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Telemedicine - Nigeria case study
Telemedicine: Nigeria Case Study
The 2007-2008 Ministry of Health/NigCom Sat-1 Initiative
Nigeria suffers from many of the health problems that plague large swathes of sub-Saharan Africa and those living in tropical zones around the world. Its high population density (167.5 residents per square km, according to the UN, while sub-Saharan Africa overall has a population density of 36.2) make the spread of disease and illness all the more challenging (see maps below for population density in all of Africa and in Nigeria specifically):
Africa Population Density Map
Nigeria Population Density Map (by district)
In 2007, the Nigerian Ministry of Health worked with the National Space Research and Development Agency to embark on a pilot project using telemedicine to improve care to Nigerians living in rural areas, far from the country's professional health facilities. Specifically, the government aimed to capitalize on telemedicine's strengths to offer:
Specialist referral services
Remote videoconference consultations between patients and physicians
Remote monitoring of data
Education about medical problems
Online record-keeping and information databank services
The initiative began with eight remote terminals that would serve as stationary nodes at which patients could access care from medical professionals living in Abuja or Lagos, and a single mobile unit that would travel in more remote areas:
For the technical infrastructure needed to connecting each node and terminal, the initiative relied on NigCom Sat-1, a Chinese-built satellite ordered by the Nigerian government and launched in May 2007. The satellite links also allowed Nigerian caregivers to consult with partners in Europe and the United States in the event additional consultations were needed. Sadly for the continuation of the project, the NigCom Sat-1 failed in orbit after running out of power to due a solar array anomaly. The telemedicine initiative was forced to cease operating at the time. In 2009, the Nigerian government signed a contract with China for a new satellite, which was delivered in December 2011 (unfortunately, little data seems to be available on the renewal of telemedicine programs in the country since then).
However, the program showed great promise during it's short run. Each terminal, along with the mobile unit, was equipped with diagnostic equipment including:
General examination cameras
Image and illumination systems
Ear, nose, and throat (ENT) scopes
The terminals in Owo, Owerri, Gombe, Maiduguri, and Ibadan came online first. Within the first six months of operating, the remote centers had assisted in the diagnosis of numerous cases of malaria and cataracts:
Total patients seen
Cases of Malaria diagnosed
Cases of Cataracts diagnosed
Doubts About Preparedness
A report released shortly after the initiative began demonstrated the enthusiasm of Nigerian health professionals for the potential of telemedicine but raised doubts about their knowledge of how to incorporate telemedicine into their practices and their preparedness to utilize the new medium effectively. Entitled "Knowledge and Perception of Telemedicine and E-health by Some Nigerian Health Care Practitioners," the study was conducted by faculty from the Obafemi Awolowo University in the city of Ife and the University of Ibadan. In the report, the authors noted that despite the enormous promise of telemedicine, the health care providers tasked with operating the program appeared to lack sufficient information and awareness about the medium.
In July 2007, just as the aforementioned telemedicine initiative was beginning, the study asked 200 healthcare providers including doctors, nurses, pharmacists, laboratory scientists, medical records officers radiographers, senior nursing and senior medical students about their knowledge and views on telemedicine. Results indicated that 83 (41.5%) of the respondents had poor knowledge of telehealth and only 42 (21%) were aware of the country’s telemedicine programme. However, 141 (70.5%) responded that they will use telehealth services and 138 (69%) said they will recommend its use to others. Overall, 162 (81%) of the respondents had positive views about the relevance and benefits of telemedicine's introduction to the Nigerian health system.
The study was also interesting for what it revealed about the views of Nigerian caregivers about the quality of health care in the country. Overall, 68 (34%) respondents rated the quality of Nigerian health systems as poor while only 2 (1%) rated it as excellent; 103 respondents (51.5%) said it was fair while 21 respondents (10.5%) viewed it as good.
The survey also pointed to the potential for resistance to telemedicine among medical professionals, a phenomenon not uncommon in either the developed or the developing world as physicians are reluctant to place their trust in new, unfamiliar systems. In response to the question, "Will you use telehealth if necessary?" 141 respondents (70.5%) said yes, but 59 respondents (29.5%) said no, suggesting that nearly a third of Nigerian medical professionals are skeptical about the usefulness of telemedicine.
The authors concluded that these results highlighted the need for wider public education--specifically among the medical community--prior to forming and implementing government policy on telemedicine.
Finally, take a look at the following video, which provides a good overview of the promise telemedicine holds for Nigeria as attested to by many optimistic local health officials and physicians:
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