Telemedicine and its Application

in Sub-Saharan Africa

OGUNFOWORA OLUMIDE TAIWO

TelemedicineTelemedicine (also known as e-care) is the remote delivery

of healthcare services over the telecommunications infrastructure. Telemedicine brings health care access to rural locations by enabling practitioners to evaluate, diagnose and treat patients remotely using the latest telecommunications technology. Telemedicine allows patients to receive expert medical care without having to travel.

Main components

Successful telemedicine requires appropriate

equipment and some kind of telecommunications

medium. However, successful telemedicine requires

more than just technology. The three essential

components are:

• Skilled personnel

• Technology

• Perseverance

Main CategoriesTelemedicine can be broken into three main

categories:

• Store and forward

• Remote monitoring

• Real-time interactive services.

Store and forwardStore and forward telemedicine involves acquiring

medical data (like medical images, biosignals etc.) and

then transmitting this data to a doctor or medical

specialist at a convenient time for assessment offline.

It does not require the presence of both parties at the

same time. Dermatology, Radiology, and Pathology

are common specialties that are conducive to

asynchronous telemedicine

Remote monitoringRemote monitoring, also known as

self monitoring or testing, enables medical

professionals to monitor a patient remotely using

various technological devices. This method is

primarily used for managing chronic diseases or

specific conditions, such as heart disease, diabetes

mellitus, or asthma

Interactive telemedicineInteractive telemedicine services provide real-time

interactions between patient and provider, to

include phone conversations, online

communication and home visits. Many activities

such as history review, physical examination,

psychiatric evaluations and ophthalmology

assessments can be conducted comparably to those

done in traditional face-to-face visits

Why Sub-Saharan AfricaSub-Saharan Africa is, geographically, the area of the

continent of Africa that lies south of the Sahara

Desert. It is made up of 48 countries.

• By the end of 2001, an estimated 40 million people worldwide—2.7 million under age 15—were living

with HIV/AIDS. More than 70 percent of these people

(28.1 million) live in Sub-Saharan Africa. Another

killer, malaria, is responsible for as many as half the

deaths of African children under the age of five. The

disease kills more than one million children each

year—2,800 per day—in Africa alone. As such

statistics demonstrate, the need for medical care in

Sub-Saharan Africa is paramount.

• Sub-Saharan Africa has fewer than 10 doctors per 100,000 people, and 14 countries do not have a single radiologist.

• The specialists and services that are available are concentrated in cities.

*Data from the charts come from the World Bank and World Health Organization

Benefits• Telemedicine overcomes the barriers of physical

distribution of medical resources by bringing medical

personnel and expertise virtually to those who need

them

• Medication Adherence; SIMpill

• Health Worker Communication

• Health Education

• eEmergency and Disaster Response

Current InitiativesPan-African telemedicine initiatives

• The New Partnership for Africa’s Development

(NEPAD) by the African Union

• The Pan African e-network project is another one and

so far the biggest project for distance education and

telemedicine in Africa resulting from the growing

partnership between India and Africa.

• HEALTHNET is the most developed Africa-wide

initiative, which aims at improving the practice of

telemedicine among health professionals. It is

currently implemented in 20 countries.

Projects within countries

• RAFT started in Mali and has extended to 10 African

French speaking countries

• Rwanda has also initiated a telemedicine project to

address its major challenge of few doctors and other

health service providers.

• In Uganda attempts to telemedicine infrastructure

appears substantive and will call for sustainability and

scalability.

• In Nigeria, efforts are underway to design and

implement telemedicine infrastructure.

Barriers to Telemedicine in Sub-Saharan Africa

• Lack of budgets largely due to absence of

telemedicine policies at national and regional levels

• Poor technology support; connectivity to the rural

areas that are most in need of support

• Pan-continental shortage of medical personnel

• Low computer literacy rate among health

professionals

• Lack of training in telemedicine

• Continuing regional conflicts in Africa

Future Direction• There is a need for telemedicine training throughout Africa,

as, without it, telemedicine practice will remain the domain of a few enlightened enthusiasts.

• The use of international projects such as the Swinfen Charitable Trust, iPath, RAFT and the new Pan African Telemedicine Project will assist the introduction of telemedicine, but, unless substantial use is made of these services, they will not make a major contribution to improved health care in Africa.

• Problems such as international cross-border practice of telemedicine have not yet been adequately addressed, nor have questions of international and ethical standards for the practice of telemedicine. Africa needs to solve these problems so that they do not impede further progress.

• For telemedicine to be of assistance in Africa, there

needs to be greater government will to embrace

telemedicine, changes in telecommunication policies,

provision of affordable bandwidth, and the

development of sustainable and affordable rural

telemedicine solutions. This will require substantial

external assistance, goodwill and perseverance.