Health, education to go hi-tech

Launched in 2004 with an aim to provide specialised health care and education services to rural and other lagging regions in Africa through information communication technology (ICT), the high-tech capacity-building project will be rolled out in Zimbabwe “very soon,” according to Mukesh Kumah, the acting Indian ambassador to Zimbabwe. The initiative aims to link Zimbabwe’s top-level universities to India’s premier centres of learning for distance learning, and the country’s largest referral hospitals to the Asian country’s “super speciality” hospitals to provide off-site, but real time health case consulting, examination and treatment.
“It’s coming just at the right time for Zimbabwe,” Kumah said. “Satellite and fibre-optic networks have already been established between India and Africa. Zimbabwe has a lot to benefit from the programme, especially in terms of health care through telemedicine.”
Telemedicine is an ICT-based health care model developed and practiced in many developed countries as a tool for providing synchronous, specialist medical attention to patients in any type of medical institution, especially remote rural areas with marginal or no power or telephone connection, using off-site specialists.
A tele-otoscope, for instance, allows an off-site physician operating from a “super specialty” hospital to listen to a patient’s heartbeat or examine what is inside an ear by attaching auxiliary devices linked to a network of computers to the patient.
In many developed countries, a greater proportion of distant training for medical personnel, dissemination of medical knowledge, epidemic surveillance, case consulting, examination and treatment is increasingly being done through voice and data communication, especially e-mail and video-conferencing. This has leveraged health care access between rural and urban areas.
By global comparison, the disparity in rural-urban healthcare distribution is most pronounced in Africa, where doctors tend to be concentrated in the more developed metropolitan areas, a phenomenon that has traditionally forced the rural folk to travel long distances to get specialist health consultation and treatment.
Under the envisaged e-networking programme, Zimbabwean doctors and hospital technicians will receive short technical training in India on how to operate and maintain the e-health system and jerk the local health industry into a new era in medicine.
A decade of inexorable economic downturn squeezed the country’s three largest referral hospitals out of working capital for the procurement of drugs, importation of spare parts and maintenance of essential equipment and machinery, resulting in their closure early last year.
Emerging from politico-economic crisis, which also triggered a record brain drain that pushed the country’s doctor-patient ratio 70 percent below the World Health Organisation’s benchmark of 1:10 000, Zimbabwe considers the initiative a smart solution to its public health care delivery system currently plagued by a debilitating shortage of equipment, machinery, drugs and specialists.
Both for the technology transfer to occur swiftly, the country will need to expeditiously develop an e-governance policy and legislation to establish an operational framework within which the investment will take place.
ICT Minister, Nelson Chamisa, says the government is ready to launch an ICT law, which espouses an national e-strategy, an e-health policy and an e-governance framework, within the next 12 months to pave the way for a major ICT revolution, including e-education and telemedicine.
The programme was piloted in Ethiopia in 2000 with the setting up of a portal for sharing information called the National Telemedicine Centre at an initial cost of about US$79 million.
Whereas the centre started with under 20 radiologists who served some 75 million Ethiopians, by 2006, the number of radiologists had doubled, resulting an a record improvement in the doctor-patient ratio to 1:39,000, one of the best in Africa.
So far India has connected 23 African countries to its premier hospitals under the Pan-African E-networking Program and plans to cover all 53 African Union member states in the near future.
The Indo-Zimbabwe telemedicine initiative entails the installation of computers loaded with medical software, voice over internet (VoIP) services, satellite technology, video-conferencing, tele-otoscope and other high-tech equipment at Parirenyatwa Group of Hospitals, Harare Central Hospital, both in Harare, and at the Bulawayo Central Hospitals to facilitate two-way distant health case consultancy between India and Zimbabwe.
Connected to diagnostic devices such as an X-ray machine or scanner or an ECG, the computers will transmit patients’ medical data such as diagnoses and blood test results to specialist physicians based in a “super specialty” medical centre in India through a satellite link or fibre-optic network.
After examining the reports, the off-site specialists, with the assistance of local doctors, then discuss each case through video conferencing and prescribe a treatment.
Within the rubric of the programme, the facilities would then be extended in sequence to provincial and district referral hospitals as a low-cost way of creating contact between patients in rural hinterlands with specialist doctors in Harare, Bulawayo or India.
Jonathan Mafukidze, a development policy researcher, says a deregulation of the telecommunication industry will be necessary to create an efficient digital or knowledge economy in order to improve teledensity and bridge the rural-urban digital divide through an expansion in the national information infrastructure.
Teledensity in the country, measured by the number of telephone lines per every 100 people, is estimated at 12 percent and internet penetration at around 10.9 percent or 1,351 people out of some 12 million Zimbabweans – poor ratings by any comparision.
Unless telephone connectivity and internet penetration is enhanced under the programme, Mafukidze argues, it will be difficult for provincial and district hospitals to go beyond simple store-and-forward methods of medical examinations as real-time consultation on a health case requires efficient, high-tech technology applications.
Zimbabwe, like many African countries, has in the past dragged its feet in liberalizing the telecommunications sector or advancing ICT policies and regulatory systems partly because of e-security concerns, but also because of a lack of appreciation of the benefits to be derived from such investments as they do not appear directly related to economic growth and development.
“We don’t yet see the impact of the ICT revolution in Africa in the light of globalization. We don’t yet see how ICT can spur socio-economic development, particularly in fighting poverty in Africa,” Dr. Aida Opoku-Mensa, the United Nations Economic Commission for Africa (UNECA) Officer in Charge Development Information Services Division, said in 2006.
“But after missing out on the industrial and agricultural revolutions, Africa cannot afford to be left behind in the ICT revolution as it is a vital tool for the development of the continent.”
Though, on the whole, the adoption and implementation of telemedicine as a low-cost public health care model in Africa has taken off at a slow pace, the few countries that have embraced it have made some strides in improving access, Mensa added.