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:The Nigerian Doctor

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Telethinking: The Nigerian Health sector

Site Admin, Monday 14 September 2009 - 05:12:01

Dr Olajide Joseph Adebola

eHealth Consultant, CEO Home Plus Medicare Services Ltd
ED, Operations Rose Ego Center for Health Informatics (ROCHI)
President Society for Telemedicine and eHealth In Nigeria (SFTeHIN)

Over the past decade medicine has witnessed a substantial change in technological complexity (Sandeep Shah eHealth the fifth
medical revolution ) and the reduction in cost of information communications technology (ICT) has resulted in a symbiotic
relationship between the healthcare and ICT sector. Globally, the information age as transformed how we rethink, redesign and rework
how businesses and public services operate, aimed at improving productivity, effectiveness and efficiency both internally and in
external relationship with clients, customers, suppliers and partners. Recent advances in information and communication technology
and the dissemination of networked data processing have led to widespread access to information resources and globalization of
communications, businesses and services.

Internet based ICT solutions have brought about the greatest impact and they are rapidly changing the way health organizations,
providers, care plans, payers, regulators
and consumers access information, acquire health products and services, deliver care and communicate with each other. In the health
sector, this trend is express by the growing consolidation of eHealth - an area rapidly growing in health today distinguished by
the utilization of electronic communication and information technology to transmit, store, and retrieve digital data for clinical,
educational and administrative purposes at the local and distance site.

The essence of eHealth is reliable transaction delivery in a fast changing environment involving people, processes and a service or
business infrastructure focused on the ill or healthy citizen. Emerging eHealth applications are oriented to professional networking,
integration of the clinical care process management and provision of web-based health information and patient care including remote
monitoring and healthcare. This expanded view of ICT in health sector has been promoted as the final stage in bringing online the
entire healthcare industry. eHealth solutions have emulated e-commerce and e-government strategies and experiences in using
internet-based networked technologies to provide healthcare services.

Today in Nigeria the use of e-commerce and e-business strategies is already been deployed in major sectors like Banking, Oil & Gas,
Manufacturing etc while the health sector is yet to fully witness the emulations of this tools to provide efficient health services. The
health sector is an enterprise characterized by the use of information for every decision taken. eHealth deployment in our health sector
will provide opportunities for individuals, medical professionals and healthcare providers to obtain information, communicate with
professionals, deliver first-line support especially where distance is a critical factor (telemedicine) and promote preventive medicine
programmes.

Our health system in Nigeria faces so many challenges which can be summarized as; a lack of resources; poor utilization of the
resources available; a high disease burden, driven by HIV/AIDS, Malaria and other infectious diseases, contributing to high infant and
maternal mortality and morbidity; poverty driven by poor health that robs the society of its most productive sectors, while driving up
the birth rate, robbing families of a chance to get out of poverty; shortage of educational capacity in the rural health care settings,
exacerbated by the brain drain of talent to the urban centers and abroad; a lack of capacity to gather and process health statistics with
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which to target health spending and resources. Traditional healers and birth attendants are outside the health care system, but they
have closer relationships with the patients at the village level than do the western oriented doctors and nurses. The combination of
these factors makes the achievement of MDG and the national health sector reform goals unlikely without some creative approaches.

One of the creative approaches is to think along the use of ICT for Health in Nigeria. The health related Millennium Development
Goals 4,5,6 (Health for All) is achievable through ICT enabled interventions such as increased access of rural care- givers to specialist
support and remote diagnosis (telemedicine), enhanced delivery of basic and in-service training for health workers (eLearning) and
increased monitoring and information-sharing on disease and famine (Health portals, Geographic Information System) to mention
few. The next question is do we have the ICT infrastructure to drive ICT for Health in Nigeria?

Despite Nigeria s classification as a developing nation, it has done very well in her telecommunications industry. Nigeria has a
robust telecommunications industry that is the third fastest growing in the entire world (China, Brazil and then Nigeria). Telephony
growth in Nigeria is astonishing and as of 31st December, 2008 recorded a figure of 63 million mobile user base which is 60 percent
increase on its 2007 record. The country has a vital and vitally competitive mobile environment. World Health Organisation (WHO) has
proposed the use of low cost telecommunication tools in healthcare delivery for developing nations. Globally proponents of eHealth are
supporting the use of mobile technology platform like the cell phone (both GSM and CDMA versions) as demonstrated in the UN
Digital Health Initiative in the Millennium Village projects supported by Ericsson mHealth tools.

This popular inexpensive device is owned by roughly half of the worlds population (over 3 billion on record) and in Nigeria over 63
miilion users have been recorded making it the single most important electronic device that has impacted on the peoples live and
social order. When mobile phones are equiped with camera, the ubiquitous device can conceivably be used in remote areas as the
eyes and ears of doctors without the need for an on-site visit.

The new capabilities of modern cell phone are creating new possibilities for healthcare.
The ease of use, mobility, powerful computer functions, and communication capabilities will enable future phones to become the
computing and communication device of choice for consumers, patients, healthcare providers and others. The cell phone is ideal for
promoting the use of ICT for Health in developing nations like Nigeria or remote areas lacking advanced medical equipment and
trained medical specialist. More advanced heavy medical technology equipments used for telemedicine have not been cost effective
due to lack of technical support. They have not been able to sustain the continuity of care once the equipments break down due to the
high cost of maintenance and technical support.

Orascom telecom CEO Mr Naguib Sawiris during an opening ITU telecom Africa 2008 said, a mobile handset attached to the
internet delivers more than just a chance to speak; it offers access to the wealth of information that the internet provides and do not
underestimate the power of this device to change your life . Ms Claire Thwaites, head of the United Nations and Vodafone
technology partnership speaking at the mobile World Congress in Barcelona, Spain recently said that the cell phone technology has
many health applications- so, you might be looking at text messaging to improve awareness about malaria, HIV etc. Prevention or
how to prevent HIV/AIDS: what precautionary measures need to be taken; or you could use mobility to support public health data
collection, campaigns or immunization campaigns. Then you get to more sophisticated uses of mobility to support consultation and
remote diagnosis (telemedicine), as well as being able to communicate with health workers, which there s a huge lack of in the
developing world, she says.

The introduction of 3G technology in Nigeria by the mobile telecommunication industry has ushered in the triple play of voice, video
and data at high speed. Besides phone calls, 3G allows fax transmissions, emails, including large attachments, while on the move.
High speed internet access allows web browsing and fast downloading of data files, software, and image or music files. 3G can be
used for video conferencing and some 3G handsets can also function as personal organisers, with electronic diaries, contact list,and
automatic reminders. Most 3G networks offer global roaming.
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3G will save lives, save time, cut down travelling, save money , change the way Nigerians conduct their daily affairs or activity of daily
living and part of it will include the delivery of medical care. Improved clinical care for example , common access to clinical practice
guidelines will aid standardization of care, and use of specific mobile health applications such as teleconsulting will raise the
confidence and skills of clinicians in rural and remote locations. Greater knowledge sharing: mobile health network with emphasis on
knowledge rather than simply information will ensure greater knowledge sharing. Greater scope for research: interaction through the
network will enhance partnerships and sharing of resources, which will in turn contribute to a greater scope for research.

Greater capacity building in particular, will be strengthened through a mobile network. Administrative resilience: a successful mobile
health network will strengthen administrative resilience. Specifically, the benefits to patients ,health care workers and Nigeria s
health care system includes the following: enhanced access to trained specialist; reduction of patients waiting time; reduction of
patients/health care workers travel expenses; prompt specialist opinion, leading to more accurate diagnosis and treatment
outcomes. It will create new opportunities for continued medical education; more efficient screening of patients; enhanced continuity of
care and reduction in health care costs, reduction in hospital admissions, increased efficiency in the use of human resources. All these
noted benefits have already been experienced in countries that have implemented telemedicine/eHealth programs.
The eHealth space is becoming a promising and attractive addition to the broader and powerful knowledge age world. How can we in
Nigeria forge sectoral, national, regional and global strategic partnership? What deliberate strategy can be adopted to effectively
manage technological investments and allocation of healthcare resources in Nigeria? How can the opportunities offered through
the eHealth technologies be appropriately harnessed in the Nigeria Health sector?

This article is to be continued