How do rural communities benefit from e-health?
E-health can benefit rural communities in so many ways. It is only when you are healthy that you can sustain work on the land to provide food and fetch safe drinking water. There is a huge amount of time and labour hours lost due to travelling long distances to specialist hospitals where patients often wait in long queues. The money and effort involved in this process can be better used for other family needs. The important factor is to create access to quality and affordable care and thus improving the overall health of people in rural areas.
Does a rural clinic need to have an expensive computer, internet link and specialized software to take part in an e-health scheme?
I don’t think so. If a rural clinic has a mobile phone that is connected through a dedicated line to a specialist centre then they can quite easily ask for a second opinion and receive significant support in their healthcare provision from a distance.
I think mobile phones will be particularly useful in e-health provision because they are affordable to many people and demand less power to operate which is a major consideration in rural areas with no connection to the main electricity grid.
But cost, in places where resources are already limited, is going to be one of the major challenges for proponents of e-health. Supporters have to convince policymakers to spend money on technology when they are still battling with basic needs like drug supply.
Should governments invest in these basic needs, delivering safe drinking water and sanitation, for example, as well as drug supply, or would the money be better spent on e-health schemes?
There is a need for both. Governments need to invest in safe drinking water and sanitation because these are primary healthcare concerns. E-health is a tool to help achieve the provision of, or support, primary care. Governments need to spend wisely and decide on the priorities of any e-health scheme depending on the needs of the population.
How can e-health reduce the cost of providing healthcare to rural areas?
There are very few studies that have looked specifically into the cost-effectiveness of e-health projects and those that did only reported on small-scale projects. However, the main problems of rural healthcare include access to qualified professionals and the burden on patients who have to travel long distances to see a specialist. E-health solves this by providing timely access to medical experts and removes the need for patients to travel long distances. Put simply, e-health allows increased healthcare coverage to a larger population.
For example, when there is no radiologist present at a rural hospital, trained staff can take a digital picture of the X-ray and forward it via email to a radiologist several hundred kilometres away, and get a diagnosis back the same day [see page 4]. Hospitals can use technology to avoid unnecessary delay in the treatment of patients and that is more cost-effective than paying for a specialist in every health centre.
Can e-health ever be as effective as a physical visit to a doctor?
This is debatable. You cannot replace face-to-face consultation in all clinical practice with technology but the doctor involved in a face-to-face consultation can easily seek a second opinion using e-health techniques in real time. We should not forget that e-health is a tool to compliment face-to-face care rather than replacing it as a new form of care.
Can e-health also be applied to prevent disease?
There is a major role for e-health in preventive care. Today a lot of projects worldwide have demonstrated the use of short message services (SMS) to provide health education and introduce campaign programmes to the target population. In Nigeria, the national AIDS agency uses SMS to send information detailing where patients can receive voluntary HIV counselling, testing and care. Parents are also reminded of immunization days using SMS.
Will taking part in e-health schemes only give busy doctors extra work? Do we still ultimately need more doctors?
The doctor to patient ratio is very low in Nigeria compared to World Health Organization standards. The African Commission said Africa needs to train one million health workers in order to achieve the Millennium Development Goals by 2015. This is not possible even in places with the resources to establish new training institutes. We have to look for alternative means of training and technology can help there too.
We can use the whole range of ICTs to train students on long-distance health courses at under- and post-graduate level. But any e-health scheme has to be planned appropriately, based on needs of the target population and available healthcare workers. We have to be careful not to thin out resources and give too much extra work to busy doctors.
Dr Joseph Adebola is president of
the Society for Telemedicine and e-Health in Nigeria.