In many rural communities around the world, including SA, the healthcare delivery system faces many challenges and telemedicine can be an important strategic tool in delivering equitable healthcare. This can be done irrespective of distance and the availability of specialised expertise particularly.
Telemedicine enables a physician or specialist at one site to deliver healthcare, diagnose patients, give intra-operative assistance, provide therapy or consult with another physician or paramedical personnel at a remote site. Some governments have started telemedicine projects in order to rectify this inequality in health delivery.
In SA, the Department of Education and the Medical Research Council developed the National Telemedicine Research project. The State Information Technology Agency (SITA) Technology Research, together with the Medical Research Council (MRC), is currently involved in the Nkomazi district in Mpumalanga in a Telemedicine Test Bed Pilot Project. This is an exercise to research various options and technologies in the telemedicine space. In this pilot project, the MRC drives medical research, while SITA supports the project by investigating technology issues.
A successful telemedicine programme is the product of careful planning, sound management, dedicated healthcare professionals and support staff and a commitment to appropriate funding to support capital purchases and on-going operations. Successful telemedicine programmes also require the melding of multiple technologies such as medical devices, network computing, video conferencing, software and telecommunications, into a seamless system. Currently SITA and MRC are investigating the following issues:
* The applicability of American and European methodologies and technologies in the African context.
* Identifying and testing the applicable configuration of medical peripherals.
* Identifying and testing the applicable communication technologies, with relation to both hardware and software.
* Assessing the impact of the human computer interfaces in remote areas.
* Assessing support requirements.
Current technologies on the market prove to be too expensive for volume procurement to address the needs of over 4 000 clinics in SA. These technologies are also too complex to be practical in the application areas. The available technologies also do not address the unique African requirements in primary healthcare, aimed at alleviating the suffering of patients in the underserviced areas. New solutions have been identified in China, where telemedicine must be applied in similar conditions. Price points are also favourable and affordable. Further research and testing is indicated on this issue.
Development of a successful telemedicine programme is a challenging task. A developed comprehensive plan, involving all stakeholders and covering the implementation and operation of the programme, needs to be in place. In SA, some of the major stakeholders are the MRC, DoH, Medunsa and UP, who are the co-sponsors of the Formal Telemedicine Training. SITA's role is to investigate technology issues and advise accordingly.
Regarding the Nkomazi project, some testing in wireless and satellite technologies are completed, but more is required to provide a definitive solution. This was provoked by the fact that very early in the project, the challenges posed by various communication technologies were identified. Traditional copper-based communication offered too limited bandwidth, was too expensive to run over an extended period and could also not be guaranteed, due to the risk of copper theft. Alternatives were investigated and two transport mechanisms identified.
For short to medium distances, wireless technologies offer the best promise. It is relatively cheap to install, offered all the bandwidth required and has no recurring costs. On the downside, extensive planning is required to address the implications of terrain challenges and this also requires an application for an ICASA licence. For longer distances, where standard communication is not available, satellite communication offers the most promising solution.
Remoteness of the clinics requires a rugged solution to be used, with little requirement for technical skills of the medical staff and with total integration of the medical peripherals into a standardised solution. It must be easy and intuitive to operate, be very reliable in terms of medical quality requirements and must offer remote support capabilities.
An appropriate training programme to overcome the human challenges must support any telemedicine project. Very capable medical staff is scared to use the technology and this poses a threat to the levels of utilisation and value derived by deploying the technology. The MRC, DoH, Medunsa and University of Pretoria, are the co-sponsors of the Formal Telemedicine Training Programme for the National Telemedicine System.
In SA there is quite a number of telemedicine sites including the Northern Cape, Eastern Cape and KwaZulu-Natal. A very promising derivative of this exercise, Nkomazi Telemedicine Test Bed Pilot Project, is the levels of international support and interest expressed. The interest has escalated and it is now discussed for funding at both NEPAD and SADC forums. International funding is now under discussion. The implications will be to escalate the project for early delivery and to expand it into at least two additional African countries.
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