eHealth and the Digital Divide: An African Solution
The Head of Tele-health and the Acting Head of the department of Physiology, Professor Maurice Mars delivered his inaugural lecture on the 20 August 2003 at the Nelson R Mandela School of Medicine. Titled 'eHealth and the Digital Divide: An African Solution, 'Professor Mars said that this title encapsulates what is expected of him in the new department of Tele-Health at the Medical School'.
At the Inaugural Lecture, Professor Mars explained that eHealth is the coming together of computer science, medicine, and the use of information communication technology (ICT) for healthcare delivery, education and the management of patient information, which is linked to public health, epidemiology and biostatistics.
Modern Tele-Medicine began on March 10, 1876 when Alexandra Graham Bell successfully used the telephone. Said Professor Mars, "The advent of the telephone followed by the radio, television, the computer, satellite communication and more recently the cellular phone has led to a point where telemedicine has the potential to take off and work in a meaningful way".
The digital divide describes the division of the world into people who do and do not have access to, or the capability to use modern information technology. The digital divide also exists between the educated and the uneducated, economic classes and more or less industrially developing nations.
It was pointed out that two thirds of the cases of HIV/AIDS are in sub-Saharan Africa and that Africa does not have the medical capacity to cope with this problem. In addition there is already a shortage of doctors in sub-Saharan Africa. Healthcare is given lower priority in Africa, with the percentage of GDP allocated to health ranging from one fifth to one tenth, that of the first world nations. As a result, some countries spend less than $10 per capita per annum on health.
So is ICT a possible solution to Africa's Medical and Medical Education Problems?
Mars made the point that technology should only be used to solve a problem and not for the sake of using technology or being seen to be using technology.
There is however a certain allure in the concept of Tele-Health which could in one stroke be the panacea that reduces the problems of declining numbers of medical practitioners, and the increased burden on under resourced state health infrastructure. Telemedicine would improve rural healthcare by allowing doctors to get advice and second opinions and increase the availability of scarce specialists. This would then reduce unnecessary transportation of patients over long distances and effectively reduce the doctor shortage. At the same time education can be provided over the same infrastructure and research in rural areas can be facilitated. However can one justify the cost of infrastructure and the on-going cost of ownership against the provision of drugs and other hardware such as x-ray machines in small hospitals?
The fee for service model of telemedicine is not yet viable. Set up and maintenance costs and problems with acceptance of telemedicine by health funders presently dictate that internationally, the cost benefit ratio is not yet in favour of telemedicine. Telemedicine is expensive and uses high technology tools and telemedicine and tele-Education as practiced in the developed nations is largely too expensive for the poorer countries. Cheaper and simpler solutions need to be found. Mars discussed simple store and forward low tech solutions to telemedicine using digital camera images and the internet. As a solution to the shortage of doctors, several local telemedicine projects were described in which extra medical capacity in countries such as Cuba and the United States can be used to service rural hospitals in KwaZulu Natal.
A related problem to the shortage of doctors in Africa is the shortage of doctors to train more doctors and information technology is a possible solution to the African problems of medical education. Said Professor Mars, "One way would be through the formation of a co-operative of medical schools based around regional nodes of Information technology excellence. Shared teaching materials would be stored electronically on a database, which can be easily accessed. Appropriate regional specific teaching materials could be delivered on line or to stand alone PC隆娄s through the provision of disks or CD隆娄S and a web browser".
Looking at local lessons already learned in Tele-Health Mars identified the following issues The folly of turning the economic dictum of 'supply and demand' to 'supply without demand'. Having supplied appropriately, the key is training, especially as staff turn over can be high.
Rapid on site maintenance is required to keep enthusiasts going.
A trend among some healthcare workers says that telemedicine is not in their job description and they will not take on extra work.
Educational Issues: By setting up co-operatives of medical schools who will share educational materials in a database, that will allow them to convert material to meet local demand.
Aspects of patients service, the shortage of doctors and the issues around fee service can be approached through low tech store and forward telemedicine that requires only a telephone line, modem and a low end computer.
Professor Mars closed the inaugural lecture by saying, "We have taken the first small steps down this path, and it is our hope that through exploring these relatively simple approaches that we may help Africa find an eHealth solution that also narrows the digital divide".

filetype:doc
file time: 2008-02-18
file size:26624
Click Here To Download...