Telehealth in the Developing World

Richard Wootton, Niv G Patil, Richard E. Scott, Kendall Ho, Richard Wootton, Niv G Patil, Richard E. Scott, Kendall Ho

• Publisher: CRC Press
• Year: 2019
• Print ISBN: 9781853157844
• eBook ISBN: 9781351989459
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Telecommunications bring the potential to improve both the quality of and access to health care in the remotest areas of the developing world. Telemedicine offers solutions for emergency medical assistance, long distance consultation, administration and logistics, supervision and quality assurance and education and training for health-care professionals and providers. Telehealth in the Developing World aims to balance the relative lack of published information on successful telehealth solutions in the developing world. It is written for all e-health and telehealth proponents interested in learning about, or contributing to the implementation of, appropriate solutions for 80% of the world's population.Topics featured include:

• Teledermatology in Cambodia
• Telepediatrics in Chechnya
• Telepathology in India - using digital cameras and email
• HealthNet networks in Nepal
• Medical missions for Children in Mongolia
• International HIV/AIDS discussion lists
• The Aga Khan Telehealth Network in Pakistan
• Access to mobile phones and internet in the Philippines
• Exchanging X-ray images in Ghana
• Web-based oncology registries and a virtual oncology hospital in Brazil
• Surgical training in the developing world
• The iPath international email network

SECTION 1

BACKGROUND

1 Introduction

Richard Wootton, Kendall Ho, Nivritti G Patil and Richard E Scott

What is telemedicine?

There is no generally accepted definition of telemedicine. The literal meaning is ‘health[care] at a distance’. Thus, telemedicine may represent health care practised in real time, using a video link for example, or asynchronously, perhaps by email. The type of health care interaction is perfectly general, and may encompass diagnosis and management, education – of staff, patients and the general population – and administrative meetings.

The history of telemedicine has been bedevilled by loose terminology, which, some observers feel, has not assisted its cause.¹ What began originally as ‘telemedicine’ has become successively ‘telehealth’, ‘online health’, ‘e-health’, ‘connected health’, etc. In this book, different contributors use slightly different terms to describe their telemedicine experience, depending on their local environment. While the editors have tried to reduce the number of terms used, we have deliberately not enforced a uniform terminology throughout, in recognition of these local differences.

Scope of the problem

Telemedicine is one aspect of the use of information and communication technology (ICT) in health care. It is widely believed that ICT generally has the potential to improve clinical care and public health. In addition to facilitating medical education, administration and research, appropriate use of ICT may:

•   improve access to health care;

•   enhance the quality of service delivery;

•   improve the effectiveness of public health and primary care interventions;

•   improve the global shortage of health professionals through collaboration and training.

However, many questions remain about the potential value to people in resource-constrained settings such as the developing world.

There are major problems of inequity of access to health care in developing countries, to which telemedicine offers a potential solution. It may be valuable in other ways as well.

Crisp report

In 2007, Lord Crisp reported about how UK experience and expertise in health could best be used to help improve health in developing countries.² He concluded that sufficient progress towards the United Nations’ Millennium Development Goals (e.g. in reducing child and maternal deaths, and tackling HIV/AIDS, tuberculosis and malaria) would not occur unless:

•   developing countries are able to take the lead and own the solutions – and are supported by international, national and local partnerships based on mutual respect;

•   the UK and other industrialized countries grasp the opportunity – and see themselves as having a responsibility as global employers – to support a massive scaling-up of training, education and employment of health workers in developing countries;

•   there is much more rigorous research and evaluation of what works, systematic spreading of good practice, greater use of new information, communication and biomedical technologies, closer links with economic development, and an accompanying reduction in wasted effort.

Clearly, telemedicine could play a major part in facilitating all of these activities. Furthermore, one can imagine the consequences if every hospital in the richer countries were to be linked up on a formal basis with a small group of hospitals or health centres in developing countries. Through mutual learning and collaboration in health service provision, such health partnerships could ultimately change health-care delivery at the national level; they might also change how the industrialized nations perceive the world. Telemedicine and ICT would be essential to maximizing the potential of these health partnerships.

Aim of the book

Any discussion of telemedicine in the developing world raises difficult questions about resource use, sustainability and global equity in access to health care. Despite the large number of published articles on the concept of telemedicine in the developing world, there are remarkably few examples of successful implementation.³ In this book, we have attempted to assemble a representative cross-section of the very wide range of work that has been carried out to date. Thus, the book offers a state-of-the-art review of telemedicine in the developing world, and should also provide the basis for a high-level operations manual. It could be considered unethical, after all, not to learn from the experience of others and to squander scarce resources on an idea that may have already been proved to be unfeasible.

The major sections of the book cover policy, clinical and educational matters. We hope that you enjoy reading it.

References

1   Wootton R. Telemedicine and isolated communities: a UK perspective. J Telemed Telecare 1999; 5(Suppl 2): 27–34.

2   Crisp N. Global Health Partnerships. The UK Contribution to Health in Developing Countries. London: COI, 2007. Available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicy-AndGuidance/DH_065374.

3   Wootton R. Telemedicine support for the developing world. J Telemed Telecare 2008; 14: 109–14.

SECTION 2

POLICY

2 Bridging the digital divide: Linking health and ICT policy

Joan Dzenowagis

Introduction

The past decade has seen a remarkable growth in the diffusion of information and communication technology (ICT) across the world. This growth has been fuelled by technological advances, economic investment, and social and cultural changes that have facilitated the integration of ICT into everyday life. The general public – consumers – as well as a range of new stakeholders have had a significant impact on shaping this growth, for example by demanding better products, services and value for money. As these technologies enter the mainstream of business and cultural life, there is also a greater awareness of their potential as economic and social tools and, with it, new social and political pressure to re-frame ICT as a public good to be made accessible and available to all. This shift has had important ramifications in countries and at the international level as well.

Despite this encouraging progress, however, the uptake of ICT globally continues at an uneven pace, and the ‘digital divide’ remains a significant obstacle to achieving global development goals. The digital divide is understood broadly to be the gap between those with access to ICT and its benefits and those without. It is specifically acknowledged in the United Nations Millennium Development Goals (MDGs). Goal 8, Target 18 of the MDGs proposes ⁴ a global partnership for development to make available the benefits of new technologies, especially information and communication technologies’.¹

Recent events such as the G8 Summits and the World Summit on the Information Society² have continued to promote this target and to highlight the striking gaps in access to ICT worldwide. In some countries, both urban and rural regions remain isolated from the knowledge society: infrastructure is non-existent, costs for basic services are beyond average income levels and well-intentioned ICT pilot projects end without ever scaling-up. While this can be disastrous for national economies competing in a global environment, it is also a tragedy for the health sector, where ICT is essential to improve health and help alleviate inequalities.

ICT in the health sector

In the health sector, ICT is a cornerstone of efficient and effective services. In many countries, use of ICT within the sector continues to grow, and the Internet in particular is driving significant change. For example, in middle- and high-income countries, the Internet is dramatically changing the way in which consumers interact with health services, including access to health information and the ability to purchase pharmaceuticals and other health products. The Internet also plays a key role in expanding the reach of health services to remote areas. The spread of broadband networks and the development of new e-health applications, defined as the use of ICT for health, have a mutually sti...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Contributors
• Foreword
• Preface
• Section 1: Background
• Section 2: Policy
• Section 3: Educational
• Section 4: Clinical
• Section 5: The Future
• Index