Corporate Africa

ORANGE HEALTH IN AFRICA

Spearheading France Telecom Group in the health sector, Orange Healthcare aims to become an engine of e-health in Africa. Thierry Zylberberg, Director of Orange Healthcare, speaks to IT Consultant Thérèse LETHU.

What is the history of Orange Healthcare?

T.Z. Orange Healthcare is the healthcare division of the group founded in late 2007. Our team is still small, we must make priorities. Geographically, we are targeting our services to countries where we are operators, Cote d'Ivoire, Senegal, Mali, Niger, Kenya, Botswana, and Equatorial Guinea. The experience of Orange in new technologies and care information technology and communication has grown over the last ten years. We also benefit from the expertise of our team of researchers from Orange Laboratories who are over a hundred in the field of health throughout the world. Innovation is crucial to develop workable solutions to health via mobile phones. And in Africa, the stakes are at the height of our ambitions. This is a true revolution in how care is provided in question.

What services do you deploy?

T.Z. We provide the link between the actors involved, listed and rated patient care teams. Our services are designed to meet the requirements of the new practices of care for patients needing more and more transmission of information, identification, secure health, medical data storage or integration of various skills such as medical software, and communicating medical sensors. Thus, in our country, to meet the needs of an aging population, with its share of chronic diseases, loss of autonomy, Orange develops tele-monitoring of chronic diseases, maintenance and home care. Among our specific services, Columba intended for Alzheimer's patients, can be located through a dual system of GPS and mobile network Orange. Through tele-monitoring diabetic patients can themselves monitor their disease. In addition, other services are also promising, as support for the organization of emergency, in partnership with Mondial Assistance. In Africa, we have also initiated innovative projects in terms of health services delivered via mobile phones, to enhance efforts at prevention, patient care, medical assistance and collection of medical data.

Of all the pilot projects that you initiated, which ones are most promising in Africa?

T.Z. We wish to extend Pesinet, Infant Scales on the Net in the region, to sustain and make it professional. This is a driver that worked well, but it remains to be transformed into a robust and sustainable service. Initiated in Mali, with support from the Foundation of Orange and Alcatel-Lucent, the project aims to deploy Pésinet preventive medical services to children under five years of low income families through a diagnostic distance-based tracking system, which monitors their weight curves. The service consists in weighing children at home every week - twice per week for children less than one year - by trained health professionals living in their communities. The results are very encouraging. Other services are already initiated and plans exist to develop them. One such project is teledermatology. The results of this pilot initiative in Egypt are very promising for Africa where the disease targeted is a real health concern, particularly in rural areas. With this system, the doctor or nurse on site can take pictures and transfer them with their mobile phone to a dermatologist at the capital or abroad to make the diagnosis. The quality is sufficient for dermatology is a science that places emphasis upon images, we do not need to be present physically. In other areas, projects are also planned in Kenya, Senegal, Burkina Faso and Mali.

What are the limitations you face in developing these services?

T.Z. The approach that we can deploy in Europe through ADSL networks still cannot really work in Africa, where networks are not always present. The mobile is the best way to deploy services. In order not to overload the network, it must then focus on applications that do not require too much speed. Another limitation is geographical, since many areas do not have electricity. Of course, solar offers interesting prospects, but before resolving these still complicated problems, plans are in place to extend the m-Health in accessible areas.

What are the factors for successful projects?

T.Z. Our experience shows that for service work must first have funding, which paradoxically may be the easiest to find. Doctors who are interested in the projects and who are involved needs to be identified and secured, which is more difficult. Then we must find a real structure to ensure implementation of the project and deployment, which is even harder. We initiate pilot projects; but the number of affected population is very limited, resources are available but are concentrated on a few sites. But the scaling is very difficult, because this step requires an appropriate structure of project management and deployment activities that is lacking today.

Why did you join the alliance m-Health?

T.Z. To meet these challenges, we joined the m-Health Alliance to ensure that all these elements crystallize around the progression of health and m-Health e-Health. This partnership will indeed explore how we can harness the expertise and assets available to Orange to offer solutions based on the health of West Africa which are both sustainable and scalable. With this new momentum in 2009 that acts as an umbrella organization and coordinator of the multiple initiatives underway, we hope to facilitate the scaling up of many projects in this region.

What are the services that could be induced to grow faster?

T.Z. The remote monitoring services that do not deal with masses of information should be set to grow rapidly. This is the case Pesinet and teledermatology I already mentioned. A constraint to the development of these techniques, including monitoring of diabetes, hypertension control is the wages of individuals, it must compensate the agent who will analyze the data and follow the curves. It is possible to find funding, but again, it must also identify physicians who are available to monitor a population at a distance. We must establish the system, the treatment pathway, the appropriate type of contract and management arrangements for the long term. These are operational issues that require time and energy.

Regional economic and political frameworks in Africa or the Mediterranean, could they not be appropriate?

T.Z. Indeed, these regional policy frameworks would work very well. But as I said, the challenge remains the establishment of a permanent operational team. It can be coordinated at regional level, but we need every country to become involved with motivated managers. It must also develop business models to allow passages to scale and sustainability of services. Policies should focus their efforts on this plan and create the enabling environment for development of such services, including training of officials. Regionally, there is also the problem of language and semantics standardization. For example, an English-speaking doctor will not have the same standards as its French counterpart. As part of the Union for the Mediterranean, for example Jordan is one of the leading countries of this initiative, we have a branch dynamics. We work together, among others, with Cisco to develop the remote medical presence, with technology sophisticated enough. It is an interesting axis for the region.

What is the scope of financial services and money transfers via mobile phones?

T.Z. These services are called to grow and cover the largest number of users motivated by saving time and safety, simplicity and traceability of operations. Prospects are especially strong in Africa as these countries have a low rate of banking services. Very few of our users have a bank account. As operator, we are legitimate to meet their needs in this area. The mobile user has an account; you can perform simple financial transactions such as depositing, withdrawing and transferring money, the settlement of bills for electricity or telephone, or purchases in some shops. This service is particularly suited to the needs of the Diaspora, but also to creditors and beneficiaries of micro credit as it allows both parties to save time and resources by reducing the collection of payments. We are still cautious, because we are far from a generalization of these services. Technical challenges remain unsolved. To develop this activity, we created Orange Money that we test in some African countries like Cote d'Ivoire, before applying them to other countries, including Asia.

What place do you give to the stewardship and maintenance of systems?

T.Z. This is crucial because the lack of system maintenance and monitoring logistics is likely to jeopardize the viability of projects. You are right to note this because stewardship is often a weak point for projects. Developers tend to think that stewardship will follow. However, the reverse, it must be ahead. Anticipate the questions that will arise among users, such as how to use, practical recommendations, after-sales services and support to users. We must plan how we will train and monitor our users. As for the maintenance of systems and laptops, it is essential to the success of any project. As I said, it is our challenge to find a doctor who will provide leadership, both on the medical and manager. It must be qualified and be invested enough to predict the development of the project to fruition and anticipate problems and solutions required as and when it is deployed. I would say with great tenacity because these projects still face many unexpected difficulties.

How do you move the market in this area?

T.Z. For now, we are pragmatic, for we have the necessary market structure. In three years, attitudes have changed and we cannot go much faster than the music. We should give Africa the time to get to grips with these new technologies. Orange is in Africa for the long-term. We have a policy of social responsibility through our local businesses. Many initiatives, including with NGOs, are beaten on a limited period. But it is a long-term presence that is needed. For our part, as operator, we do not want a business with an immediate return. We want to develop services that really work; in other words, concrete actions with results, not short-term effects of advertisements.

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