Tag Archives: telemedicine

Health Management Systems Rolled Out in Tanzania


In preparation for my health sector presentation next week, I decided to examine how ICTs can be used to improve health in a developing country. But since I have already done a blog post on the Cariopad in Cameroon, a front office technology, I will focus on the back office application of ICTs to improve health system management in Tanzania. “Back office applications,” says Richard Heeks, “help better planning, decision-making, and management” (Heeks ICT Manifesto 2005). After writing my national ICT policy analysis, I learned that healthcare affordability for the patient alone doesn’t improve the overall level of health of a country. The affordability and efficiency of health systems for doctors and hospitals to treat more people at higher quality improves the overall development of the health sector in the long term. For this reason, I will focus on health management information systems in Tanzania.

There have been many ICT health-focused initiatives in Tanzania since the Ministry of Health and Social Welfare (MoHSW) proposed a strengthening of the country’s health information systems (HMIS) in 2000. Two such initiatives, Telemedicine, and eRCH4BC, are examples of how technology can be used to increase communication between doctors and community health workers to treat patients with severe cases who reside in places far from specialists or high quality health care.

Telemedicine in Tanzania enables doctors in remote areas to consult specialized doctors with healthcare expertise and resources in the cities for better diagnoses. “People who can afford it come to cities for their health care in huge numbers and at enormous cost. Telemedicine is beneficial for patients, because they can get specialist consultations and treatment in their own hospital.” Doctors are able to exchange medical data, still images, x-rays, live video and audio over the Internet to a panel of expert doctors in cities. Within a short period of time, they come up with the results and tell the rural doctors what to do. Dr. John Materu of Kibosho Hospital says, “Referral is easier when you can tell the patient the advice that you have got from a specialist-doctor on the right treatment” (IICD video). In terms of efficiency and cost-effectiveness, Telemedicine has the power to transform health development by cutting costs for patients and extending the knowledge of specialists. It seems to be financially sustainable since the Internet-based software is free and training manuals are easily adopted online or through visits from Telemed training institutions. My concerns about the project are the privacy and safety of patients’ information since it is discussed online by a panel of doctors. Also, if the Internet is down for an extended period while someone is in critical condition, there should be a back-up method of communication that doesn’t rely on Internet. Since the project has been able to push funding past their two-year pilot into Phase 2, hospitals are asked to provide funding from their own resources, which also could be a hindrance. Overall though, I am optimistic that Telemedicine is the key to improving HMIS and patient health care in remote areas.

Since I provided a comprehensive review of Telemedicine, I will go into less detail with the second health-focused ICT initiative. “eRCH for better care” was a joint pilot project between Spider and ITIDO from 2011 from 2012 with the objective of improving reproductive and child healthcare systems through ICT intervention in the Rufiji district of Tanzania. Amongst other RCH challenges, e-RCH4B aimed to solve the lack of antenatal check ups and lack of support for community health care workers (CHWs) in rural areas. To solve the former, an electronic record keeping system with both mother and child’s health data made check-ups easier and enabled data transfer data between facilities upon referrals. For the latter, eRCH4BC provided CHWs in with “Tele-maternal,” like to telemedicine but only for mothers, to identify danger signs of women and children “so CHWs can advise them to go to nearby health facilities for more professional care.” It is  significant that civil society recognized the lack of formal education that CHWs have to provide new and expecting mothers accurate diagnoses. I hope the Tanzanian government will catch on too. Although Spider has not yet released the project’s evaluation, I am glad to see initiatives addressing fatalities that could be prevented with ICTs.

Profile: The International Telecommunications Union

The International Telecommunications Union (ITU) is a branch of the United Nations that specializes in ICTs. Founded in 1865 in Paris as the International Telegraph Union, ITU adapted its current name in 1934. In 1947, with the founding of the United Nations, it became an agency within it that specializes in ICTs. The ITU is an agency that works with both countries and the private sector to coordinate with its agenda. According to its website, ITU currently has “a membership of 193 countries and over 700 private-sector entities and academic institutions.”

ITU focuses on development projects, initiatives, and new technologies to fulfill its vision.

ITU focuses on:

  • development projects [such as telebanking and telemedicine]
  • cyber threats to provide security to the world
  • social media
  • many more

ITU vision: “committed to connecting the world”

Telemedicine in Ethiopia

This article, a resource Professor Ports gave to my “Health in ICT” presentation group, is a good case study on the topic of telemedicine. Telemedicine is defined as a healthcare delivery technology where physicians examine patients from distant locations using information technologies. It has been growing in popularity for many reasons because:

  • there is a clear need/shortage of physicians
  • poor infrastructure of clinics in general and access to them
  • physician communication can be increased

As I mentioned in my sector presentation, sub-saharan Africa has less than 10 doctors per 100,000 people. In Ethiopia, for example, there are only 38 radiologists nation-wide, and 30 of them are in the nation’s capital. The country’s lack of infrastructure makes it difficult to provide healthcare as well, and often times when clinics are set-up in rural areas they are ill-equipped, according to the WHO. Since its inception, telemedicine has been able to reduce costs and provide optimal utilization of the healthcare system in many countries. This case study illuminates how telemedicine has been beneficial for cardiac patients, since they would not need to factor in as many travel costs. Other possible benefits of telemedicine may include:

  •  reduced direct and indirect costs to the healthcare sector, patients and providers
  • enhanced equality among citizens, in terms of access to special medical services
  • improved cooperation between specialized care and primary healthcare centers
  • promote the proficiency of physicians and other healthcare practitioners through ICT trainings and conferences

There are many examples of telemedicine in Ethiopia and have been supported by many international organizations and NGOs. There are many stakeholders involved, including the patients, doctors, universities , IT workers, and government and development workers.

While it is true that telemedicine has made significant contributions to healthcare sector of Ethiopia, many major challenges do exist. There are cultural, economic, organizational and technical issues. One example is that, since there are not many specialists in the country to begin with, they do not have much time to set up these tele-sessions. The technologies might also be difficult for the doctors to use. Other obvious barriers to this method of healthcare include the absence of affordable and reliable telecommunications and the power infrastructure. Internet also costs a good deal of money, and might be delayed. With all of these challenges, there must be a strong commitment in order to make telemedicine more mainstream. In this article’s abstract it was expressed that the universities and higher education have a great role in assisting with these sorts of initiatives. How do you think universities can make lasting contributions to projects such as these? What do envision as the future of telemedicine?

Equal Opportunity Healthcare Emerging from ICTs

Gone are the days of going to a doctor’s office– today we live in a world where it is possible, and feasible, to access professional health care services through the comfort of your own home. The field of telemedicine, which is a specialized branch of the broader telehealth category, seeks to improve patient health by opening a two-way communication channel between patient, and provider, no matter the distance.
What used to be seen as an expensive, futuristic way of delivering services has now grown to a common, more cost-effective manner than traditional face-to-face physical examinations. Supplementary technology services, especially video conferencing, that build upon existing radio/mobile telephony ICTs have been key to the growth of telemedicine. Telemedicine uses a unique combination of the following three sects to provide real- time consultations, testings, monitoring and medical procedures over geographical barriers: 1. Remote Patient Monitoring (RPM) 2. Patient Data Storage and 3. Interactive telemedicine.
In recent years, RPM has grown rapidly, allowing for substantial decreases in health care costs. More sophisticated devices allow patients who suffer from chronic diseases to transmit information, like blood pressure or sugar levels, to a central monitoring station from which a doctor can review it and stay up to date with his patient’s progress from virtually anywhere, any time. This data taken from RPM is kept stored in a network of numerous pieces of equipment, each with a unique storage feature. Data stores combine to form a patient’s complete medical history which is able to be backed up, secured, and forwarded to necessary personnel. Telemedicine then employs the use of interactive features, like video conferencing, to allow for a real time patient to provider or provider to provider communication.
Telemedicine has shown promise, especially in places like Kenya, where often times patients die not from their ailments, but rather from misdiagnoses and subsequent mistreatment. Providers can connect with their colleagues in order to ensure a proper diagnosis and correct course of treatment. This is especially helpful when looking at the skill and training gaps between doctors in developing nations and doctors in more developed ones. In this sense, good health care becomes available to those who previously suffered unnecessarily at the hands of poorly trained physicians.
Of course, there are still issues of accessibility in accordance with a nation’s networked readiness, but the future of telemedicine looks bright as we continue to shift our everyday lives more and more towards technological reliance.

Use of e-Health: Teleradiology in Mali

As was made evident during class discussion last week, there is a lot of controversy over whether e-Health and telemedicine are the best ways for countries to currently spend money developing.  One of the major issues many people had with it was that there was a lack of basic infrastructure.. i.e. poor or no electricity/internet.

Through my research on Mali this semester I have found that they are fairly far behind and represent a very low spot in the digital divide.  For example, I could not even find a national ICT plan.  However, they have surprisingly been able to accomplish the teleradiology.  This project aimed to connect rural health centers with the larger hospitals in the Timbuktu, Mopti, and Sikasso.  They established internet connections that successfully enabled specialists in the hospitals to make more accurate determinations of x-ray images. The idea for this project is based on the statistic that “in general half of the generalist doctors make mistakes in interpreting an x-ray, compared to only 5% of the radiologists.”

Although there were some struggles along the way, such as unexpected additional costs and lack of training programs, these have been fixed in the current model for the program.  Now it is possible for people living in some rural areas to get much quicker and reliable information/results. Furthermore, there is now established internet connectivity between the rural areas and the major health/business centers in the surrounding areas.  This should help to decrease the digital divide and encourage others to utilize the internet and increase the amount of internet users in the rural villages.

Source: Teleradiology in Mali

Telemedicine adoption “disappointing’ so far

February 17th, 2012

This article is a general overview of the disappointments of the slow adoption of telemedicine, a provision of healthcare or medical information/services through communication lines or broadband connection. This technology has been around for decades, and while it has great potential for solving problems of global healthcare (especially in developing countries) the adoption of this technology has been less rapid than hoped. Jamie Yap, the author of the article, discusses a few reasons for the slow adoption of telemedicine.

1. One of the most prevalent reasons for low adoption rates was the lack of official government support as well as insurance companies in reimbursing patients for the cost of telemedicine services and devices. Clinical reimbursement is one initiative that would provide motivation for people to use telemedicine services.

2. A lack of broadband penetration in emerging markets such as Vietnam, Indonesia, and the Philippines. Limited availability of broadband networks is also serving as a large infrastructure related obstacles in large, rural populations such as India and China. Low broadband availability also means that there is less awareness among practitioners and patients towards the benefits of telemedicine. This awareness also creates obstacles in a legal sense as some practitioners are reluctant to use telemedicine because of legal issues surrounding possible medical indemnity issues.

3. Patients above the age of 65 experience hesitation or difficulty in adopting this new technology. However, the elderly is a group that could likely experience great benefits from the adoption of this technology.

4. Most telemedicine projects tend to be government-funded initiatives that lack private sector support. This leads to a lack of sustainability in the initiatives once government funds run out. There needs to be a unified effort between government and private sectors in order to promote sustainable telemedicine initiatives.

Hopefully the future of telemedicine will be bright. A new wave of medical school students are being educated in the areas of telemedicine. This new focus in education will help to promote awareness of the benefits and opportunities that telemedicine adoption presents.

Telemedicine adoption “disappointing” so far

The article focuses mainly on the barriers preventing telemedicine to succeed in both rural and urban areas.  Since telemedicine has existed in the healthcare landscape for over a decade now, its adoption efforts in most areas are considered “modest, if not disappointing,” but some believe that as broadband initiatives have become more pervasive on a global level in the past few year, telemedicine has potential to be revived and revolutionized.

Telemedicine now includes doctor to patient phone calls, teleconsultations, videoconferencing, and real-time remote patient monitoring using mobile devices.  These ICT labors have the potential to maximize efficiency in the health care industry, but there are few blockades that come along with its adaptation efforts.

Reasons for low adoption of telemedicine:

  1. Lack of support by governments and insurance companies to reimburse patients for the cost of telemedicine services and devices
  2. Lack in access, awareness and legal understanding
  3. Lack of examples of telemedicine succeeding on a wider scale beyond pilot programs
  4. Standards, regulations to create ubiquity
  5. Needs public-private joint support

Overall, the telemedicine system seems to be supported but not enough for it to be adopted on full scale.  ICT systems like this will not be affective unless they are fully implemented, utilized and sustained with great collaboration between the public and private sectors.