forward with training and support for health workers and is also working to ensure data security and privacy as it builds out its digital health identification system.

To create a foundation for such a digital system, Ethiopia’s leaders have, over the past few years, streamlined the country’s medical records system. Currently, over 60 facilities have successfully adopted on-premises-based electronic medical record systems. Melkamu explained that adopting such systems is resource intensive. The health ministry faces challenges delivering timely technical support to meet demands.

“There are challenges we have worked around and continue to work around,” said Melkamu. “For example, we have more than 17,500 health posts. We can’t give each health post a server. We can’t even give our 4,000 health centers a server. These posts don’t have proper connectivity and health centers don’t have the tech support.”

So, following the country’s digital health blueprint and guidance from the technical working group, Melkamu said, Ethiopia is working toward a hub and spoke model. Seven data centers serve as hubs nationwide. Each nearby health facility is linked to a centralized hub. This enables them to retrieve health information stored in the hub and securely transmit information to be stored in it.

As the effort rolls out, Ethiopia’s 48,000 health extension workers will help introduce the digital health identification card to their patients and generate demand. The nation-wide biometric digital identification system is expected to have every eligible adult registered by the end of 2025.

Editor's Note: A recording of ID4Africa's livecast on the subject of digital identity for health, featuring health leaders and digital ID experts from across Africa and around the world, is available here.