Govt’s telemedicine initiative may fail if not done well!…….Pt.1

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In incidences where telemedicine services do improve overall health outcomes the value is high, but this can come at a great burden to a struggling health care system……WHO (World Health Organisation GOE-Telemedicine)

When government recently indicated among many e-initiatives a key consideration for telemedicine in the health sector, I had a mixed reaction about it. On one side I was happy for the idea, and on the other worried – because if it’s not done well, it will be a big failure and another waste of public funds or grants, and of course human capital.

It’s a fact that telemedicine is not new to Ghana. There have been various pilot projects initiated already in various parts of the county. Initiatives such as BisaDoc and that of Novartis Foundations in collaboration with Ministry of Health, Ministry of Communication, etc. are generally reported as being successful.

I am more concerned with a full national roll-out of Telemedicine. Has there been any broad stakeholder engagement?  It must be noted that just throwing out telemedicine into the overall health system will not be an automatic success story.  Our health system, as we know, is not in the best of shape; and so before adopting a whole new way of health delivery, proper – and I mean proper – stakeholder consultation should be done.

Telemedicine is a good thing, and when done well the whole population can harness its full potential. With a background in basic public health studies, laboratory services and extensive IT system deployment and client relations, I am excited to see this is finally going to be given some attention.

Defining Telemedicine

Telemedicine is an integrated approach to health care delivery that needs great understanding of the various facets which will be involved.

It is going to involve public health procedures, medical practices, telecommunication processes, good relationship management skills etc.

The implementation should be done in a totally inclusive way for all – not for a privileged few or defined marginalised group.

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To simplify, telemedicine is the remote diagnosis and treatment of patients by means of telecommunications technology.  As a heavy dependent of technology, which is never static but always evolving, there should also be consideration of continuously adapting to tech advancements in order to stay relevant.

When Telemedicine platforms become a reference point for medical or health FAQs (Frequently Asked Questions), it is important to stay relevant with the kind of information the platform will offer. The culture of not updating information and staying current cannot be tolerated in this instance.

There is a growing incidence of misdiagnoses wherein a clear distinction between Jaundice and a serious liver malfunction is problem. The common error of providing a wrong sequence for probing symptoms can be detrimental.

Crafting the pointers for a national telemedicine agenda:

Maybe WHO’s highlighted key pointers can be a guideline for us.  I might not know the full details yet of the intended roll-out, but I think we can be guided by the following:

  • Are we aiming to provide a clinical support to the existing NHIS? If this is the case, how best are we looking to place the telemedicine initiative so as to better serve the population?
  • Or, is it simply going to be a means of getting patients’ health queries answered via contact centres? If so, then a great number of common diseases can be managed remotely.
  • Maybe, for us, it’s just the use of modern ICT tools to facilitate processes within our health care delivery that is of interest.
  • Or perhaps we are aiming at using Telemedicine to champion a preventive-health culture by ensuring that Ghanaians stay healthy and so improve their general wellbeing.
  • Whatever the case may be, I am calling for some wider stakeholder analyses to be done, as in every standard project, to ensure stakeholders satisfaction when the project is delivered.
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One Key Benefit

Like the price of commodities these days, there is a growing disparity between the diagnosed results for the same set of symptoms when patients shop around for solutions to their ailments.

 

This idea of moving from one clinic to another collecting medicine and keeping and presenting the same ailment to the next clinic is because of the mistrust in diagnoses these days. This is creating a huge cost burden for the NHIS.  To ensure some consistency within the Ghanaian health care practice, telemedicine can be a good bet.

 

Some Identified Challenges:

As a project manager, I always receive my risk register in time and update it as the project progresses.  So, here the WHO has some pointers for our risk analysis:

  • Good initiatives are always started well here in Ghana, and the case has been that they begin to struggle when the initial funding is exhausted. Then we sit and wait for the next funding for a similar project but with a different name. Such projects obviously don’t have any sustainability plan beyond the initial funding sources. If there is no clearly-defined future funding plan, then let us not do a national roll-out in the first place.
  • Aside from funding, there is never any proper maintenance planning of infrastructure or systems to ensure longevity of initiatives. Telemedicine, as we have already noted, is an integrated approach to health service delivery. There is going to be need for continuous training, infrastructure maintenance and replacements, consistent reviews etc. If this can’t be maintained, please don’t roll out.

 

To be continued….

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