INTRODUCTION
For more than 30
years, health professionals and researchers have been investigating the use of
advanced telecommunications and computer technologies to improve health care.
At the intersection of many of these efforts is e-health - a combination of
mainstream and innovative information technologies. Information and
communication technologies (ICTs) have great potential to address some of the
challenges faced by both developed and developing countries in providing
accessible, cost-effective, high-quality health care services. Telemedicine
uses ICTs to overcome geographical barriers, and increase access to health care
services. This is particularly beneficial for rural and underserved communities
in developing countries – groups that traditionally suffer from lack of access
to health care.
In light of this
potential, the World Health Organization (WHO) established the Global
Observatory for e-Health (GOe) to review the benefits that ICTs can bring to
health care and patients’ well-being. The Observatory is charged with
determining the status of e-Health solutions, including telemedicine, at the
national, regional, and global level, and providing WHO’s Member States with
reliable information and guidance on best practices, policies, and standards in
e-Health. The observatory
indicates insufficient efforts to optimize the use of telemedicine in most
African countries, especially those at the south of the Sahara. With
declining economic performances, a history of political instability and low
levels of development, the health sector in most of Africa lags far behind its
counterparts in the industrialized World. Given that at least 60% of African
populations live in large underdeveloped rural areas the problem of healthcare
delivery is even more serious. The other set of challenges that face
Sub-Saharan Africa, arises from managing a dual healthcare system: these are
the Western medicine and the Traditional African medicine. In the poor
peri-urban and rural areas, the traditional healthcare centers are more
accessible than those for modern medicine. Hence a high percentage of cases
that reach modern healthcare facilities are likely to be emergency cases that
have passed through the traditional medical system.
The African healthcare system in general is over stretched, with
doctor to patient ratios as high as of 1 to 10000 or more in certain cases.
Furthermore, research and technological facilities are very limited which
reduces possibilities for enhancing the work of health workers. The general
state of technological and infrastructural development in many African
countries remains a major hindrance to optimal research and communication. In
most remote parts of Africa access to ordinary telecommunications and
electronic facilities is a virtually non-existent.
Against such a background, it is not surprising that in Africa the use
of information and communication technologies (ICTs) in the health sector is
largely limited to urban centers.
For a continent that has seen fatal outbreaks of Ebola, Malaria and is
currently faced with alarming rates of HIV/AIDS infection, it is quite clear
that an increased practice of telemedicine would contribute to the improvement
of healthcare delivery. It follows therefore that increasing the use of ICTs
would effectively improve the practice of telemedicine and further address
academic and research concerns that are necessary for Africa to more
efficiently deliver healthcare to its inhabitants. Telemedicine should
therefore be of concern to health policy makers. “The idea behind telemedicine is said to be
to ensure a health service to all people regardless of their situation. Access
to medical services may be limited by geography, climate, communication,
transportation and economy, as well as shortage of trained personnel.”
Conceptualizing the Development
of Telemedicine Components
The terms e-health and telemedicine are
often used interchangeably but telemedicine is a field within e-health. However, our focus is on
telemedicine.
E-health/Telehealth
E-health is the provision of health-related services and
their attendant information using telecommunication facilities. It comes in
many forms and shapes, depending largely on the telecommunications and IT
infrastructure of the region in question, and the sorts of medical or health
needs of the target population.
Telemedicine
Telemedicine which literally means “healing at a distance” is the provision of clinical health care remotely using
telecommunications.The American
Telemedicine Association (2013) defines telemedicine as "the use of
medical information exchanged from one site to another via electronic
communications for the health and education of the patient or healthcare
provider and for the purpose of patient care." As broadly defined by the
WHO, telemedicine is " The delivery of health care services, where
distance is a critical factor, by all health care professionals using
information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention
of disease and injuries, research and evaluation, and for the continuing
education of health care providers, all in the interests of advancing the
health of individuals and their communities".
History of telemedicine
Historically,
telemedicine can be traced back to the mid to late 19th century with one of the
first published accounts occurring in the early 20th century when
electrocardiograph data was transmitted over telephone wires. Telemedicine in
its modern form, started in the 1960s in a large part driven by the military
and space technology sectors, as well as a few individuals using readily
available commercial equipment. Examples of early technological milestones in
telemedicine include the use of television to facilitate consultations between
specialists at a psychiatric institute and general practitioners at a state
mental hospital, and the provision of expert medical advice from a major
teaching hospital to an airport medical centre.
Recent
advancements in, and increasing availability and utilization of ICTs by the
general population have been the biggest drivers of telemedicine over the past
decade, rapidly creating new possibilities for the health care service and
delivery. This has been true for developing countries and underserved areas of
industrialized nations. The replacement of analogue forms of communication with
digital methods, combined with a rapid drop in the cost of ICTs, have sparked
wide interest in the application of telemedicine among health-care providers,
and have enabled healthcare organizations to envision and implement new and
more efficient ways of providing care. The introduction and popularization of
the internet has further accelerated the pace of ICT advancements, thereby expanding
the scope of telemedicine to encompass Web-based applications (e.g. e-mail,
teleconsultations and conferences via the internet) and multimedia approaches
(e.g. digital imagery and video). These advancements have led to the creation
of a rich tapestry of telemedicine applications that the world is coming to
use. The early forms of telephonic and radio communication in telemedicine have
a largely been supplanted by video telephony and telemedical gadgets that
enable in-home health care access.
Types of
Telemedicine
Broadly telemedicine can be classified into three major
types, namely:
·
Store
and forward
·
Remote
patient monitoring
·
Interactive
or real time services
Store
and forward
In this type of telemedicine, there is no physician-patient
interaction or the presence of both the parties concurrently. The patient
information in the form of medical images or bio signals are transmitted via
electronic media to the physician, who reviews it at a convenient time and
provides expert opinion. A precise and well-structured history and clinical
background of the patient, preferably in electronic form is included along with
the images for the benefit of the physician.
The ‘store and forward’ type of telemedicine is useful in the medical
diagnostic fields of pathology and radiology, and dermatology. The major
drawback of this form of telemedicine is that the physician cannot obtain the
medical history directly from the patient or perform a physical examination,
but instead has to rely on the information provided in electronic form.
Remote patient monitoring
This
type of telemedicine involves monitoring the patient remotely using various
technological devices. It is especially useful in the follow-up of chronic
conditions such as diabetes, asthma, and heart disease. The outcomes appear to be comparable to
traditional physician-patient encounters. It might be cost-effective and saves
patients the trouble of traveling long distances with their health condition
for frequent follow-ups.
Other
applications of remote patient monitoring include management of joint disease
and home-based nocturnal dialysis, to name a few.
Interactive
and real time services
In
this type of telemedicine, there is an interaction between the physician and
the patient, for example, over videoconferencing, with the need for both to be present simultaneously. It is
possible to obtain a history and perform several assessments in this form of
telemedicine.
Specialties
where Telemedicine can be used
Telemedicine is used in the following specialties:
i.
Telenursing involves the use of information and communication technology to
provide nursing care and services to patients even in the presence of physical
distance.
ii. Telepathology is another area where the transmission of high
quality microscopic images through the internet can be used for teaching,
diagnostic and research purposes. It is necessary for a qualified pathologist
to choose the appropriate, representative high quality image to be sent for
analysis.
iii. Teleradiology Radiology is one of the areas where telemedicine is
employed in a big way. Radiological images such as x-rays, CT scans and MRI are
transmitted via the internet to a radiologist or physician, who needs to have a
computer with a high quality screen display, and if possible, a printer that
prints high quality images.
iv. Telepharmacy
- In telepharmacy, pharmaceutical care is made accessible to patients at
locations where they may not have access to a pharmacist. The pharmacist can
monitor treatment, counsel patients about intake of medications, and authorize
prescription drug refills using teleconferencing or video conferencing.
v. Teleophthalmology:
Using digitized medical equipment and communication technology, optimal eye
care facilities and monitoring of chronic eye conditions such as diabetic retinopathy can be done for patients living in remote locations. This
helps in providing low-cost eye care and access to eye specialists for poor and
uninsured patients.
vi. Telecardiology: Specialist care and opinion in fields such as cardiology
may be made accessible to patients by transmitting their ECG’s and other test
results using the internet to experts at the receiving end.
vii. Teledentistry: involves the use of electronic media for the purposes of
dental care, and consultation and creation of public awareness regarding dental
health.
viii. Telepsychiatry: Videoconferencing and other communication technologies can
be used to make accessible specialist psychiatry services to persons living in
underserved locations.
ix. Teledermatology: Involves the use of audiovisual data transmission of skin
conditions for specialist consultation, diagnosis and treatment.
Teledermatology can also be used for educational purposes. In this way,
patients living in places where specialist care is inaccessible can be served.
x. Telerehabilitation: refers to the use of communication technology to provide
rehabilitation services to patients that include speech therapy, occupational
therapy, neuropsychology, physical therapy and audiology.
xi. Teletrauma care: Uses modern communication tools to provide expert health
care to patients in a trauma or disaster situation. Doctors and health
personnel at the scene of disaster or trauma can interact with specialists via
the internet or smartphones to help in assessing the severity of injuries and
to determine management, and whether a particular patient might have to be
shifted to a secondary or tertiary care center for further management.
Global statistics and facts on telemedicine
services
Statistics
according to the WHO region related to the four fields of
telemedicine-teleradiology, telepathology, telepsychiatry and teledermatology
are mentioned below:
Ø
Regions of
Southeast Asia, Europe and Americas had the highest proportion of established
telemedicine services.
Ø
Southeast Asia
and Europe had high level of established teleradiology programs compared to the
global rate.
Ø
African and
Eastern Mediterranean had the lowest proportion of established telemedicine
services.
Ø
High income
countries have a higher proportion of established telemedicine programs,
probably due to presence of well-developed information and communication
technology systems, and allocation of funds for health care.
Ø
Store and forward
initiatives are generally implemented with lesser difficulty compared to real
time services, since they require less bandwidth for videoconferencing
purposes.
Ø
Telepathology,
teleradiology and teledermatology services are less bandwidth intensive and
more often employed than telepsychiatry, which requires a real time
doctor-patient interaction.
Ø
Globally, 25% of
countries reported having a national telemedicine policy or strategy.
The Advantages/Benefits of Telemedicine.
To Patients
o
Enhanced access to a
specialist leading to more accurate and earlier diagnosis and better treatment
outcomes leading to reduced burden of morbidity
o
Reduction of patient’s waiting
time and hospital stay days
o
Reduction of expenses
(travelling, accommodation, consultation fees in referral hospital)
o
Availability of healthcare to patients living in rural or
underserved areas without necessity to travel to the hospital.
o
Useful in post-disaster, natural calamity situations or
other emergency
situations
when traveling is not possible.
o
Elderly patients and persons with chronic illnesses can have
regular follow-up and monitoring through telemedicine.
o
The time for travel is saved and the cost of treatment may
also come down.
o
Allows patients to participate in the decision making
process since knowledge is made available to them.
o
Home-based dialysis options are available to patients
through video link supervision, whenever needed.
To Health care Providers
o
Saves work-loss time and
increase productivity
o
Joint consultation with expert
Consultants for better management of complicated disease.
o
Telemedicine is an excellent
opportunity to share the knowledge between Health Professionals all over the
world
o
Local doctors can be updated
at any time with the most recent advancement in medicine.
o
More efficient screening of
patients with medical problems
o
Better follow-up of patients
with selected medical problems
o
Monitoring of drugs and dose management can be done through
telephone.
o
Facilitates health education by allowing students or health
workers to observe and listen to experts in their respective fields. Medical
teaching is possible by making available academic material and case
presentations through webcasts, and teleconferencing.
o
Electronic search engines, online medical sites and journals
provide latest research news helping health professionals to stay updated.
Specialists can also communicate with each other to solve difficult cases.
o
Presence of computerized database, especially in primary
care settings allows the physician to access patient records and for
multidisciplinary collaboration whenever needed. This could improve the quality
of patient treatment.
o
Can possibly overcome the risk of transmission of infection
between health care professional and the patient, or between patients.
o
Accuracy of diagnosis /
reduction of medical errors.
Although telemedicine clearly has a wide range of
potential benefits, it also has some disadvantages.
Disadvantages/Challenges/Drawbacks of Telemedicine
The following may be considered as possible downsides of
telemedicine:
·
Lack
of direct interaction between the physician and the patient.
·
High
cost of communication and data management equipment and its maintenance, which
may not be easy for older people living alone.
·
Necessity
to train personnel technically to handle communication and data management
equipment.
·
Possibility
of error when health care is delivered in the absence of a trained health
professional.
·
Possibility
of misuse of patient data through electronic transmission(confidentiality).
·
In
certain instances, time taken to provide health care through telemedicine may
actually be longer than traditional consultations because of increased time
taken to assess and treat patients through virtual interactions.
·
Poor
quality of records or images made available to the physician at the receiving
end and omission of relevant clinical information might affect the quality of
health care delivered.
·
Absence
of proper legal regulations for some of the telemedicine practices.
·
Difficulty
in claiming insurance or reimbursements in certain fields.
TELEMEDICINE IN AFRICA
Despite the bleak
background painted about telemedicine in developing countries in general and
Africa in particular, some efforts with respect to telemedicine are worth
mentioning. The purpose of this study is to identify some African countries
where telemedicine is used, how they function, their benefits and challenges.
The scope of the study is limited to four countries, namely: Cameroon, Ghana, Kenya and Nigeria.
Telemedicine in Cameroon
Shortages of skilled health personnel in remote areas,
deficient infrastructures and equipment as well as the limited purchasing power
of a large proportion of the population are factors that threaten the health of
many in Cameroon. Because of this, people in rural and remote areas have great
difficulty in accessing basic health care and appropriate treatment.
Telemedicine (care and health services, social services, preventive or
curative, done remotely via technology and communication) has the potential to
reduce inequality on health care quality between urban and rural areas.
It also reinforces health care workers isolated in rural areas by giving access
to a sound medical knowledge base.
There is no official framework for the promotion of
telemedicine in Cameroon; however some private initiatives have been put in place.
Case
1: Genesis Telecare
Genesis Telecare SA is the first telemedicine company in
Cameroon, created on April 21, 2009 by Jacques Bonjawo, also CEO of the group
which Genesis Telecare lies under: Genesis Futuristic Technologies Inc., a U.S.
software firm which has the bulk of its operations based in India.
Objectives
a)
Bring
the patient's physician closer, reducing wait times and maximize the
effectiveness of medical consultations;
b)
Enabling
rural access to examinations and specialized services such as medical support
for cardiovascular disease, or monitoring of difficult pregnancies or other
treatments during early childhood.
Approach
Genesis Telecare opened the first telemedicine center in
Cameroon in April 2009.
The project is composed of a team of
general practitioners, nurses, engineers and skilled technicians in advanced
technology. Their collaboration provides a real-time interaction between
physicians and patients through a highly secure computer system where each
patient has a complete electronic medical record.
To date, there are six telemedicine
sites in several localities in Cameroon: Yaounde (where the technical platform
is found), the regional hospital of Abong Mbang(in the East), Regional Hospital
Yagoua (in the Far North), the health center at the SOSUCAM Nkoteng (in the
central region) and the medical Center in Akonolinga of the Endom district (in
the central region). For each center, nurses are trained specifically to the
technologies used. Medical specialists remotely perform interpretations of
tests either in real time or delayed, and if required, other physicians, based
in India, France and the United States are asked to analyze some complex cases
corresponding to their specialty.
To overcome the problem of frequent power outages in rural
areas in Cameroon, generators have been installed in each telemedicine center
and some instruments are being developed to run on solar energy. Following the
success in Cameroon, telemedicine centers are being created in Gabon, Chad and
the Democratic Republic of Congo.
Benefits
a)
Easy
access to medical specialists without having to travel long distances +
electronic medical records
b)
Low
care costs which are affordable for the poor
c)
More
than 15,000 patients consulted since April 2009; 2000 electrocardiograms and
1500 ultrasounds performed.
Case
2: DigitalMedLab
Cameroon government has a low tax base and therefore limited power to
provide ICT infrastructure especially on areas addressing healthcare. One
startup, digitalMedLab has been established in Cameroon to
meet this end. Founded in 2012 in Zürich, Switzerland by Cameroonian physician
Dr. Patricia Sigam and Australian developer Andreas Lorenz this is set to
facilitate African telemedicine, eHealth and mHealth. And it is not just useful
for the African context but should have universal appeal.
According to Dr. Sigam, “Health Systems in Africa are mostly
institutional and public. The early Ebola
outbreak has shown the
mistrust of the population regarding Healthcare Services and NGOs. The private
sector could play an important role, by offering sustainable healthcare [tech]
solutions at an affordable price. One of such is the +WoundDesk app. It is a mobile app
designed for wound management. It captures patient’s health records and
conducts semi-automatic wound management processes. It has a decision support
system mechanism that incorporates alerts and notifications. And is already in
use in a French nursing home in France and a rural hospital in Cameroon. With this app, doctors are able to exchange
data with colleagues in a secure and confidential environment. The app has the
capacity to reduce the number of wound patients that need to travel for these
services.
The founders decided to focus on wound management, as a
critical issue in both African and European countries. But as many health
practices across Africa are far from optimal, the app also offers numerous
additional benefits. The most pressing of these is that the majority of
patients in Cameroon do not have medical records. This means many hospitals and
dispensaries sell a miniature notebook (sometimes called “card”) to the
patient. However, this is costly for poverty stricken patients and often lost
before the next visit. To counteract this, the app providers combine a patient
health records with a mobile app. According to Dr Sigam's explanation of discovery of this app, that a web-based
modular medical record was developed, an Android-based mobile application with
a special image processing system that allows automated non-contact wound
surface area measurement was built, but due to
low access to internet in Cameroon, an
offline modes to assure access anytime anywhere was integrated to this
app. When asked whether the project could operate within our context of abject
poverty and illiteracy and without many smart technologies, Dr. Sigam answered
yes and also said that the app is only for trained health professionals.
Case 3: The CardioPad
The CardioPad is
a touch pad that has embedded applications
for medical use. The tablet invented in Cameroon by computer system
engineer Arthur Zang , records and analyzes the
cardiac activity of a patient to transmit to a specialist who will produce a
diagnosis. The CardioPad is designed for remote populations.
Operation
The tablet has the following
functions:
·
ECG exams (acquisition of the patient signal, scanning, processing,
display and printing of the examination report);
·
remote and
GSM network transmission of exam results to cardiologists;
·
presentation
on an interface;
·
storage of
information and notifications in an SQL database;
·
remote
monitoring.
This invention already equips some
hospitals in Cameroon.
Beside the main cases stated above, there are
other private initiatives such as Imaging Department in Mbingo Baptist Hospital and Gifted Mom
that are implementing some basic
telemedicine practices but very little
has been documented.
Gifted Mom, a text-messaging application that gives
no-cost health advice from doctors to women in rural villages across the
country of Cameroon. The app is ambitious, expecting to reduce the maternal
mortality rate in Africa by at least 70 percent.
As far as telemedicine
is concerned, very little has been done in Cameroon as compared to other
African countries. This may be due to lack of funding and political will, to
support private initiatives whose scopes are reduced.
Telemedicine in Nigeria
In 2003, the Nigerian Communications Satellite Limited (NIGCOMSAT
LTD), and the China Great Wall Industry
Corporation (CGWIC) signed a contract for the design, manufacture, and launch
of the NigComsat-1 satellite in 2007. The satellite provided links that would
allow Nigerian caregivers to consult with medical providers across the globe
with ease for additional examinations and consultations.
On November 11, 2007, the National Space Research and development
Agency (NASRDA), a Nigerian Federal Government establishment, along with the
Nigerian Ministry of Health began an initiative to embark on a pilot project
using telemedicine to improve care to Nigerians living in the rural areas, far
from the country's professional health facilities. The initiative relied on
NigComSat-1 and began with eight remote terminals that would serve as
stationary nodes at which patients could access care from medical professionals
living in Abuja or Lagos, and a single mobile unit that would travel into more
remote areas of Nigeria. The satellite failed woefully in November 2008 owing
to a technical error from the satellite's northern solar array.
In March 2009, Nigeria signed another contract with the Chinese
government on the launch and delivery of a replacement satellite called NIGCOMSAT
1R. The new satellite was delivered and launched in December 2011.
Design and sustainability of telemedicine systems still poses a big
challenge to most developing countries, despite its wide usage in developed
countries. However, the advancement of technology continues to decrease this
challenge. ZYcom GlobalMed. - a corporation founded in Texas of the United
States of America, duly registered with the Federal Republic of Nigeria -
partners with GlobalMed to leverage the fiber optic infrastructure ring
trenched around Africa, specifically Nigeria, to integrate a wireless fiber
optic NODE network backhaul. With this integration, Zycom GlobalMed has been
able to revolutionize telemedicine by using its wireless fiber optic node
network designed to generate unlimited bandwidth. The fiber optic nodes create
a stable network for video conferencing and providing an effective telemedicine
solution. This also allows all areas of Nigeria to gain access to the quality
and specialized healthcare they deserve at an affordable cost. Zycom GlobalMed
invented telemedicine solutions directed at bridging the gap between patients
and specialists globally.
Current
challenges and prospects of telemedicine in Nigeria
Telemedicine still faces a lot of problems and bottlenecks
in Nigeria, some of which are:
a)
Slow
growth or usage of Telemedicine: There is every need for the expansion of
telemedicine through education. The understanding of the telemedicine
technology is very important to the expansion of telemedicine.
b)
Little
or no connectivity to rural and remote communities: To enhance the application
of telemedicine in health care, there ought to be access to fast and reliable
internet in most cases. Such fast and reliable internet connection is not
available in most rural and remote communities in Nigeria.
c)
Costs
of Telemedicine in Nigeria: Not withstanding that telemedicine reduces cost,
the cost of telemedicine is still not affordable to many especially those in
rural and remote communities in Nigeria and even in the Urban Areas despite
these challenges, Nigeria being a third world country could benefit so much
from telemedicine more than the so called technologically advanced countries.
The essence of telemedicine is to provide specialist medical
care where there is no specialist. In essence, large sums of money spent by the
government on its officials' regular visits abroad can be reduced to a minimum.
In addition, the higher numbers of qualified Nigerian doctors in the diasporas
could offer their services to hospitals in Nigeria There could also be a multiplier
effect to the extent that, rather than fresh medical graduates leaving the
country for better jobs abroad, they can stay back and yet still work for
foreign hospitals right here from home. This can help stem the effect of brain
drain.
CONCLUSION
Telemedicine has the potential of increasing health-care
delivery and making qualified health Personnel accessible by patients in remote
areas. Other benefits include reducing the costs of Health-care delivery,
long-queues in hospitals access to health personnel at any period of time.
However, telemedicine faces a lot of problems in Nigeria.
Telemedicine in Kenya
Ø
Overview
of the Telemedicine in Kenya
Access to
healthcare by people
living in rural
Kenya is still
hindered by lack
of physicians situated in
those areas. According
to a report published by
Kenya National eHealth Strategy (2011), having equitable and affordable
healthcare at the highest
achievable standards to
all citizens is
one of the
overall goals of
Kenyan Vision 2030. Telemedicine was identified as one of the strategic
areas of intervention in Kenyan e-Health strategy presented in Vision 2030
report. Basing on the Kenyan geographic distribution, the majority of citizens
are located away from hospital where healthcare
specialists are located.
In a study on the reliability of telemedicine systems in rural Kenya,
Qin et al. (2013) noted that patients living in rural Kenya fail to receive
treatment due to the high costs involved
to travel to
urban areas where
the medical specialists
are based. On the
other hand, specialists located in urban areas fail to visit the rural clinics due
to their busy work schedule as well as costs involved in travelling to rural
areas.
Case
1:Call-a-Doctor
A recently launched service "Call-a-Doctor"
initiated by a mobile phone service provider Safaricom which has partnered with
clinicians to provide a tele-health consultation service, provides patients with a chance
of calling a
doctor to seek
medical attention. This
followed a move
meant to spur adoption
of e-health services
and solutions; the
Kenya government has developed
a national e-health strategy through the ministry of
medical services in order to help enhance health service and medical
provision by utilization
of information and
communications technologies. The strategy is expected to among other
things address the country's low doctor to patient ratio which is currently
estimated to be
0.14 physicians per
1,000 people while
expenditure on health
care services takes up about 4.9 per cent of the GDP (GoK, 2012).
Case
2:MedAfrica
Recently,
Shimba Technologies, a
local software development outfit,
and Nokia launched
MedAfrica, a mobile
application that provides information about medical solutions
upon download with the aim to make healthcare information affordable and
accessible to Kenyans.
MedAfrica seeks to
improve the health
of communities and regions
in which it
operates by increasing
access to healthcare-related information
and services in Africa. Good health is a universal need that affects the
output of communities directly impacting their
socioeconomic standing. The
MedAfrica app aims
to create platforms
that facilitate
dissemination of information
and build communities
around the different
issues and conditions. “The
content in the platform will be provided by the government (courtesy of open
data portal), private sector, academia and the general health practitioners
(Ndegwa, 2012) The MedAfrica app
is currently available
for download in
Kenya and other
African countries with similar
infrastructural challenges as Kenya's. The platform will be accessible via a
number of channels mobile
applications (Java, Nokia,
and Android), mobile web,
Unstructured Supplementary
Service Data (USSD), web
and short message
service (SMS).
Case
3:SemaDoc
On August 10, 2015, First Lady Margaret Kenyatta quietly
launched a service, dubbed Sema-Doc, that promises to disrupt and completely
revolutionize the medical care sector in Kenya. In a first for the region, the
service seeks to utilize mobile phone and Internet communications to expand the
reach of health services in the country. However, the initiative has come in
for lots of criticism and skepticism, especially from the medical fraternity.
Doctors are wondering how patients will be able to get quality healthcare
without actually physically visiting health institutions to be seen and checked
by a medic. This situation is compounded by the very poor public health
facilities on offer in the country, and which are frequently exposed in the
media as little more than excuses of health centres with little or nothing to
offer in the way of medical care.
Case
4:ConnectedMed
A Johannesburg-based eHealth startup, ConnectMed founded in 2015, has rolled out their telemedicine platform
in Kenya with the aim of providing affordable medical advice to patients
outside of a healthcare setting. Through the ConnectMed platform patients can
schedule a secure virtual 15 minute doctor’s appointment for the same day via
any connected computer or mobile device. All the doctors registered with
ConnectMed are screened, licensed professionals that are able to provide
treatment for over 30 ailments as well as electronic prescriptions, referrals
and sick notes.
The benefit for doctors being registered with the platform
is that they’re able to choose their working hours and save money on marketing,
rent and travelling costs.
ConnectMed also offers an Enterprise solution ideal for clinics experiencing a shortage of doctors, as it
allows them to treat more patients and improve the medical skills of existing
staff. During trials in Kenya it became evident that the top adopters of the
platform were elderly patients who found it difficult to travel and university
students seeking sexual and mental health advice. According to ConnectMed, to
make their service more accessible to the general public they plan to roll out
physical PC stations in locations such as pharmacies and internet cafes.
Other
Initiatives
With the advances
in information technology
infrastructure in Kenya,
various organizations such as
AMREF (Computer Aid International, 2013),
AAR healthcare services and Safaricom Ltd (Galgallo, 2013) have
embarked on telemedicine
projects. However, most of
these projects stall for
several reasons, such
as human resources necessary to
maintain the projects
not being trained
and doctors rejecting
the idea of seating
in a call
centre to answer
to patient queries.
This could be
because physicians work in a
different working environment with higher requirements for their qualification,
professionalism, ethical behavior,
autonomous practice and
professional responsibilities.
The result is they have dissimilar technology acceptance decision making and
readiness. However, most studies that investigate factors that influence
adoption of telemedicine in Kenya focus on the infrastructure, government
policies and funding overlooking the fact that for an innovation to be
successful the consumers, in this case, physicians and nurses, need to accept
it and continue using it fully.
Telemedicine in Ghana
Ghana, a developing country in West Africa. In 1957 Ghana
became the first African nation to achieve independence from its colonial
ruler. Although Ghana has suffered mixed political and economic fortunes, some
see Ghana as a model for North – South cooperation [Horton, R. (2001).]. With a wide area of 238,500 square kilometers and an
estimated population of 20 million people it is important to realize the
significance of healthcare. The life expectancy in Ghana is 57years old [1Horton, R. (2001).]. According to the CIA World Fact book,
only 19.6% of the population in Ghana use the internet. Telemedicine is a developing system to better help medical
institutions to better use information and technology to treat patients.
It is the use of
video and informational systems to help doctors and other medical staffs better
diagnose and treat patients Alves, M.,Canoui, E.,Deforges,
L.,Garderet,L.,Guidet, B.,Offenstadt, G., &Maury, E. (2012). Through these information systems, doctors can locate
articles and information that may have been previously used before to treat
patients and use that to quickly and more efficiently treat patients in the
future.
Healthcare is a growing issue
in Africa, and with the spread of HIV and AIDS on the rise, it is necessary to
have the tools required to be able to handle the issue of infecting others. Not
only is telemedicine useful in treating patients from a distance, it can help
patients who are in rural areas to receive
healthcare or information necessary to be treated accordingly. By using
telemedicine and the information provided through telemedicine, it can cut down
on the amount of hospital space and beds significantly by remotely treating
patients. Komofo Anokye Teaching Hospital is the second largest hospital in
Ghana Built in 1954, it was known as the Kumasi Central Hospital and help only
500 beds. In 1975 it was converted to a teaching hospital and accredited for
postgraduate training by the West African College of Surgeries and now holds
1000 beds. Telemedicine will be a huge step in the right direction regarding
healthcare in developing third world countries, yet having proper medical
supplies and medicines remain a major issue.
Overview of Telemedicine Infrastructure in Ghana
Ghana’s telemedicine adoption rate highly depends on the
support of third-party funding and the economic balance of Ghana. There are
only seven health centers in Ghana [Novertis. (2011).]. One of the main obstacles hindering the use of
conventional healthcare is the distance between each health center. The journey
to these health centers often require 4-wheel drive vehicles in order to safely
navigate to each center. E- health or electronic Health is one of the most
rapidly growing areas of technology in Health today, especially in developing
countries like Ghana Novertis. (2014). The use of E-health along with advances in
telemedicine will dramatically improve the way patients receive care who may
not have transportation to these health
centers. Ghana shows promise in their efforts to develop telemedicine and other E-health applications [5].
The Novartis Telemedicine
Project is stationed in the Bonasso cluster; this cluster holsters 6 villages and
has an estimated population of about 35,000
people. Communities in the cluster are very diverse and separated, most of the
villages are separated by miles of unpatched road and challenging terrain
making it especially difficult to receive efficient healthcare without having
to endure a hazardous journey to one of the seven health centers. This
difficulty is furthered by the limited number of health centers, and weather
conditions that may make it impossible for some cases to even receive
healthcare. Taking into account the several diseases prominent in Ghana such as
Malaria, Anemia, Tb, HIV/AIDS, it affects the every health of the patients in
the communities. To reduce the danger in traveling and minimize traveling the
health centers placed throughout the communities have taken steps to eliminate
the risks almost completely. One of the many steps that have been implemented
is the use of teleconsultation.
The practice of
teleconsultation reduces the time needed and the overall cost of receiving
healthcare dramatically [Novertis. (2014).]. Healthcare can be addressed and
delegated to those who need it through protocols develops by Med Gate in
Switzerland (NTP); the teleconsultation program is being pioneered to adapt and
better utilize the techniques implemented by Med Gate. The first step in
maximizing efficiency in telemedicine was to evaluate and assess the current
need for technology. The next step was to identify and enroll medical staff and
important health personnel and enrolls them into a workshop to develop their
skill in telemedicine applications; during this phase of the Novartis
Telemedicine Project, healthcare personnel and even doctors attended extensive
workshops and were presented with mobile technology and more ways to interact
with telecommunication applications as well. The benefit of this was to create
a skilled group of doctors and medical staff to successfully practice
telemedicine and teleconsultation services to reach patients who do not have
transportation to health centers.
With the help of the Ghana
Ministry of Communications, several telecommunication stations and antenna were
installed across the Bonasso Cluster, this in turn created a better range for
telecommunication systems and telemedicine
applications. The extended range and signal provided increased network
accessibility to over 21communities and all seven health facilities, which is
necessary for the successful
implementation of telemedicine throughout Ghana. Through the support of the Novartis Foundation,
medical staff were able to procure mobile phones and other telecommunication
devices that could be used in the advancement of telemedicine in Ghana. It is
clear that telemedicine is successfully being a breakthrough in the advancement
of medicine in developing countries.
Future endeavors of the
Project include providing 24-hour support to teleconsultation centers,
development in logistics, human resources and technical advancements, as well
as a greater number of workshops that will be available to staff in order to
ensure the proper use of telemedicine applications Einterz, E. (2001).The growth of telemedicine has
improved dramatically since 2011. According to an online article written by
YomiKazeem, Ghana could soon surpass South Africa, Ethiopia, and Mali in the
construction of Telemedicine Kazeem, M., Yomi,K. 2016. A telemedicine
consultation center set up in Amansie West provides a round the clock support
with experienced medical staff who could provide extensive medical advice over
mobile phones and networks. Ghana Health Services reports that 60%of calls were
maternity-related and 54% of calls in 2013 were resolved entirely by phone.
During the 3-year phase starting in 2012 the Telecommunication Center in
Amansie West only served 30 communities but currently they service the entire
district.
Case
1 – Teleradiology
With an estimated 250000
citizens whom are Human Immune Deficiency Virus (HIV) positive in the country
of Ghana, Africa the need for healthcare and telemedicine is detrimental. Tuberculosis,
a potentially serious infectious disease that affects the lungs, is very common
among HIV/Aids patients. To ensure proper diagnosis and treatment, radiologic evaluations must be performed.
With few radiologists available Ghana has collaborated with UNAIDS Program
Coordinating Board to improve this division of healthcare in the country. The World Health Organization(WHO) recommends a ratio of
228 health professionals per 100,000 population. The director of Health Service
for Greater Accra region stated the doctor
patient ratio was approximately one doctor to 15,259 patients in a year Drislane,
F., Frank, W., Albert, A., & Harry, W. (2014. Lack of radiologic
interpretation results in higher patient morbidity and mortality. Upon the
implementation of teleradiology for the Komoko Anokye Teaching hospital from
2012-2013 they were able to use X-Ray images from 158 patients. Eighty-six
percent of X-Rays performed were chest radiographs, 7.8% were spine
radiographs, and the other 5.8% undocumented. Results of this implementation
has changed patient management by reducing the time it takes to diagnose and
also helped prevent misdiagnosis. Teleradiology has enhanced patient care by
collaborating radiologists. Ghana reduced new HIV infections by 53% from 2001-2014. Ghana and the West African
Region has addressed the need for better healthcare for particular populations
at higher risk. These gains will help move toward an AIDS-free generation.
Case
2 – Teledermatology
With low doctor to patient
ratios, dermatologists are few to none in Ghana’s community, As access to
mobile communication increases dermatologists are now able to use the mobile
telecommunications infrastructure to provide “mobile teledermatology”, which
uses mobile devices to provide dermatologic services at a distance rather than
face to face consultations [9]. This study evaluated diagnoses made by 3
Ghanaian dermatologist examining patients face to face compared to a Ghanaian
teledermatologists using Samsung mobile platform and a U.S. teledermatologist
using a computer. 34 patients with skin symptoms were randomly selected from the cities of Accra and Kumasi in
Ghana. As the face to face visits were made images and data were collected with
the use of a Samsung mobile telephone and sent to the U.S. and Ghanaian
teleconsultants. Through on the phone access to the world-Wide Web-based
interface the Ghanaian and U.S. teledermatologists diagnoses were in accordance
with the face to face Ghanaian dermatologists. The degree of accuracy comparing
face to face visits with the Ghanaian and U.S. teleconsultants were 80%, with
eczematous eruptions most common, followed by acne, drug rash, pigmentary
alterations, tinea versicolor, and others Osei-tutu, A., Ting, S., Alyx, R., Nathan,
A., Rajiv, N., Daniel, S., & Carrie, K. (2013).]
Mobile teledermatology is a positive step in the healthcare in Ghana and has
helped eliminate costly equipment, providing a cost effective solution.
Case 3 -Teleconsultation
In Ghana it is extremely
difficult to receive health care without traveling long distances. Most
patients can never make it to a healthcare facility due to the lack of
transportation and safe means of delivery to each location. Due to the extreme
road conditions and lengthy distances between health centers and communities,
patients rarely, if at all, receive healthcare and most likely end up dying or
suffering severe illness or disability. Although health centers are placed in
highly populated areas, it is the rural areas and communities that need the
most help. There are new applications and new means of getting healthcare to
these patients as well. The method that is becoming a standard in healthcare in
rural areas is teleconsultation. Teleconsultation is the consultation between
doctors and other doctors or doctors and patients on a video link or channel.
With teleconsultation the amount of risk involved in receiving healthcare in
rural areas can be reduced for the patient. A Teleconsultation service was introduced
in the Amansie-Westdistrict in 2010 Opoku, D., Scott, P., & Quentin, W.
(2015 it linked communication between the district hospital and the local
teleconsultation clinic. The service was placed there to assess the healthcare
professionals perceptions of the benefits and challenges of servicing this
area, and to identify possible areas of improvement [Opoku, D.,
Scott et al.. The trial received positive feedback from medical staff and was
described a dramatic improvement to the quality of care, which in turn reduced
the need to refer patients to the district hospital. Some problems occurred
such as phone service delays, stressful workloads on
the telecommunication staff, and inadequate information received from phone
calls, but steps have been taken to rectify problems that arose. In conclusion,
the teleconsultation service had the potential to improve the quality of care
to those who needed it the most; however, problems due to technical
difficulties threaten the potential effectiveness of the teleconsultation. Through
proper training and maintenance, teleconsultation should be the future of
medicine in Ghana.
Case
4 – Teleradiology
At Korle Bu Teaching Hospital
in Accra, Ghana a study was conducted to analyze nephrectomies performed in
adults over a twelve-year span. Nephrectomy is the removal of a kidney and is
used for malignant as well as benign lesions. In evaluations of renal pathologies
they have used abdominal ultrasound, urography, abdominopelvic computerized
tomography (CT) scans and radioisotope renal scans. Over the twelve year study
sixty-two nephrectomies were carried out. The average age of the patients was
forty-nine plus or minus sixteen years, and the male to female ratio was 1:1.
The data was taken and analyzed using a Statistical Package for Social Sciences
for Windows operating system version 19. Studies showed that 85% were proven to
be malignant, while 14.5%were found to be benign [Kyei, M., Klufio, G., Mensah,
J., Gyasi, R., &Gepi-Attee, S.(2015). ].
Recommendations
a)
The
medical staff should be exposed to telemedicine during training and technicians
available to guide them in its usage.
b)
General
medical policies should be reviewed to introduce the remuneration of doctors
who give consultations using media as a way of encouraging the use of the
system.
c)
They
should be a limitation to the kind of health care that can be given via
telemedicine as many of the other doctors were found to be more hesitant in
embracing this technology..
d)
During
the establishment of new telemedicine infrastructure the medical staff should
be consulted so as to allow for the adoption and use of the equipment.
e)
More
medical staff should be encouraged to use telemedicine to improve service
delivery.
f)
Because
of the unstable nature or lack of electricity supply, hospitals should be
equipped with solar energy or stand-by generators.
g)
One way in
which the international community may assist Africa to develop telemedicine is
by establishing regional centers of excellence in telemedicine, equipped with
state-of-the-art equipment for training and research.
GENERAL
CONCLUSION
Most African countries have suffered many decades of poor
healthcare, a state of affairs usually attributed to the prohibitive costs of
setting up public health facilities and training medics. Telemedicine is the future of healthcare in rural areas as
well as urban areas in developing countries. With the support of
Government-based programs and third-party funding, telemedicine can
successfully make its way to patients in secluded and diverse areas.
Improvements in Telemedicine project continue to provide telemedicine
applications and workshops to educate and inform medical staff and medical
institutions so that telemedicine can be effective and affordable. The extended
range provided satellites will service rural areas thoroughly to reduce the
need and cost of transportation to medical institutions dramatically. Through
proper training and methods of distributing technology to doctors, telemedicine
will lead the way in cost-efficient, safe, and reliable healthcare provision.
African countries are still developing, with a structured healthcare system
being set in motion, telemedicine will influence the way medicine is delivered,
especially to rural areas.
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