The berth of telemedicine
The Coronavirus pandemic which crept up on the entire world and grounded the economies of even the most developed of nations and totally overran the world’s most sophisticated and robust health services, exposed a need for greater application of technology in the Nigerian health sector. Trying to take the fight to an invisible enemy, which is what the virus is, and endeavouring to both treat and contain the spread of the virus, really brought this urgent need to the fore. Technology was beckoned upon to bridge the gap and widen accessibility to health services.
Telemedicine first emerged over forty years ago is not a new concept in Nigeria either but the renewed focus has been turned to it and other technological advancements in recent times, to provide better and more efficient health services to the country’s citizens.
Melissa Conrad Stöppler, MD, chief medical editor of eMedicinehealth.com a WebMD Inc. company defines telemedicine in a paper she titled Medical Definition of Telemedicine on March 21, 2021, as, “the use of medical information exchanged from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care. Telemedicine includes consultative, diagnostic, and treatment services”. Telemedicine consists of multiple benefits, some of which are; wider access to medical services by reaching those in locations that would otherwise have been too remote to reach; provision of timely medical services while reducing or totally eliminating physical interaction between doctor and patient, thereby containing the spread of a deadly virus; cost-effective and cheaper service as movement cost does not come into play and hospitalization is reduced; medical assistance is just a phone call, video call or an email away, making it a fast and easy service to employ; interestingly, records have shown that telemedicine has been outperforming traditional services in areas such as intensive care and mental health, so improving the quality to medical services. Telemedicine has generally gained much popularity with patients, their families, and even with communities because without having to endure long-distance and sometimes very stressful travel, patients have been able to receive much-needed medical attention.
In the early days of the pandemic, cases of Coronavirus surged in Nigeria and specifically in Lagos State and this led to Lagos State Government, through the Lagos State Health Management Agency (LASHMA) launching it is own telemedicine outfit, Eko Telemed, on April 21, 2020; albeit a temporary service. It was an eight-week initiative only. The 24/7 healthcare service for Lagos State residents was set up to cater for only non-COVID-19 health issues. The Director-General of LASHMA, Dr. Emmanuella Zamba, revealed that the purpose of the outfit was to reduce the risk of residents contracting the deadly virus by limiting their exposure to it. By providing toll-free lines which residents could use to contact experienced physicians, Lagos residents enjoyed receiving competent and helpful consultation from the comfort of their homes and they were referred to designated Healthcare Providers under the Lagos State Health Scheme (LSHS) or preferred Healthcare Providers, in cases where further medical attention was needed.
This efficient and timely service delivery will in turn dramatically reduce delays typically suffered in trying to book appointments and the need to endure the stress of travel to see a doctor or nurse.
Though probably the most successful, the Lagos State Eko Telemed wasn’t the first government telemedicine initiative in Nigeria. The Federal Government, through Lagos University Teaching Hospital (LUTH) had introduced its own telemedicine service on April 4, 2020. It is also significant to note that almost a decade earlier; the Federal Government had commissioned an ill-fated pilot telemedicine scheme. The NigComSat-1 Telemedicine project, berthed by the Ministry of Science and Technology in conjunction with the Health Ministry, used satellite-based technologies. The satellite was to provide an efficient medium for transmitting heavy streaming video and audio signals required in Telemedicine, as well as transmitting bio-signals and patient images from the telemedicine centres to the base stations.
The objective of the project was to provide effective emergency healthcare and home monitoring solutions. Unfortunately, it never really saw the light of day, as it was scrapped due to inapplicability and horrendously high costs.
The private sector however has witnessed the take-off of several telemedicine initiatives and many of them have been extremely successful. One of these being the Glo-Telemedicine Centre, a collaboration between Nigeria’s Globacom owned Global Resources and Projects, with healthcare providers in the US, Egypt amongst other countries, which was established in 2011. The cost of private sector schemes however renders them inaccessible to the majority of the Nigerian population.
As a further illustration of how the use of technology can be employed to bridge the health service gap, we need to look no further than the Rwandan example. As a first step, the Rwandan Government embarked on an aggressive nationwide digitisation project by investing in a broadband infrastructure that now covers 90 percent of the country and has also ensured an impressive mobile phone penetration of over 75 percent of the population. This provides the foundation that made other technological initiatives possible. In concert with the Partners in Health group, the government then developed electronic health records (EHR) and services for HIV patients in 2005 before going on to include all clinical records. Building on this intent to rely on technology to drive its health sector and improve the overall quality of its services, the government, in March 2020, entered a ten-year deal with the UK-based remote consultations provider, Babylon Health. This collaboration which is in the process of creating the world’s first digital-first universal primary health care service will ensure all Rwandan citizens above the age of 12, have access to consultations with physicians using their mobile phone as the medium. This efficient and timely service delivery will in turn dramatically reduce delays typically suffered in trying to book appointments and the need to endure the stress of travel to see a doctor or nurse. What makes this innovation particularly fascinating is that its operators are pulling out all the stops to make sure the majority of consultations are done via texts and voice calls to guarantee maximum accessibility to all; so no one is precluded simply because they are not connected to the internet. To further ensure all and sundry can benefit from it, the service will be paid for through Rwanda’s celebrated Mutuelle de Santé community-based insurance scheme. This program is one world’s first that Africa can be proud of and it is actually just an expansion of an earlier collaboration with the government of Rwanda which since its 2016 launch, has registered two million users and successfully provided over one million consultations. Babyl, the 2016 precursor project is actively supported by the Bill and Melinda Gates Foundation.
Changing the nation…one mind at a time