On a visit home to Zimbabwe in 2016, Dr Yangama Jokwiro saw first-hand how the digital divide between Africa and much of the rest of the world had grown. A small gap in the early days of the internet had become a deepening chasm in health equity over two decades.
The experienced nurse, now living in Australia as a senior lecturer in nursing at La Trobe University’s Rural Health School in Shepparton, Victoria, saw something else on that visit: a heap of broken-down computers at the local hospital. Provided by aid agencies, the computers were as good as useless at a facility without an IT department or tech support.
“Someone can donate 50 computers and it’s a big story in a newspaper,” says Jokwiro. “Nurses are photographed with the computers, and everyone is happy. Six months down the line, there’s no one to do software upgrades, repairs or protect from viruses. There are no resources.”
Jokwiro realised that a powerful, sustainable solution to health disadvantage in Zimbabwe was, quite literally, in the nurses’ own hands.
Working with his younger brother Addmore, a medical doctor in Zimbabwe, Jokwiro hatched a plan to connect the nation’s nurses to resources and opportunities via their own smartphones. By turning their phones into essential workplace tools, nurses could access medication guides and up-to-date protocols to support the clinical decision-making that saves lives.
“In Zimbabwe, almost everyone has a phone. If we’ve got digital technologies that can improve knowledge and skills for nurses and we don’t use them for that purpose, that’s completely unacceptable,” says Jokwiro. “We might have access to different physical resources, but there should be no difference between nurses trained in a developed country like Australia and nurses trained overseas.”
Dialling up nursing skills
Jokwiro and his brother have realised their ambition, with more than 95% of Zimbabwe’s nurses having signed up to their MyCpdZw app. Versions of the app are now being used in Botswana, and will soon be adopted in Lesotho.
Working with the East Central African College of Nursing and Midwifery the pair have also expanded into digital education across Africa, developing hybrid (in person and online) post-graduate nursing programmes in critical care, midwifery and chronic disease management, which are now offered in 16 countries through their Guild Learning Centre platform. A two-year course costs about US$3,000, a fraction of the cost of a similar qualification in Australia. Jokwiro says partnerships with aid agencies and corporates are generating scholarships and other opportunities for those with fewer funds to access the programmes.
Born into a family of teachers but drawn to nursing, Jokwiro never imagined adding “tech innovator” to his resume. For generations, his family have been leaders in the region of Murewa; his grandfather had built the first school in their home village of Kambarami.
“[My grandfather] would take me to local meetings and I learned initiative and leadership from him by osmosis, in terms of starting things up and having conviction to say, ‘If I can change something, I will just try it and see what happens’,” says Jokwiro.
Jokwiro completed a nursing degree at the University of Zimbabwe in 2004, following opportunities to learn and work in major Australian cities before accepting a teaching position in rural Shepparton in 2019.
“Many of our La Trobe students are the first in their family to come to university. In regional towns, students often have difficult circumstances, and nursing empowers them. You see the personal growth of people and feel like you’re creating great impact,” he says.
Working in Australia highlighted how advances in digital healthcare have passed Africa by. “When we trained as nurses [in Zimbabwe], the digital divide was small,” says Jokwiro. “Computers weren’t being used in hospitals in Australia, and it was the same in Africa. But over the last 20 years, digital advances in developed countries – care processes, diagnostics, robotics, artificial intelligence – have benefitted patients.”
Determined to create change, Jokwiro workshopped ideas for an app with Addmore, who also took the opportunity to visit a Melbourne hospital while in Australia on holiday, to see what might be possible. “He reminded me that our privilege [in Australia] is high-speed internet, but in Zimbabwe, it might be a bit different. So, we should also make information available offline.”
The high cost of health innovation
The unlikely tech-entrepreneur brothers briefed an India-based app developer, but found challenges in communication, scale and cost. Supportive but unwilling to invest, the Zimbabwean government requested that the app have capacity for the nation’s nurses to register for their annual licence, creating additional complexity and expense. While a small registration fee generated income, it wasn’t close to covering the US$30,000 the brothers had ploughed into MyCpdZw, nor for funding maintenance, content creation and expansion.
“Overnight, it pretty much digitised the nursing profession in Zimbabwe, hosting more than 30,000 nurses,” Jokwiro says. “But there were loads of things we hadn’t considered, like training, site maintenance and troubleshooting, secure hosting and security … all of those things cost money.”
Fearing that their app was financially unsustainable, in 2021 Jokwiro signed up to the La Trobe Accelerator Program, a start-up incubator run by his university. It taught him about business and tech, the power of collaboration and how to identify philanthropic funding opportunities. It also encouraged him to think like an entrepreneur.
“I even pitched at an investor conference in Sydney,” says Jokwiro. “Here I was, among the various venture capitalists and people who want one-word sound bites, and I’m a teacher who loves telling stories. Absolutely outside my comfort zone!” he laughs.
Jokwiro’s stories captured the attention of Peter Williams, an Australian philanthropist with expert knowledge of business in Africa. Williams became a mentor, helping the brothers create the VAKA Health Foundation, a not-for-profit organisation through which they could seek financial support, apply for grants and develop programs. Williams urged them to think big for maximum impact on the health of all Africans.
At the same time, the United States Embassy in Zimbabwe was impressed by Addmore’s public presentations on MyCpdZw and awarded him a full scholarship to study digital health at the US Centres for Disease Control and Prevention in Atlanta for two years, to learn about database development, disease surveillance and informatics throughout the COVID-19 pandemic.
Improving nursing practice during COVID
The pandemic showcased the app’s potential to counter misinformation and arm nurses with current advice from reputable international sources.
“There was scary information coming out, videos of people collapsing …. some nurses just wouldn’t come to work, because they did not want to be exposed to the virus,” says Jokwiro. “But we used the ‘push notifications’ on the app to send protocols on how you can do consultations and screen people on the phone. [That way, nurses could] make sure that by the time the patients come to hospital, they already know if they’ve got COVID symptoms and can protect themselves.”
Jokwiro agrees that, to some degree, ignorance was bliss when it came to creating a digital health startup: with no idea of the challenges and difficulties, the brothers felt little fear. Jokwiro attributes their success thus far to their strong partnerships and collaborations, and to the resilience and patience that comes from being African. They understand the broader health, historical, political and social context in which they operate, and care deeply about nurses and their patients.
“I have always thought that, eventually, we’ll be able to run the largest nursing school in Africa, if not the world, because most other nursing schools operate within their countries. This is a cross-country project, which is huge,” says Jokwiro.
“The most important thing, and the question that drives me, is: how can we provide better care for the people that we are looking after?”
Story by Michelle Fincke
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