By CHARLES SIMENGWA –
THE digital revolution is bringing sweeping changes to many areas of life in both developed and developing countries.
As a report in The Economist – in October, 2014 – observed, the modern digital revolution, with its hallmarks of computer power, connectivity and data ubiquity, has brought iPhones and the Internet, not crowded tenements and cholera.
Information and Communication Technologies (ICTs) have taken on a new, positive energy, and are introducing a whole fresh range of service delivery.
Zambia has benefitted immensely from the digital revolution, and more rewards are yet to be felt by communities around the country.
Consider the case of Zamtel, which has moved out of the shadows of its day-to-day business by launching the tele-doctor health service.
This is a service that will connect patients and medical doctors in order to deliver cost-effective health services through mobile phone technology.
Tele-doctor will help push health service delivery forward, more so that Zambia, like other developing countries, is grappling with a poor doctor-patient ratio.
This is worsened by the limited physical health infrastructure which does not adequately cater for modern medical services.
In his foreword to the National Health Strategic Plan for 2011-2015, Health Minister Joseph Kasonde wrote that since 1992, the Zambian Government had been implementing significant health sector reforms aimed at strengthening health service delivery.
The reforms have yielded good results in form of strengthened health systems, improved access to healthcare and better health outcomes as reported in the 2007 Zambia Demographic Health Survey.
However, these achievements are yet to put Zambia on course to achieve the Millennium Development Goals (MDGs) by this year.
The country has remained under much pressure to further reduce the disease burden and improve the health status of the people.
The plan has been an attempt to significantly impact on service delivery and accelerate the attainment of the MDGs and other national priorities.
According to the situation analysis in the plan, Zambia has a high burden of disease which is mainly characterised by high prevalence and impact of communicable diseases, particularly malaria, HIV/AIDS, and tuberculosis.
There is also high maternal, neonatal and child morbidities and mortalities. The country is also faced with a rapidly rising burden of non-communicable diseases, including mental health, diabetes, and cardio-vascular diseases.
The main objectives of the National Health Strategic Plan include reduction of the under-five mortality rate from 119 deaths per 1,000 live births to 63 deaths per 1,000 live births by this year.
It also focuses on the drop of the maternal mortality ratio from 591 deaths per 100,000 live births to 159 deaths per 100,000 live births by 2015.
Other objectives are to increase the proportion of rural households living within five kilometres of the nearest health facility from 54.0 per cent in 2004 to 70.0 per cent by this year.
The reduction of the population/doctor ratio from 17,589 to 10,000, as well as the lowering of the population/nurse ratio from 1,864 to 700 by this year, also formed part of the targets.
The launch of tele-doctor has, therefore, come at the right time when crucial interventions are needed to improve the health sector.
Since ICT usage is rising steadily in Zambia, the tele-doctor health service, which draws from the broader concept of tele-medicine, will mitigate some of the challenges patients face.
Tele-medicine is the use of telecommunication and information technologies to provide clinical health care at a distance.
It helps eliminate distance barriers and could improve access to medical services that would often not be consistently available in distant rural communities.
Tele-doctor seeks to provide easy access to health information using mobile phone technology, to provide easy and quicker access to qualified health professionals, to facilitate rapid referral service to established health institutions, and to provide options for home consultations for patients and their families.
It will target all members of the public with access to mobile phones, as well as tourists visiting Zambia.
A database on common health problems in Zambia will be developed and responses to these problems will be given.
The aim is to provide information as quickly as possible, and to suggest the next course of action.
Members of the public could text a special number with questions and then immediately receive a set of options which they could click to get what they want.
ICTs are already enabling specialist doctors and medical staff at Maina Soko Military Hospital and Mount Eugenia Health Centre of Zambia Air Force in Lusaka West to conduct live tele-medicine sessions between the two hospitals.
This technology allows interaction via live video link by providing real-time healthcare consultation services.
It stores data for the patient while capturing video and photos which are later sent to medical consultants for diagnosis and follow-up treatment.
Tele-medicine is particularly beneficial for rural and underserved communities in developing countries.
According to the World Health Organisation, access, equity, quality, and cost-effectiveness are key issues facing healthcare in both developed and less economically developed countries.
Modern ICTs such as computers, the Internet, and cell phones are revolutionising how individuals communicate with each other, seek and exchange information, and enriching their lives.
These technologies have great potential to help address contemporary global health problems.
Zamtel chief executive officer, Mupanga Mwanakatwe says although Government is working hard to address healthcare challenges, access is still low, especially among the rural population.
Dr Mwanakatwe said, during the launch of tele-doctor in Lusaka recently, that the gap in the delivery of quality healthcare service had created an opportunity for e-health services using ICTs in order to better serve both rural and urban communities.
He said Zamtel would play a major role in creating platforms through which patients and doctors would be able to interact for purposes of accessing health services.
Tele-doctor chairperson, Wilfred Mutale said the doctors who would be handling all calls are licensed to practise in Zambia.
He said the service would help reduce overcrowding in hospitals and would also help facilitate coordination and referral of patients across the health sector, linking them to appropriate care.
Medical Association of Zambia president, Aaron Mujajati said the tele-doctor service had come at the right time when e-health was being embraced globally.
The innovation has been welcomed by Government, which is eager to see improved healthcare services in the country.
Community Development, Mother and Child Health Minister Emmerine Kabanshi said Zambia should come up with innovative ways to reach expectant mothers with crucial messages that would facilitate safe delivery for both the mother and the newly-born.
Ms Kabanshi, during the launch, said the tele-doctor service would complement Government’s efforts in improving maternal and new-born survival in Zambia.
The real challenge in remote areas has been access to qualified medical personnel and long distances women travel to get even the most basic advice.
Therefore, the introduction of a call service centre would help lessen the hardships women go through.
Tele-medicine may be a nascent concept in Zambia, but it has been in existence in the developed world, and has grown to include a number of features.
According to the American Tele-medicine Association (ATA), tele-medicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.
Starting out over 40 years ago with demonstrations of hospitals extending care to patients in remote areas, the use of tele-medicine has spread rapidly and is now becoming integrated into the ongoing operations of hospitals, specialty departments, home health agencies, private physician offices as well as consumer’s homes and workplaces.
Tele-medicine is not a separate medical specialty. Products and services related to tele-medicine are often part of a larger investment by health care institutions in either information technology or the delivery of clinical care.
Even in the reimbursement fee structure, there is usually no distinction made between services provided on site and those provided through tele-medicine and often, there is no separate coding required for billing of remote services.
Patient consultations via video conferencing, transmission of still images, e-health, including patient portals, remote monitoring of vital signs, continuing medical education, consumer-focused wireless applications and nursing call centres, among other applications, are all considered part of tele-medicine and tele-health.
Tele-medicine is closely allied with the term health information technology (HIT). However, HIT more commonly refers to electronic medical records and related information systems while tele-medicine refers to the actual delivery of remote clinical services using technology.
ATA states that sometimes, tele-medicine is best understood in terms of the services provided and the mechanisms used to provide those services.
Some examples include primary care and specialist referral services, which may involve a primary care or allied health professional providing a consultation with a patient or a specialist assisting the primary care physician in rendering a diagnosis.
This may involve the use of live interactive video or the use of store and forward transmission of diagnostic images, vital signs and/or video clips along with patient data for later review.
With such delicate features, Zambia stands to draw immeasurable benefits from the tele-doctor innovation being spearheaded by Zamtel.