The potential of telemedicine in developing countries
In absentia healthcare has been around for a long time, utilising methods such as smoke signals, the post and two-way radio, but with the help of telephony (in particular mobile telephony), the internet and other IT technology such as satellites the possibilities for medical professionals and healthcare staff to communicate with one another and with patients at great distances has essentially been blown wide open, and hence we have the concept of modern telemedicine.
In developing countries such as South Africa, Nigeria, Kenya, Malaysia and India, where transport and healthcare infrastructure are often extremely poor and so remote districts are greatly underserviced, telemedicine offers a viable and much-needed method of providing remotely dwelling citizens with healthcare services.
The problem however in terms of the degree to which telemedicine can remedy healthcare service and infrastructure shortages is that very often a country or region’s power and IT infrastructure is primitive and/or unreliable. In Southern Africa, for example, the power grid is relatively extensive but supply is critically short, and there are periodic outages. IT-based telemedicine is therefore not as reliable as it would be in a society with a constant energy supply.
Sven Byl, Head of Healthcare for Africa and South Africa at KPMG, recently hosted a Lunch with our Leaders session in which he was asked about the viability of telemedicine in emerging markets. Speaking about Africa, Sven replied:
Telemedicine is very important, but we require the IT backbone to support it. This requires high speed internet and that is not always available. So, we need to think about lower tech options like sending medical information in smaller data packets via SMS to remote locations. Some of this is already happening whilst we await for fast internet to arrive.
The power of mobile telephony
Unlike in the developed world, where HD video conferencing is easy and endeavours are advancing to the point of providing digital screening and other gear within ambulances for transit telemedicine, Africa requires context-specific solutions that take into account its underdeveloped infrastructure and healthcare sector.
Mobile telephony has soared to unexpected levels across the continent and is arguably the most viable means for widespread and inclusive telemedicine in Africa. An SMS sent to a rural patient, for instance, to remind them to take their meds or to come for a follow-up appointment is a good example of a very real, sustainable telemedicine solution within the African context.
Case study: Kenya
In Kenya, like in many African nations, access to health and medical care is unequally distributed. Generally speaking, the Central Province and Nairobi are deemed to have the best facilities, whereas the North-Eastern Province is the most underdeveloped. Poor people in rural areas who are ill and choose to seek care usually only have the option of treatment at primary care facilities. These facilities are often under-staffed, under-equipped and have limited medicines. Among those Kenyans who are ill and do choose to seek care, 18 percent are hindered by the long distance to the nearest health facility. It is in this context that telemedicine is so important.
M-health (telemedicine based on the use of mobile phones) is gaining much traction in Kenya, where mobile operators such as Safaricom and Airtel have in recent years been enjoying enormous success and increasing mobile penetration to unprecedented levels. At present the country’s mobile penetration stands at roughly 75 percent. Internet penetration is half that figure, fixed line subscriptions are in decline, and connectivity to the national power grid stands at only about 30 percent, highlighting the supremacy of mobile telephony in any national or NGO-based telemedicine strategy.
Many telemedicine projects are under way in Kenya, many enjoying measurable success in areas such as malaria prevention and treatment. Mashavu, for instance, which means chubby-cheeked in Swahili, is an initiative that has been utilising kiosks to offer rural citizens ‘e-visits’ to the doctor; kiosks, manned by trained professional volunteers, offer the chance for remote-dwelling individuals to undergo basic diagnostic tests. The results of the test are then electronically sent to a doctor who can say if a consultation at a healthcare facility is necessary.
M-health is helping to improve and streamline national healthcare efforts in Kenya. Clinics embracing m-health initiatives do not need to refer visitors to larger hospitals, cutting down on travel time and costs for the patient. They also allow for better distribution of patient load and so avoid bottlenecks at larger hospitals. Furthermore they are aiding in the timely and effective distribution of medicines, leading to an overall improvement in the national healthcare service.
There is clearly much growth room for mobile and software solutions companies within the telemedicine industry, particularly in developing nations like Kenya where mobile technology has overstepped some of the ‘gateway’ technologies used in the developed world and supersedes in feasibility technologies such as the video conference, which require a stable, high-speed internet connection.
While telemedicine is the new frontier for healthcare, presently, in the developing world, m-health is the key division of it in terms of allowing clinical healthcare to reach patients living remotely and lacking the resources to access far-away, expensive healthcare.