Sub-Saharan Africa is a region carrying the multiple burdens of widespread communicable diseases including HIV/AIDS, tuberculosis and malaria paired with low health service coverage and a serious health workforce crisis.
The brain drain of doctors and nurses moving North where health personnel is in short supply as well is aggravated by the many deaths of skilled personnel from communicable diseases. To make matters even worse, people live so remotely that even the most modern means of telecommunications are out of reach. This combination of diseases, health service shortages and poverty provides a hefty challenge for any kind of possible solution. But be it as it may, there is an urgent demand to train health workers, there is an urgent need for high-quality clinical services, and there is an urgent need for the collection and management of health information.
In 2006, a task force named Telemedicine Task Force (TTF) for sub-Saharan Africa and composed of the relevant African Organizations, the World Health Organisation (WHO), the European Commission (EC) and ESA was set up in order to explore the framework of a telemedicine programme in the sub-Sahara Africa. TTF should focus on the following issues:
Revision of existing health infrastructures in the region and identifying areas where telemedicine could add value.
Assessment of the current status of existing telecommunications infrastructure and their ability to support the development of health services particularly for poor, rural or remote communities.
Review the existing telemedicine programs in terms of their further development, costs and resources.
Assess health policy priorities of the sub-Saharan countries thus identifying opportunities to integrate telemedicine into national heath policies.
These activities of the TTF are supported by two studies funded by the European Development Fund (EDF) and the European Space Agency (ESA). The first study – funded by the EDF - concerns the analysis of the cost benefits of the implementation of a satellite-based network of telemedicine for each country. The second study – funded by ESA - focuses on system architecture and costs of a satellite-based network of telemedicine at three levels: country, region, and pan-Africa.
Where neither terrestrial nor mobile phone networks provide access, satellite services are the only possible means of modern communication. This is especially true for remote areas in sub-Saharan Africa.
Although not contested as a fact and possibility, the potential that satellite communication offers for health care improvements has not even been scratched at the surface.
User- and demand-driven: this is the approach the TTF wants to follow; an approach which should bring improved access to information and knowledge for health workers, which shall provide better and targeted health services to people in remote areas, and which shall – after all – be based on the economic realities of sub-Saharan economies. Therefore, implementation means the use of open standards, interoperable systems and services, modularity, and off-the-shelf components.
African stakeholders ensuring African ownership for African benefit of their populations and economies need to be at the center of telehealth efforts. Ownership of the African stakeholders is essential if sustainable eHealth and telemedicine services for the entire sub-Saharan population are to become a reality and to achieve the Millennium Development Goals of the United Nations. Given previous experience it is exactly the level of national and/or regional ownership, which has been the sore point. This ambitious and highly sophisticated project needs clear grounding in real life Africa in order to succeed.
The Telemedicine Task Force (TTF) was recently renamed eHealth Task Force for Africa. I hope sincerely hope that in the not-too-distant future I can share a report on their progress in addressing the daunting problems described in this article.Harald Himsel is managing director and partner at consulting firm AGEG eG. To read more of his articles, please visit his columnist page.
Edited by Erin Monda