What is Telemedicine?
The word ‘telemedicine’ originates from the Greek word “tele”, which means “at a distance”, and the Latin word “mederi”, meaning “healing” (referring to medicine). Thus, telemedicine can be said to literally mean “healing from a distance”. More concisely put, telemedicine refers to the use of information and communication technology (ICT) for diagnostic, therapeutic or health educational purposes, usually in situations where distance is a challenge. Most African countries and many other underdeveloped or developing countries worldwide regularly struggle with the burden of ensuring adequate provision of healthcare services to citizens, due to the fragile health systems of these nations. With the consistent emergence of new challenges to healthcare such as novel disease outbreaks, extreme medical conditions and overpopulation problems, there is a need to employ new approaches to tackling these challenges. Advances in information and communication technology, especially in the aspect of internet use, have been very efficient in bridging the distance gap among individuals, organisations, nations and continents. Applying the concepts of medicine and healthcare to communication technology has birthed the fast-rising era of telemedicine, which is proving to be a very innovative way of handling the distance challenge in healthcare, especially during periods like the COVID-19 pandemic, where minimal physical contact is required.
What are the prospects of Telemedicine?
Over the years, telemedicine has played an important role in bringing medical knowledge and expertise closer to patients over long distances, and has also initiated a shift in the provision of healthcare services from within the regular health facilities all the way to people’s homes. The most common communication pathways in telemedicine involve virtual interactions between healthcare professionals and patients or between two or more health professionals. In situations where a medical professional is confronted with a complex patient ailment, they can simply take a photograph or x-ray and send it via electronic means to a more experienced medical professional, who can then make an accurate diagnosis and send a suitable feedback that will be used for the patient’s treatment. Also, a health professional working in a rural health setting such as a primary healthcare center can communicate with and send back health reports virtually to the health professionals based in urban hospitals or clinics. Patients can now communicate with their health consultants through videoconferencing, emails and other means of virtual communication, thus, reducing the burden of regularly visiting the hospital. Perhaps, the most important use of telemedicine is in the aspect of ensuring a smooth and regular flow of information between rural and urban healthcare facilities. As most rural communities are faced with a shortage of skilled health workers, the application of telemedicine will provide a means through which medical expertise in diagnosis and therapeutics can be virtually brought closer to the individuals in these communities.
Current Applications of Telemedicine
There are many examples of how telemedicine has greatly improved the delivery of healthcare services. A good example is the initiation of the 1998 telemedicine project in Mozambique, East Africa, by the International Telecommunications Union, which involved the use of low-cost tele-radiology equipment to swiftly send compressed images of radiology scans between the central hospitals of two of Mozambique’s major cities, Beira and Maputo. Since then, this technique has been greatly enhanced and is now used for sending out radiology scans in the radiology departments of various hospitals in African countries. Similar techniques have also been used by some medical diagnostic laboratories to virtually process and send test results to patients, while maintaining patient confidentiality. The emergence of the COVID-19 pandemic interrupted a number of healthcare services, such as that of maternal and child health, but this was overcome by employing the use of virtual consultation services where pregnant women were able to regularly interact with their Obstetricians or Midwives via video conferences to avoid missing the required antenatal contacts, and also eliminate the need for having to visit the hospital for medical checkups. Another excellent example of the impact of telemedicine is the creation of the Surveillance Outbreak Response Management and Analysis System (SORMAS), which is an open source eHealth System that processes data on disease outbreaks, control and surveillance, particularly in resource-poor African settings. This platform was particularly helpful during the COVID-19 response in Africa, as most epidemic surveillance officers were able to effectively upload the surveillance reports from their regions on the virtual platform, and also follow the COVID-19 trends and reports from other regions. Many other examples abound that illustrate the importance of telemedicine, especially in the African region.
Challenges of Telemedicine in Africa
The major obstacle to fully establishing telemedicine in Africa is the problem of poor infrastructure. Despite efforts at strengthening the healthcare and communications sectors, a lot is yet to be seen. The effect of this is fully observed in rural settings, where electricity supply is very deficient and network connection is greatly hampered. As a result, virtual communication between health workers and health facilities across rural and urban settings becomes very difficult, if not impossible. An example where this can be quite detrimental is in a situation where epidemiologists carrying out disease surveillance activities in rural communities may encounter a problematic infectious disease outbreak in a local community, but find it hard to swiftly send a report back to the district surveillance headquarters due to problems with electricity supply and internet connection. In a scenario like this, delays in sending out such reports will cause a delay in the necessary outbreak response, which could lead to a quicker spread of the disease. Another barrier to telemedicine in Africa is the lack of technological skill and literacy among health professionals, which is necessary for handling most communications equipment, especially those more complex than the conventional mobile phones.
What are the possible solutions to Telemedicine Challenges?
The very first step to establishing telemedicine is the total involvement of national governments and relevant bodies in all telemedicine-related projects or initiatives in the African region. In terms of health systems strengthening, the focus should not solely be on healthcare facilities, but should also cover feasible alternatives like telemedicine, that will expand the reach of healthcare services to the grassroots. This can be achieved through public-private partnerships, as well as African-foreign alliances to fund, develop or provide the necessary infrastructure for effective telecommunication and healthcare. Also, collaborations between telecommunications operators and healthcare providers should be strengthened, as the reality of telemedicine can only be possible through their combined efforts.
As rural communities always get the short end of the stick when it comes to development, it is necessary for more developmental efforts to be channeled toward the communities in dire need of telecommunication and healthcare services. More telecommunication masts and electrical power lines need to be installed in the communities, and the state of their health facilities needs to be improved. Mobile or fixed ‘telecenters’ can also be established in these communities for ease of access to telehealth services. Provision of these infrastructure will enhance the establishment of telemedical operations in the rural areas, and will also ensure their overall structural development. The problem of expensive internet subscription in most African countries can also decrease the utilization of telehealth services due to the accompanying data subscription costs of most virtual communication platforms such as Zoom, Google Meet, Facebook, etc. A move by African telecommunication companies to subsidize the costs of internet data subscription or provide free Wi-Fi services to citizens will increase people’s level of engagement with telemedical services.
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2. Mbarika VWA, Okoli C. Telemedicine in Sub-Saharan Africa: A Proposed Delphi Study. Available at: https://www.researchgate.net/publication/221183561.
3. Okoroafor IJ, Chukwuneke FN, Ifebunandu N, Onyeka TC, Ekwueme CO, Agwuna KK. Telemedicine and biomedical care in Africa: Prospects and challenges. Niger J Clin Pract. 2017;20:1‑5. https://doi.org/10.4103/1119-3077.180065.