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Telemedicine and Africa

By Amal Bholah Moderator Emeritus | 23 Jun, 2015

Telemedicine holds a great potential improving healthcare services. It improves clinical management, enhance access, quality, efficiency and cost-effectiveness. It can be an access point for the underserved.

In my country, there is no telemedicine service. I have plan to start something.

Where should I start?



Jossy Onwude, MD Replied at 6:10 AM, 23 Jun 2015

Hello Amal,
Your desire to start is the first place to start, thus you have started.
But next step is for you to do a thorough research. What country in Africa
are you from? Cause I got a feeling that there would be someone out there
doing something already(doesn't mean you can also do yours). And if you
find out there is, get intouch with them, learn from them. But dont forget
you will need to have MDs onboard if ever. so build connection and validate
the need for such in your area.

arnab paul Replied at 6:29 AM, 23 Jun 2015

Hello Amal,

Considering the resource constraint of developing countries, it is always good to have a road map. It is commendable that you want to work in this direction. I am enclosing a report by Continua, just the kind of resource you are looking for. though it is a report by IWG Asia task force on Telemedicine, i am sure you will find a starting point in this report. Hope it helps.

Attached resource:

A/Prof. Terry HANNAN Moderator Replied at 6:39 AM, 23 Jun 2015

Before this discussion escalates with an array of inputs i would like to inform all that we conducted a panel discussion on Telemedicine several years ago on GhDonline. I will try and find the location of this as we enlisted international experts to the panel.

A/Prof. Terry HANNAN Moderator Replied at 6:50 AM, 23 Jun 2015

As expected there are resouces going back to 2009. Search in Health IT. I have asked part of the organising committee to see if these can be listed in a pooled resource.

Jai Ganesh Replied at 10:35 AM, 23 Jun 2015

Where are you based? Mauritius? Clinique Du Nord, Mauritius did have a
telemedicine link with Manipal Hospital at Bangalore, India. But that was
good 10 years ago. So you could check with them if it is still functional.

Would draw your attention to the WHO Global Observatory for eHealth survey
(2009) for Mauritius <http://www.who.int/goe/publications/atlas/mus.pdf>
and National eHealth Strategy from Ministry of Health and Quality of Life,
Mauritius <http://health.govmu.org/English/Documents/plan.pdf>.

Roger Downey Replied at 2:06 PM, 23 Jun 2015

Starting a sustainable telemedicine program requires the support of the people who have a voice in government. To get that, you need physician champions and other well-respected leaders. I would suggest you use the island nation of Cape Verde which recently inaugurated a telemedicine program for its 500,000 citizens as a model. Specialty care had only been available at one of the two hospitals on the main island. Now, before making the trip via ferry or plane, residents are seen telemedically to determine whether they need to be seen in person. Also, the nation's program allows timely care of health problems before they become more serious.

Lawrence Wasserman PhD Replied at 2:57 PM, 23 Jun 2015

Telemedicine in Cape Verde

Your comments bringing telemed to Cape Verde can be looked at as case study.

It would be interesting if you can identify and reply to some key points namely.

Need and requirement to provide teleconferencing by changing laws and regulations

If there was health care professionals against telemed like physicians, or medical community

Was the installing costs high as entry into this market?

How was telemed program financed?

How was the telemed program evaluated?

Privacy and security provided?

Lawrence Wasserman PhD
Telehealth and Mobile Health Specialist

Emmanuel Nzabonimana Replied at 1:05 PM, 24 Jun 2015

Hi everyone,I am Emmanuel from Rwanda, The issue of telemedicine are still a problem due to lack of infrastructure
The video conference tools require a good network, but in Africa most of the area have poor connection bundle that affect the implementation of telemedicine. Telemedicine is powerful, and it's resolve many problem all over the world.My concern if Telemedicine implement in Africa ,it's allow case sharing and centred treatment to all health professional all over the world.
The Good implementation of telemedicine require first to have a good network bundle, otherwise have the emedicine with poor network, it can't help.

WooYoung Lee Replied at 2:01 PM, 24 Jun 2015

Hello Amal,
I admire your plan.

Telemedicine has great potential to reshape the medicine.
At this moment I hope to think about 3 things, Regulation, Infrastructure, Prevalence rate of Dominant diseases.
At first we need to study target country's regulation whether telehealth could be possible. And insurance which covers this is another important factor for sustainability.
About infrastructure I am studying new method of care to overcome poor infrastructure. We can choose flexibly mHealth instrument according to infrastructure.
Even though telemedicine can cover variety primary care field, we had better focusing on several prevalent diseases in the aspect of cost effectiveness.
Please feel free to contact me if there are anything I can collaborate on with you.
God bless you.

Best regards
WooYoung Lee,M.D.

Víctor Aravena Replied at 7:12 PM, 24 Jun 2015

Hi everybody.
Is important have the help the nurse together the patient. Telemedicine helps reduce the more specialized medical consultations (the second level). About the technology is important ensure the audio. The other is that the doctor can see the any imagen or report of laboratory (Phone Medicine). When the Doctor needs more information will be necessary use full conference (TeleMedicine).
Is important defined the circuit the attention.

Pratap Kumar Replied at 12:21 AM, 25 Jun 2015

I started health-e-net (www.health-e-net.org) in Kenya to overcome specific limitations of telemedicine that have been raised in this discussion. As Emmanuel points out, reliance on videoconferencing technology is not sustainable - makes it too expensive and unreliable for most parts of developing countries (and developed ones too!). The other challenge is scale - most countries in Africa don't have enough doctors as it is, and therefore hub-and-spoke models of telemedicine are difficult to scale because of the few doctors who can provide telemedicine consultations (Cape Verde is a great example of what is possible though in a more constrained setting). We're therefore working with a large, distributed network that allows doctors like WooYoung to contribute to global telemedicine. The technology we've developed is designed mainly with nurses in resource-limited settings in mind who should be able to easily create and share a detailed medical record (including, as Victor points out, images, labs, etc. that can be easily viewed remotely). Amal, Emmanuel - I'm happy to discuss how you could use this platform.
As for regulation, I firmly believe it will follow implementation. There are very few countries in Africa with regulations around medical data sharing and we should be the ones shaping these. But we will need to demonstrate best practices. Some of the best practices we're focusing on are - data is stored in the country or origin, sharing is completely de-identified, patient access to medical records is maintained, local providers are involved/central to consultations, etc. It'll be some time before regulations around these practices are shaped.
WooYoung - how can I contact you?!

WooYoung Lee Replied at 1:06 PM, 25 Jun 2015

Victor, Pratap I appreciate sharing great ideas. I agree with your opinion.
Here is my personal email address.

Please feel free to contact.

Joaquin Blaya, PhD Moderator Replied at 7:49 PM, 25 Jun 2015

As Terry mentioned, we had a Telemedicine Expert Panel which you can see

it was really interesting and I think could help in your decision. There is
one group there headed up by Antoine Geissbuhler
<http://www.ghdonline.org/users/antoine-geissbuhler/> which could also be
an opportunity to create a project in your country.

Gerente de Desarrollo, eHealth Systems <http://www.ehs.cl/>
Research Fellow, Escuela de Medicina de Harvard <http://hms.harvard.edu/>
Moderador, GHDOnline.org <http://www.ghdonline.org/>

A/Prof. Terry HANNAN Moderator Replied at 7:58 PM, 25 Jun 2015

Joaquin, I have just gone back and reviewed this Panel Discussion and now recall the value of its depth an content. I can highly recommend participants on the current discussion to access the link you have provided then frame their inputs after reading the discussions contents.

Lorna Owens Replied at 4:27 PM, 29 Jun 2015

Footprints Foundation will be using Telemedicine quite a bit in Jamaica. We plan to have doctors working in the NICU in Jamaica do grand rounds with a leading children!s hospital here in Miami.

Ephrem NKUNZABO Replied at 2:12 PM, 7 Jul 2015

Wonderful. Telemedicine is needed worldwide. In Rwanda, we aspire at that

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