• The project is testing whether structured SMS reminders can improve adherence to tuberculosis treatment in Ethiopia and Liberia.

• As traditional SMS faces declining usage and competition from OTT platforms such as WhatsApp, embedding A2P messaging into critical health services offers telecom operators an opportunity to reposition SMS as a high-reliability, value-added channel.

• If successful, the pilot could inform national TB strategies and support broader digital health integration across Africa.

The Africa Centres for Disease Control and Prevention (Africa CDC) has launched a new pilot in Ethiopia and Liberia to test whether simple SMS reminders can improve treatment adherence among tuberculosis (TB) patients, the agency announced on December 3.

“This research is significant because it provides an opportunity to integrate digital innovation into TB care in Africa, advancing patient-centred solutions that address real-world barriers to treatment adherence,” said Dr Mosoka Fallah, Acting Director of Science and Innovation at Africa CDC.

The study, backed by a US$100,000 grant from the World Bank, runs from 17 November to 12 December 2025 and is being implemented with the health ministries of both countries, the University of Liberia College of Health Sciences, Dire Dawa University, and the Dire Dawa Health Bureau, under the coordination of Africa CDC’s Science and Innovation Directorate.

According to the Africa CDC, TB remains one of Africa’s deadliest infectious diseases. In 2023, an estimated 10.8 million people globally fell ill with TB, and more than 1.25 million died, with Ethiopia and Liberia among the hardest‑hit countries. Their estimated incidence rates – 119 and 308 cases per 100,000 population, respectively – underline why improving treatment adherence is a priority: when patients stop or interrupt medication, programmes face higher failure and relapse rates and a growing burden of drug‑resistant TB. Africa CDC’s study is designed to test whether structured SMS reminders can close this adherence gap at scale.

The SMS business in Africa remains commercially significant, particularly through Application-to-Person (A2P) traffic, including one-time passwords, banking alerts, government notifications, and marketing messages. The professional A2P SMS market in the Middle East and Africa is projected to reach USD 3.55 billion by 2034, accounting for 11.6% of global revenues and growing at a CAGR of 2.1%, according to the Market Growth Report.

However, the sector faces mounting pressure as person-to-person texting declines and over-the-top (OTT) platforms like WhatsApp and Rich Communication Services (RCS) gain traction. By 2027, third-party apps are expected to carry 1.7 trillion business messages, slightly surpassing SMS at 1.6 trillion. As younger users shift to app-based messaging and enterprises adopt richer, interactive formats, SMS-only strategies risk becoming obsolete.

Against this backdrop, initiatives like embedding SMS into critical health services—such as tuberculosis treatment—offer a path to reposition A2P messaging as a premium, high-reliability channel rather than a low-margin commodity. If pilots demonstrate improved treatment adherence and reduced programme costs, similar models could be scaled for HIV, maternal and child health, immunisation, and chronic disease management—thereby generating predictable, high-volume A2P traffic streams and revitalising the role of SMS in Africa’s evolving digital ecosystem.

Africa CDC says the evidence generated will inform national TB strategies in Ethiopia and Liberia and feed into continent-wide guidance on integrating digital tools into TB control. The project is a timely demonstration that SMS can still sit at the heart of Africa’s digital health and service‑delivery ecosystem, with clear commercial upside if they position themselves as reliable partners to governments and development agencies.

Hikmatu Bilali