THE PROMISE AND PROBLEMS OF TELEMEDICINE

Computing

As the 11th annual conference of the International Society for Telemedicine and eHealth drew to a close Wednesday in Cape Town, South Africa, the ability of Africa to adopt and sustain telemedicine to improve delivery of health care in under-serviced rural areas came under discussion.

eHealth enables rural health clinics with no in-house specialist care to obtain expert consultation and diagnosis through various information and communication technologies (ICTs) such as video-conferencing, or the e-mailing of digital images of patients to specialists in urban referral hospitals.

However, telemedicine projects already operational in sub-Saharan Africa show that the region presents several challenges concerning the demands of eHealth technology.

ICTs central to telemedicine tend to be taken for granted in developed countries, but are often lacking in sub-Saharan Africa. Catharine Omaswa of the Ugandan National eHealth Committee noted, for instance, that her country might only have a modern ICT infrastructure by 2025.

A lack of computer skills on the part of health care personnel and limited understanding of the role of ICTs were also cited as pitfalls. All of this leads to a sobering question, said Maurice Mars of the Department of TeleHealth at the University of KwaZulu-Natal in the South African coastal city of Durban: "Are the First World standards of telemedicine going to allow telemedicine to flourish in Africa?"

He also cautioned that telemedicine might not be Africa's answer to health problems because "we may be transferring the problem (of diagnosis and care) from one overburdened doctor to another overburdened doctor" -- this in reference to the shortage of medics across the continent.

Better news, however, emerged concerning Rwanda's telemedicine programme led by the only eHealth specialist in that country, Richard Gakuba. Since the implementation of the programme's pilot projects in 2003, "We have seen better expertise in eHealth service delivery and we have a task force firmly in place," he noted.

The programme is not without problems. But, Gakuba said success had come as a result of the government's strong commitment to the project, evident in the ICT systems installed in some hospitals.

Added Irma Velasquez of the World Health Organisation's (WHO) eHealth for Health Care Delivery Programme, "Telemedicine is impossible without the support of government."

Joanna Fursse of the Brunel Research Group for Health Technologies at Brunel University in the United Kingdom noted further that the sustainability of telemedicine had to be given thorough consideration before projects were started: "Consideration of sustainability factors during the planning stage can reduce the delay of a project."

Every initiative, she said, also needed someone to champion it -- a proponent of eHealth who could spread enthusiasm for telemedicine in the community, and amongst patients and care givers.

Successful implementation of eHealth policies would provide a boost to a continent that currently shoulders a substantial disease burden. Estimates from the Joint United Nations Programme on HIV/AIDS and the WHO show that two thirds of the approximately 40.3 million people in the world infected with the HI-virus live in sub-Saharan Africa.

The WHO further notes that malaria kills over a million people every year, 90 percent of them in sub-Saharan Africa.

Inter Press Service