As the COVID-19 pandemic crossed into Egypt’s borders, forcing the government to enact many restrictions including the closure of cafes, restaurants, cinemas, sporting clubs and many other kinds of public spaces, Egyptians found themselves with little choice but to stay at home and find remote alternatives to their everyday needs.
In addition to a significant number of people following the World Health Organization’s (WHO) advice on staying home and socially distancing, this caused a massive shift towards internet alternatives across the country such as online shopping, remote working and Zoom meetings.
One thing which has witnessed an upsurge in use and demand have been online healthcare services which come under the umbrella term “healthtech”, short for health technologies.
These range from booking in-person clinic visits on a website or a smartphone application, to ordering a doctor for a home visit, to having completely online appointments and consultations which lead to a diagnosis without the patient ever having to leave their home, a service that has come to be known as telemedicine or telehealth.
What happened to the healthtech sector since COVID-19?
Online-based healthcare providers witnessed a massive jump in the demand and use of their services since COVID-19 measures came into effect across Egypt.
One of the earliest and current major players in the market has been the website and app Vezeeta (Egyptian slang term commonly used for doctors’ fees). When the pandemic hit, Vezeeta was mainly a platform for finding doctors to book in-person appointments, according to its founder and chief executive officer (CEO), Amir Barsoum.
In April, they launched their telehealth service and around the end of July and early August, soft launched their online pharmacy. “The doctor consultation market got into a little bit of a dip that got well compensated by our telehealth services,” Barsoum says. “Then things picked up even better than before COVID-19.”
He adds “if you asked me 12 months [ago] where [I] would expect telehealth to be today, I would’ve said around 2 to 3 percent of our business. Today, it’s definitely 10 to 15 percent.”
Another platform is Dr. 7alan (founded in January 2020, just two months before the WHO classified COVID-19 as a pandemic), a smartphone app which functions 24/7 in a similar way to Uber through which users can search for a doctor in their local area and promptly request a home visit.
Ahmed Abou Shady, founder and CEO of Dr. 7alan, says they already had a good start from January to March with many downloading and using the app. Then, “there was a lot of stress on us during the COVID-19 period starting from April,” he says. Things only started to calm down around a month ago.
Just for well-off Cairenes?
Does requiring an internet connection and a smartphone to access healthtech services mean that only wealthier income groups concentrated in the capital get to enjoy them? Not necessarily.
Barsoum says that healthcare in Egypt is generally very affordable but the problem is patients managing to find and access it. He believes that healthtech providers such as Vezeeta offer patients the solution of discovering the best possible doctors at the most affordable prices.
“That’s exactly where Vezeeta could come and help. You will not need to go and pay EGP 1000 consultation fees for a [well known] doctor and there is someone else who could be EGP 70 very close to your house and is as good.”
Ahmed says Dr. 7alan has been downloaded and used across Egypt but is mostly concentrated in Cairo, Giza and Alexandria.
“Demand hasn’t been as strong in Upper Egypt as other regions such as Alexandria, Mansoura and Gharbiya, but it has been used in Asyut and Sohag and so on.”
He says that up to triple the number of users of the app call the hotline number. “A lot of people don’t have smartphones and don’t know how to use applications and modern technologies, so the easier thing to do is to save a number and call any time.”
Interestingly, Ahmed reveals that lower to lower-middle income groups represent the majority of their users. “This was a surprise. We actually expected the opposite, that the middle and upper classes would be among the first people to use the service.”
He says around 60 to 70 percent of Dr. 7alan’s users are of this income group and live in working class and economically underprivileged areas.
What is slowing down healthtech in Egypt?
The issues which Egypt’s healthtech sector continue to face are the same broader challenges that are faced by the country’s tech ecosystem, according to Mohannad Shaddy, co-founder and chief operating officer (COO) of Zokurah, an app which provides patients with complete anonymity to seek remote male sexual healthcare (andrology in medical terms) from consultations to diagnosis without the doctor ever seeing them or knowing their identity.
“Maybe healthtech is a bit lucky because some angel investors and venture capital investors are particularly interested in it”, he says. However, he bemoans the general problem in Egypt that startups experience in the incubation and acceleration phases, the crucial primary stages that startups and new enterprises go through.
“This is the stage where [entrepreneurs] need someone to help them out in. This particular stage faces a huge problem in Egypt. The number of incubators and accelerators in Egypt is very low and there aren’t any that have any special programs for healthtech,” he adds.
“Egypt is still an extremely fragmented landscape,” Barsoum says. “And that makes any opportunity to really get into the market very expensive” because of the many different processes involved which make healthcare innovation a difficult endeavour.
Ahmed plainly states his opposition to telehealth: “I personally do not agree with it and as a company, we completely reject it on medical grounds.” He reveals that he rejected proposals from doctors to include remote consultation and diagnosis in Dr. 7alan’s services.
“Diagnosis is a responsibility. How can a doctor make a diagnosis for a patient by phone call or a camera?” Ahmed asks rhetorically. He says a patient might inaccurately report a problem which would negatively affect the doctor’s ability to give a proper diagnosis. To make an accurate diagnosis, a doctor must physically check a patient’s blood pressure, heartrate, and look at their scans and tests if needed. “None of that is theoretical. It can never be theoretical. The doctor must take all responsibility.”
Barsoum believes there are three main ethical concerns to consider in healthtech. “One of them is from the providers’ side. The most important is not to take shortcuts. There is a fact that sometimes remote healthcare may not give you the full picture and you may need to request the patient to come for a physical visit.”
On the other side of that is doctors over requesting physical visits, which would come with a higher price. “The balance between shortcutting or overdoing is a very important aspect,” he adds.
The third concern is one of the most crucial and has been a recurring theme in the wider debate around the ethical use of tech and the internet. “Data privacy. This is going to be a big thing,” Barsoum says.
Before, a physical visit to a clinic would by default be a private matter known only to the patient and the doctor. As a tech provider, “now it’s something I see and I think security is a huge thing on that front and I think it’s our duty to put the best of our efforts” to secure patient confidentiality.
Has COVID-19 changed perceptions? Is there any going back?
If a viable cure or vaccine should ever be discovered for the novel coronavirus, will those who felt forced to switch to healthtech services bounce back to physically going to clinics and hospitals as they did pre-COVID? Or did the March-June 2020 restriction measures change how many in Egypt will access healthcare forever?
During that time, reverting to online alternatives were “an obligatory trial” as Barsoum puts it. “And when they tried it, they realized it works [and] it works well.”
He adds that COVID-19 saved companies millions of dollars in marketing costs to educate consumers on the benefits of online medical services.
Mohannad says “the transformation that happened because of corona was going to happen anyway.” The pandemic only acted as a catalyst for the healthtech sector, he adds.
Ahmed believes COVID-19 caused years of progress to pass for the healthtech sector in Egypt.
“It created a new field. It created a new idea. It sped up an idea, which before corona, I never imagined would grow to this scale.”
An earlier version of this article mistakenly described Mohannad Shaddy as the CEO of Zokurah. He is in fact the COO of Zokurah. The mistake has been amended.