Evolving the digital health landscape, developing an organisation
Debbie Rogers, CEO of Reach Digital Health (formerly Praekelt.org), reflects on the growth of digital health in Africa as a simultaneous process with the organisation’s development.
“Creating solutions in the digital health field has been a 15-year continuous learning process for us. We have had a front-row seat to an evolving industry throughout this journey. Our technology and citizens’ expectations for digital services have changed.
When our organisation started as Praekelt Foundation in 2007, South Africa faced the overwhelming impact of HIV. There was great fear, and the reality was that increasing HIV infection rates crippled the health system. Despite the advances in antiretroviral therapy, access was limited, and being HIV-positive was seen as a death sentence. HIV was impacting a range of other development issues, including maternal health, life expectancy and the economy — further burdening a country already fighting to reverse the impact of apartheid on the nation’s majority.
At that moment, Gustav Praekelt, the organisation’s founder, witnessed a rapidly evolving media landscape. The exponential growth in mobile phone ownership in South Africa was eclipsing that of countries in the Global North. It was quickly becoming the number one way people communicated and sought information at all economic levels of society. Where previously, the only way to reach people at scale was through mass media like radio, now there was the opportunity to send people individual, private messaging on a national scale.
Reach was established on the premise that the ubiquitous nature of mobile phone access presented an opportunity to impact the lives of people living in poverty positively. In the past 16 years, we have dedicated ourselves to realising this impact. We have explored everything from advertising on “Please call me” messages to drive 1.8 million calls to the South African national HIV helpline in Project Masiluleke to developing a native application to improve girls’ economic access in Indonesia.
Not all of our solutions have succeeded, and in a rapidly evolving landscape, we have continually pushed to innovate and learn. Our failures have been as important as our successes, and over time, a clear path to scale and impact emerged.
However, despite the growing number of successful programmes we were launching, the scale they reached and the results achieved, scepticism about the value of reaching citizens directly with health information was prevalent. Why would we prioritise the empowerment of citizens on their health journey over the digitisation of data within the health system, for example? Surely those who need to know about health are those running the systems — those who are educated and knowledgeable and could treat the masses?
All of this dramatically shifted in 2020 with the emergence of the COVID-19 pandemic. Suddenly everyone was learning. Even the elite didn’t have all the answers, and everyone, not only those impoverished, was affected. No longer were those in power worldwide dealing with a disease affecting the “other”.
The impact of this on our work was dramatic and instant. Suddenly the development community at large understood the value of empowerment of citizens, and they sprung into action to make this possible. Within three months of the declaration of the pandemic by the World Health Organization, we had launched citizen, and health worker focussed services in 11 countries and globally with the WHO themselves, an organisation that had never previously prioritised direct-to-citizen communication about health.
Over the next two years, the COVID-19 services we developed reached over 40 million people in 200 countries, in 21 languages. For the first time since our founding in 2007, we realised the incredible potential of engaging citizens via mobile phones.
Achieving this reach was particularly fulfilling for us as we were globally navigating uncharted terrain as a team and humanity. It was emotionally and physically exhausting, contributing to the impossible task of keeping people safe and informed. Still, we were able to do so as a community by coming together around a single cause and learning together. Together with our partners, we could only achieve the scale of this size and impact at this level through radical collaboration and fearless innovation.
And so, a new vision of the future came out of the tragedy of the global pandemic — the possibility for individuals, no matter who and where, to access uninterrupted, personalised health care. In recognition of all we have achieved, and in the hope of a better future for all, we have decided to usher in this new era of digital health with a new name, a more intentional focus and a renewed optimism for what we can achieve. Reach. Together with our partners, we make health possible for all.”
