The importance of reskilling healthcare professionals who are based in Low-Middle Income Countries (LMICs) has been highlighted by organisations including the World Health Organization (WHO) and the European Observatory of Health Systems and Policies.

Reskilling refers to enabling individuals to acquire new knowledge and skills in order to be relevant in their jobs. Reskilling through digital health platforms can address significant health challenges for LMICs. For example, half of Africa’s population currently lack access to reliable healthcare, but reskilling platforms can have a positive social impact by updating local clinicians’ medical knowledge and clinical practice in local regions.

MedicineAfrica is one such digital health platform, set up to provide Western healthcare knowledge for free to medical professionals and students in LMICs like Somaliland. Winner of a Tech4Good for Africa Award in 2020, MedicineAfrica meets its purpose by connecting UK doctors and Somaliland-based medical students and clinicians through a platform.

A recent Financial Times report on the Future of AI and Digital Healthcare praises the potential benefits of digital health technologies and platforms, but highlights the need to study the context in which these technologies are used. Context matters because technologies cannot deliver benefits unless the social, cultural, economic and political environment is sufficiently supportive.

Addressing this call, we designed a study to understand what kind of knowledge is being transferred through the MedicineAfrica platform and its impact on reskilling LMIC medical professionals. We interviewed sixty medical students and healthcare professionals (clinicians in their majority) based in Somaliland and the Director of the platform. Our findings show that the platform creates social value by reskilling healthcare professionals, not only through equipping medical students with up-to-date clinical knowledge in a one-off fashion, but also by providing a global network they could be part of and seek advice when required:

“We identified a challenge in Somaliland that graduates in medicine […] may be appointed to roles in relatively isolated parts of the country without a good level of supervision. And the idea of developing a postgraduate network will be to try and better connect people, and support them, so that they have got access to a good level of continuing professional development (CPD)…”

Ultimately, we found that MedicineAfrica contributed to improving healthcare outcomes for local populations, benefitting the local community.

However, the transferred knowledge was not without problems. Teaching was often focused on equipment that was not available to local participants, it was conducted largely in English, and neglected local needs.

Medical knowledge & platform-enabled reskilling

MedicineAfrica managed to transfer clinical knowledge to healthcare professionals, especially in clinical areas where knowledge was scarce, such as radiology; psychiatry/mental health; obstetrics; and communication skills. Medical students were exposed to best clinical practice (for the West), such as taking patients’ medical history, which they were then encouraged to adopt in their own everyday clinical work. Also, through online discussions with UK-based doctors, medical students in Somaliland learnt about how clinical cases are managed in the UK and made interventions as necessary. Further, the philanthropic values of MedicineAfrica motivated several medical students to teach their peers what they had learned on the platform, expanding reskilling further.

Neglecting equipment & language

The platform unintentionally assumed knowledge that was of less relevance to participants. Some knowledge and skills were inapplicable because they relied on the use of equipment that was not available in Somaliland. In their work, clinicians would make do with whatever equipment was available instead of using the most up-to-date equipment recommended and utilised by Western peers:

“We, in Africa, sometimes use what we have. We cannot access many drugs that you guys use…”

This realisation made participants feel disadvantaged compared to their Western peers.

Also, MedicineAfrica offers most of their courses in English, limiting local doctors’ and medical students’ level of engagement with the platform and restricting their confidence and learning:

“When it is in Somali, you feel that you can ask more questions. If you ask a White person a question, the understanding isn’t there.”

Ignored medical conditions & local needs

Finally, medical students reported that platform content was often based on assumed rather than actual skill needs. Participants explained that both the range and the severity of the diseases they treat in Somaliland are different from those experienced by UK clinicians:

“When the lecturers, they are giving you information, this information must be applicable most of the time, because we need information, that is relevant for the clinical scenarios, we are working.”

Yet, there is a lack of a medical knowledge base about the range of medical conditions found in Somaliland. Instead, the knowledge received through the platform was about conditions identified in other countries where medical research is highly valued and funded. The platform does not currently offer the research skills that are needed to collect these types of health data, meaning that localised health condition knowledge cannot be developed in areas that need it most.

Platforms and reskilling in the Global South

The above issues reflect what we call unintended digital ‘epistemic colonialism’; the process by which platforms aiming to transfer knowledge to countries of the Global South end up overlooking local problems and imposing standards and knowledge assumed to be universal. This limits the potential of the platform to equip medical professionals with relevant, locally appropriate skills and knowledge.

To a degree, epistemic colonialism is inevitable, because the platform originates in the West, is based on Western medical curricula and relies on funding that is usually underpinned by return-on-investment expectations. However, the problem is not unresolvable.

We argue that platform directors need, first, to carefully consider what content to transfer by engaging with local communities, understanding their local needs, and enabling opportunities for codesign. For example, in the summer of 2021 MedicineAfrica worked closely together with local coordinators in Somaliland to codesign a CPD course in response to the Covid-19 pandemic. The course aimed to provide training on Covid-19 prevention and treatment and was delivered in a bilingual (English and Somali) format that could be a first step to addressing some of the above problems. Second, they need to consider offering ownership to local communities so that they can prepare and adapt content to their mother language and ensure the sustainability and scaling up of these initiatives.

Our study has found that platforms may produce social value, despite their perceived colonial effects. The latter though are not deterministic. Through their potential to reskill and to codesign with local participants, platforms can overcome epistemic colonialism and equalise access to knowledge.