SEATTLE, Washington — Lack of access, transparency about the cost of services and quality care are global issues that remain in healthcare. With the advent of the Internet and the rapid expanding access to smartphones, digital resources are at everyone’s fingertips. In fact, 90 percent of the population globally has access to commercial wireless signals. The mass access to mobile and institutional wireless has the potential to widely improve telemedicine in developing countries.
Telemedicine in Developing Countries
Telemedicine is the practice of caring for a patient remotely. The definition has evolved over the years. In 2007, the World Health Organization (WHO) came up with a condensed definition of telemedicine by reviewing 104 journal articles. According to the WHO in 2009, telemedicine is:
“The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities”
Telemedicine in developing countries has expansive potential. It can solve logistical constraints, provide support to weak public health systems and connect global networks of healthcare workers. Initiatives in telemedicine can solve ongoing issues to quality care by providing a cost-effective and reliable solution. Two areas where there have been improvements in telemedicine in developing countries are in developing mobile health initiatives and creating robust country-wide infrastructure to establish telemedicine in resource-constrained rural areas.
Region: Sub-Saharan Africa
Today, a central way that people are engaging in telemedicine is through the use of mobile health monitoring apps. Lately, mobile health, or mHealth, has been increasing dramatically because of its application to reach people who have limited access to health resources, transportation infrastructure and a rapidly expanding wireless network. The World Health Organization reports that “… four in five developing nations throughout the world now offer at least one type of mobile health program to deliver essential health services to the population. ”
mHealth can address health issues such as chronic disease management, behavioral health, infectious disease pandemics, smoking cessation and more. On a day to day basis, mHealth can be medication adherence support, community health worker communication, general health information, guidance on behavior change and emergency response services.
The region of sub-Saharan Africa (SSA) has a doctor to patient ratio that can range from 1:5,000 to 1:30,000. In rural areas and towns/cities where the ratio of doctors to patients is high, mHealth can be particularly useful as a solution for access to health information, consultations and disease diagnosis. Mobile use in sub-Saharan Africa has skyrocketed within the past decade. In 2025, SIM usage is predicted to surpass 84 percent of the population, up from 63 percent in 2012. There is an expansive potential for mHealth in sub-Saharan Africa.
Case Study: Botswana
In Botswana, the ratio of nurses to the population is 29 to 10,000 people with only 3.4 doctors for the same amount. Despite recently being categorized as an upper-middle-income country due to its diamond industry, the World Health Organization (WHO) also classifies Botswana as ranking low in infrastructure and human resources. Although the wealth of the country has increased, only a small number of people in Bostwana benefit from the wealth in the country. The majority of people live similarly to people in low-income countries.
From 2010 to 2013, Botswana launched four mHealth programs in 11 locations, treating 643 patients and training 24 physicians. The four pilot programs focused on women’s health, dermatology, radiology and oral medicine. Each team for each program had an in-country remote specialist, referral site coordinator, international specialist, community health worker and national specialist.
Region – South Asia
More than 23 percent of the world population lives in South Asia. It has the double burden of infectious and non-communicable diseases (NCDs). Due to a remaining lack of computers and smartphones in resource-poor areas the potential mass benefits of telemedicine in the region have not yet reached. Although critical technology is missing to advance telemedicine, the region has vast potential and is scaling up for telemedicine expansion by strengthening health systems and government infrastructure.
Case Study – India
In rural areas in India, 20 percent of the country’s hospitals have to manage to take care of more than 60 percent of the country’s population. Rural areas have the largest potential to benefit from telemedicine due to challenges they face with access to health services and lack of health care professionals to take care of essential health needs.
Although many developing countries have struggled due to a lack of structural support, India is the exception. In 2005, the Indian Ministry of Health & Family Welfare set up a set of guidelines for telemedicine and a National Telemedicine Task Force. In 2013, the Ministry of Health also created a set of telemedicine standards for electronic medical records, which they recently revised in 2016. Setting up guidelines and systemic ways to integrate telemedicine into India’s healthcare system will aid in rapidly scaling up technological solutions to gaps that remain in the country.
Within the last decade, there have been exponential advances in the development of ICTs. Not only has this translated into a reduction of cost but also the spread of technological resources to resource-poor countries or areas. The infrastructure that is required to have a robust telemedicine system is being set up worldwide. Now, more than ever, the benefits of the application of global telemedicine for enhancing the capacity to respond to chronic illnesses, pandemics and gaps in health access are abundant.
– Danielle Barnes