Challenges and opportunities for telemedicine in Africa

COMMENT

In response to the harsh realities of the ongoing Covid-19 pandemic, the Health Professions Council of South Africa (HPCSA) recently amended its guidelines for telemedicine. Telemedicine is the art of remotely diagnosing and treating a patient. It involves a network of service providers who work with remote clinics using communication technology to connect patients with healthcare workers. It provides on-demand access to healthcare services, with mutual financial benefits to the service providers and the patient.

The telemedicine services available in Africa include neonatal care; maternal and child healthcare; intensive-care services; trauma care; occupational healthcare, especially for farmers and factory workers; mental-health services; geriatric medicine; nutritional health; radiological services and e-pharmacy services. 

Telemedicine has arisen to fill the void created by the dearth of medical personnel in many parts of Africa. More than 400-million people live on the continent with little or no access to healthcare. Half of this population lives in rural areas, but only one-quarter of doctors in Africa are deployed to rural areas. According to the World Health Organisation, there are only four doctors per 10 000 patients in Nigeria, Africa’s richest and most populous country. This hardly compares to physician density of 26 and 28 doctors per 10 000 people in the United States and United Kingdom, respectively.

The future of medicine

Globally, telemedicine is the future of medicine — and Africa is no exception. Limitless possibilities exist to provide much-needed healthcare services to an ever-increasing population, irrespective of location. The travel and gathering limitations necessitated by the Covid-19 pandemic have further heightened the need for innovation. 

Telehealth services in Africa can be delivered through video consultations, telephone calls, text messages and chats. This variety of options allows service providers to cater for the healthcare needs of diverse clients, provided the patients have access to a tablet, computer or even a basic smartphone.

This patient-centred approach provides personalised care while eliminating the risks of long-distance travel and motor vehicle accidents that are commonplace on many of Africa’s poorly maintained roads. Importantly, telemedicine minimises inadvertent exposure to Covid-19 in clinic queues and waiting rooms. 

The growth and mainstreaming of telemedicine in Africa are possible because of the vast human resources on the continent. Indeed, The Lancet medical journal has dubbed sub-Saharan Africa the new breeding ground for global digital health.

However, telemedicine in Africa is currently limited by the availability of basic infrastructure such as steady electrical power, cellular network coverage and broadband internet service. Sadly, most African countries rank among those with the slowest internet speeds in the world. 

In addition, the cost for virtual consultations is currently affordable only to persons in the middle and upper classes of African society. In Nigeria, it ranges between $6 and $26 per session. This may not sound like a lot, but in a country where 40% of the populations live below the poverty line, it makes telehealth services unaccessible to the lower class.

The amended guidelines for telemedicine put out by the HPCSA are a commendable step in the right direction with regards to telehealth policy and governance. Although they are not perfect, the document puts South Africa in a better situation than Nigeria. There is no regulatory body or agency to regulate telemedicine-related matters in Nigeria. 

Currently, in Nigeria, as in most of Africa, the role of government or market actors in the development of e-health has not been explicitly defined by any policy or legal framework. Further, there is also no governance and policy mechanism in place at the national, regional and local levels to ensure implementation, support and monitoring of the strategy. This is also true for matters related to telemedicine and health insurance.

Stakeholder buy-in

To optimise the growth and expansion of telemedicine in Africa we must address the necessary human, infrastructural, delivery, design and policy challenges. 

Patient barriers to accessing and using telehealth services, such as the negative perspective of orthodox medicine residual in some communities, must be addressed using a continuous learning approach. Major stakeholders such as community and religious leaders must be engaged. The technical, clinical and communication processes should be integrated to maximise its potential, thereby improving the service design. This design must also maintain optimal data security protocols. 

Governments must also develop the policies needed to guide the implementation of telemedicine across Africa within the ethical confines of medical practice. Regulation of the scope of care, as well as minimum criteria for practitioners and facilities, are much needed. Effective measures to reduce the per-unit cost of care should be explored. Guidance for assessing the quality of care should be implemented. 

Ultimately, the increase in using teleconsultation must be matched by a commensurate expansion of resources for treatment. Public-private partnerships will be needed to optimise the use of limited financial resources, while harnessing the vast human resources on the African continent for the delivery of telehealth service.

Fejiro Chinye-Nwoko, MBBS, is a global health policy professional and business consultant with Alegna Global Partnerships. She is also a board member for House of Refuge at Freedom Foundation; Nchiewe Ani, MBBCh, FMCR, is a consultant radiologist at the University of Calabar Teaching Hospital, Nigeria. She is also the president of the Pink Africa Foundation; and Utibe Effiong, MD, MPH, is a physician, public health scientist and clinical assistant professor of medicine at Central Michigan University in the United States. He is also a senior fellow at the Aspen Institute.