Is telemedicine achievable in Africa?

Lazarus Sauti

Access to facilities and medication, lack of skills and chronic disease care continue to place demands on existing healthcare resources in most African states, while economic turbulence propels governments to scrutinise healthcare budgets.

Conversely, a growing expectation on safety, access and enhanced patient experience from the consumer space urges healthcare services to be integrated as well as ubiquitous.

This therefore calls for African governments, healthcare providers, healthcare technology entrepreneurs and healthcare policy makers to turn to technology innovation, especially in the areas of mobility, clinical decision support, patient management systems, data analysis as well as business intelligence for healthcare resource planning.

With 60 percent of Africa’s citizens living in rural areas, telemedicine is seen as a means of improving the quality of rural healthcare, increasing access to scarce specialists, reducing transportation of patients to doctors, supporting rural doctors, overcoming the shortage of doctors, delivering education and facilitating research.

But is this achievable in Africa?

Is the continent ready for telemedicine – 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?

In a journal article titled “Telemedicine and Advances in Urban and Rural Healthcare Delivery in Africa”, an expert in TeleHealth Professor Maurice Mars argues that the burden of disease is great and there is an extreme shortage of health professionals in Africa; as a result, telemedicine can provide access to scarce specialist care, improve the quality of care in rural areas and reduce the need for rural patients to travel to seek medical attention.

Mars believes telemedicine is achievable, but Africa needs to deal with poverty.

“Poverty is rife,” he said.” As a result tax bases are low and governments have less to spend on healthcare along with the provision of information and communication technology infrastructure for eHealth solutions such as telemedicine.”

Professor Mars affirms that telemedicine requires information and communication infrastructure, the ability to use that infrastructure, a relatively stable supply of electricity and people to maintain as well as support the infrastructure.

Sara El-Khalili, corporate communications manager at TA telecom (South Africa), says although mobile technology is bridging Africa’s digital divide and empowering citizens with information at the click of a button, telemedicine is still low.

“Africa’s mobile unique subscriber base is expected to grow by 7 percent per year, reaching over half a billion or 49 percent of the population by 2020.

“Because of this reason, countries within the continent are presented with a chance to embrace telemedicine and save its citizens from different diseases, although the uptake of telemedicine is still very low,” she said.

Strategist Giorgio Parentela argues that telemedicine is achievable in Africa, although the overall information and communication technology penetration as well as the availability of computers in most African countries is extremely low.

“The continent of Africa remains the most disenfranchised region in the world as regards Internet access, frustrating every effort to embrace telemedicine,” he added.

According to Internet World Usage Statistics, Africa represents almost 10 per cent of the world internet usage at 26.5 per cent penetration rate while the rest of the world represents a little over 90 percent at 45.2 per cent penetration.

Because of this, Parentela urges the continent to compliment terrestrial infrastructure with satellite communications so as to achieve complete Internet coverage of the region and lay a foundation for telemedicine infrastructure.

John Akintosin, a South Africa-based technology expert, notes that there is limited awareness of telemedicine by healthcare workers, the patient community as well as lack of government will.

“In most African countries, telemedicine is still seen as an experimental tool by health practitioners, while the patients see it as another ‘white man magic’. This limited awareness of telemedicine by healthcare practitioners as well as citizens is not good for the development of telemedicine on the continent,” he said.

Akintosin also believes financial constraints are inhibiting the adoption of telemedicine in the continent.

“Do not let us deceive ourselves, good telemedicine is expensive, not to talk of the organisational and technological bottlenecks, but many healthcare professionals across the continent are curious about telemedicine.

“Even though workers in urban health facilities are more aware, those in rural areas know they and their patients will benefit more, but they all have to wait until the technology gets cheaper, less technical and independent of public utilities that are erratic in their respective countries,” he said.

To lift disease burden from citizens and transform economies, Dr Lynette Moretlo Molefi of Telemedicine Africa encourages African governments to work with public and private institutions to embrace telemedicine.

“Working through a public-private partnership will ensure that patient waiting times are reduced in an efficient and cost effective manner. Therefore, governments must work with private and public institutions to attain this dream,” said Dr Molefi, who is also a dynamic and versatile entrepreneur and business executive, with a reputation for exemplary leadership.

Tawanda Chamburuka, a practitioner in the information technology sector, shares Akintosin and Dr Molefi’s notions.

“The success of telemedicine as well as its positioning as a major tool in ensuring effective healthcare services in the near future lies on effective high broadband penetration rate, impressive internet speed and funding commitment from stakeholders and government sectors.

“Accordingly, governments, stakeholders in information technology and health sectors as well as development partners need to join hands and work together in developing broadband infrastructural backbone if Africa is to use telemedicine to improve access to quality healthcare,” he said.

In a paper titled “Telemedicine and Notable e-health developments in sub-Saharan Africa, Professor Dr Marc Nyssen, specialist in Computer Science and Medical Informatics, says telemedicine can contribute to substantially improve health care in Africa, but appropriate targets should be set and appropriate technologies applied.

“The way forward is for Africa to reduce communication costs via fiber connections, promote open source culture and focus on appropriate patient-centric record keeping,” Nyssen said.

As for Professor Mars, tele-education is an attractive solution.

“Tele-education is by far the most successful use of information and communication technology in health in Africa.

“However, tele-education in Africa has by the very nature of the poor infrastructure in rural areas been directed mostly to urban areas and academic centres.

“It is often forgotten that when there is a shortage of doctors, there is also a shortage of doctors to teach doctors. Tele-education is an attractive solution,” he said.

Resolution WHA 58.28 of the 2005 World Health Assembly called on member nations to among other things, develop long term strategic plans for developing eHealth services, provide appropriate legal, regulatory and standards environments, develop the necessary infrastructure and establish national centres and networks of excellence.

Consequently, governments, academics, healthcare analysts and consultants, private as well as public institutions and healthcare nongovernmental organisations must work together to develop long term strategic plans for developing eHealth services in addition to developing necessary e-health infrastructures to save Africans from non communicable diseases.

They must seriously establish national centres as well as networks of excellence if the continent is to be the hub of telemedicine.