The role of information communication technology (ICT) towards universal health coverage: the first steps of a telemedicine project in Ethiopia

Abstract

BackgroundEighty-five per cent of the Ethiopian population lives in remote areas, without access to modern health services. The limited health care budget, chronic shortage of health care workers and lack of incentives to retain those in remote areas further jeopardize the national health care delivery system. Recently, the application of information communication technology (ICT) to health care delivery and the use of telemedicine have raised hopes.ObjectiveThis paper analyzes the challenges, failures and successes encountered in setting-up and implementing a telemedicine program in Ethiopia and provides possible recommendations for developing telemedicine strategies in countries with limited resources.DesignTen sites in Ethiopia were selected to participate in this pilot between 2004 and 2006 and twenty physicians, two per site, were trained in the use of a store and forward telemedicine system, using a dial-up internet connection. Teledermatology, teleradiology and telepathology were the chosen disciplines for the electronic referrals, across the selected ten sites.ResultsTelemedicine implementation does not depend only on technological factors, rather on e-government readiness, enabling policies, multisectoral involvement and capacity building processes. There is no perfect ‘one size fits all’ technology and the use of combined interoperable applications, according to the local context, is highly recommended.ConclusionsTelemedicine is still in a premature phase of development in Ethiopia and other sub-Saharan African countries, and it remains difficult to talk objectively about measurable impact of its use, even though it has demonstrated practical applicability beyond reasonable doubts.

World Federation of Pediatric Imaging (WFPI) volunteer outreach through tele-reading: the pilot project in South Africa

“…For teleradiology to be effective, the standard quality of radiology services provided must be ensured [5]. A major technical consideration for many countries is low bandwidth, slow Internet connection and high Internet service charges [3]. Areas of the developing world continue to have data transmission speeds of 10 kbps vs. the 1 mbps available in developed countries [6].…”

“…Many tele-reading programs use screen-film images converted into digital files via digital cameras, scanners or specialized digitizers. An Ethiopian tele-reading program found that taking photographs of radiographs with a regular camera, using natural light on a white glared window, produced good-quality images, and this was proposed as good solution for areas in which light boxes are not available and a stable power source is an issue [3]. Such systems are feasible, but there is limited opportunity to improve the image quality if the primary radiograph is poor [1].…”

“…The lack of accurate radiologic interpretation, common to countries of sub-Saharan Africa, is considered a contributor to higher patient morbidity and mortality. This is compounded by the growing incidence of HIV/AIDS, tuberculosis and malaria in these countries [3].…”

“…Teleradiology allows imagesharing between organizations and across national borders [2]. It has been utilized for more than 30 years and is now being adopted as a means of practice in underserved areas, providing benefits such as improved access, avoidance of unnecessary patient travel, cost savings and improved outcomes from rapid reporting and earlier and more appropriate intervention [2][3][4]. A change in diagnosis subsequent to teleradiology consultation has been reported in up to 50% of cases [3].…”

“…It has been utilized for more than 30 years and is now being adopted as a means of practice in underserved areas, providing benefits such as improved access, avoidance of unnecessary patient travel, cost savings and improved outcomes from rapid reporting and earlier and more appropriate intervention [2][3][4]. A change in diagnosis subsequent to teleradiology consultation has been reported in up to 50% of cases [3]. Teleradiology has also been reported to improve the diagnosis of tuberculosis, especially in settings with a high burden of HIV infection [2].…”