Africa should spruce up its e-health services to ensure improved access to health services as a fundamental human right, argued delegates at the IST-Africa Conference in Windhoek, New Era reports.
By Catherine Sasman
It is estimated that more than 33 million people are HIV infected, and that 90 percent of these people are living in settings with limited resources. In Africa, this health pandemic is considered the most important health challenge.
By December 2003 the World Health Organisation (WHO) and the Joint United Nations Programme on HIV/AIDS launched the ‘3-by-5’ initiative to help low- and middle-income countries provide treatment to three million people living with the disease by the end of 2005.
According to Maria Zolfo from the Institute of Tropical Medicine (ITMA) in Belgium, although the ‘3-by-5′ target has not been met yet, the global efforts to scale up access to anti-retroviral treatment (ART) has brought positive changes worldwide.
At the end of 2006 more than two million people living with HIV are treated with ART in low- and middle-income countries.
“Telemedicine is a way to assist delivery of care in remote areas,” said Zolfo.
Telemedicine is considered as one of the fastest growing areas of information, communication and telecommunication (ICT) applications that are used in the health sectors for services enhancement.
It started in the 1920s, but has since evolved, and its use in developing countries is reported to be on the increase.
According to studies, it offers a wide range of benefits, including accessibility to health services, efficiency, improved professional education, quality control of screening programmes and reduced healthcare costs.
With the necessity to support doctors in low resource settings to treat patients with newly introduced ARTs and to offer good standard of care for opportunistic infections, Zolfo said the ITMA – a leading institute providing training, research and assistance in tropical medicine and health care in developing countries – has introduced and set up a computer aided training programme for healthcare providers working in low-resourced areas.
Telemedicine advice has initially been through an e-mail network but later through a discussion forum on a telemedicine website.
“Patient’s history, physical examination, laboratory findings and questions to be answered are sent to a HIV/AIDS specialists’ network using this discussion forum on the telemedicine website. All postings submitted to this discussion forum are stored in an electronic database and available for consultation,” explained Zolfo.
The telemedicine website, she said, respects the Health On the Net Foundation Code of Conduct, which is elaborated to standardise the reliability of medical and health information on the web.
The intent of the use of the technology, she said, is to guide doctors in scaling up the ARV process and HIV/AIDS patients care.
This is one of the initiatives highlighted at the IST-Africa 2008 conference in Windhoek where participants deliberated areas of cooperation between the European Union and African partners for the development of a robust information, science and technological landscape in Africa in various fields.
As far as the health sector is concerned, said Dusan Soltes from the Comenius University in Slovakia, there exists a “natural urgency” for more attention on the health sector as far as the ICT connectivity is concerned.
“From the EU [European Union] perspective, this is mainly due to an aging population and the necessity to extend the productive age and offer a better and more accessible health care services; in Africa is it mainly to fight against HIV/AIDS and other endemic diseases such as malaria that in some regions on the continent have already almost wiped out a rather significant portion of the population in the most productive age, leaving a lot of orphans to be cared for by their grandparents. Hence, although for different reasons, it is a common task for the EU and the AU [African Union] to join forces for further development of the health care system and e-health as one of the fundamental human rights for their people,” Soltes said.
A major obstacle, however, is the level of development of e-infrastructure in different African states as a basic technical precondition for maximum utilisation of what e-health can offer.
Soltes said for a practical implementation of e-health systems, necessary legislation and organisational preparations should continue, which includes parallel activities for greater public awareness of health services as a fundamental human right.
Such a campaign, said Soltes, should be launched by the AU in close cooperation with the African, Caribbean and Pacific institutions “without delay”.
Soltes proposed that at least five to six percent of the budgetary expenditure in all AU States should be dedicated to the needs of a modern e-health orientated health care, where e-health is “definitely the only alternative for any potential success in improving the health care services according to the requirements of the international law on health care”.
Further, said Soltes, AU States would be advised to introduce “as soon as possible” an AU system of (electronic) medical records as a basic precondition for further progress in e-health, telemedicine, and health cards.
“Sooner rather than later the AU will be challenged with the higher migration and freer movement of persons within the entire AU. Without such a system of e-records, doctors are just hesitant to accept these cards for some kinds of medical treatment if they do not know the medical history, previous treatments, medications, and so on of that patient,” Soltes said.
An e-health system, Soltes said, would further combat fraud in the health care domain.
In Europe, Soltes reported, fraud in the health sector amounts to an annual loss of between 30 to 100 billion Euros.
“[It] is even more dangerous in Africa with its still rather limited resources available for health care services,” Soltes said.
“On the most general, strategic level of the whole AU, it is necessary to develop a new full-fledge common health policy based on principles of the widest possible utilization of e-health,” Soltes maintained.
In Namibia, said co-authors Meke Shivute, Blessing Maumbe and Vesper Owei of the paper “The Emerging ICT Use Patterns for Health Service Delivery in Africa: Evidence from Rural and Urban Settings in Namibia”, health service providers in both private and public institutions should have the ability to use ICTs which will subsequently influence the delivery of services to patients.
Equally, they said, patients too should use relevant ICTs to support and improve their access to health facilities.
A number of concerns, however, remain in the country.
The authors said the degree to which health care providers and patients use available ICTs remains largely unknown.
The pattern of ICT use in the Khomas and Oshana Regions showed varying levels of awareness and access.
In the Khomas Region, the researchers found that while some patients said they cannot use some of the ICTs – such as computers or Internet – most did not use these, saying the technology was either too advanced or that they did not have access to these.
Conversely, 100 percent of those subjected to the study said they used the radio and 99 percent used a telephone or a mobile phone.
Eighty-three percent said they mostly use radio and 74 percent they use television for health related services.
In the Oshana Region, there was a lower indication of the accessibility of computers and Internet services than in Khomas.
Not surprisingly then, health care providers said they provide health education to patients by using videos and films to inform patients about diseases.
Perceived benefits from ICT use in the health sector were improved two-way communication; greater support to patients in especially remote rural areas; assistance in the early diagnosis and research on patients; improved assistance to patients; and cutting traveling costs to health facilities for data collection, among others.
While there was complete consensus that ICTs would assist in accessing health information, there was a concern that the cost of ICTs remains a major hindrance to the use of such technology.
The researchers recommended that health service functions be supported through mobile technologies given the high phone penetration, and continued use of radio and television for health information.
But, the researchers said, like the ICT policy for the education sector aimed at greater effectiveness and integration of ICTs in that sector, a similar focused ICT policy is envisaged for the health sector.