Information and Communication Teachnology
ABSTRACT
As telemedicine is used throughout the rural parts of Africa, there are many professionals and patients who find the entire process very beneficial because there is an allowance for a decrease in transmission of highly contagious diseases such as MRSA (Methicillin-resistant Staphylococcus aureus). If there are clinics that are found in locations surrounding rural Africa, there are strong concerns that patients will be able to transmit their diseases to other people who are otherwise healthy. With the use of telemedicine, the patients and the health care providers can see each other through a confined space and there is no possibility of the transmission of any negative condition (Wilson, 2015). When a patient is homebound, the physician or the nurse can monitor the individual through the camera and the proper type of medication can be sent in an applicable manner without drawing close attention. Since there are a plethora of people who suffer from detrimental conditions throughout rural areas of Africa, the health care providers have been able to make a significant difference. As time progresses, there is a need for more innovation, but the health care process has improved rapidly.
CHAPTER ONE
1.0 BACKGROUND
The concept of telemedicine involves the use of information technology that can be used in order to provide clinical care to individuals from anywhere in the world, as long as there is a specific type of connectivity (Mansberger, 2015). As a whole, this process is often used in order to eliminate the barriers that are often seen when granting health care to people, especially in places where there are limited resources. There are many communities that use telemedicine in rural areas and the concept has helped many people in the face of emergencies and other critical states. Throughout the years, there have been many implications surrounding the use of telemedicine and there are some people who do not think that the concept is beneficial because health care providers are not actually able to see the patients up close. However, while this is the case, there are many imaging protocols that can be used so that a health care provider can diagnose a patient through the use of a high definition camera. This should only be done in the event that there are not qualified health care providers in the area (Mansberger, 2015).
In essence, regardless of the many different types of controversies that have been seen throughout the years, telemedicine has been known to be extremely beneficial to those in isolated areas, such as rural Africa. If there are patients who live in remote regions, there is a chance that they can precede with a medical visit through the use of technology that is available today. Instead of going to a clinic or having a health care provider visit them directly, which may take a very long period of time, they can use the technology that is available and speak to a professional through a camera. The health care provider would then be able to see them directly even if they are in another part of the world. Questions can be asked and specific sections of the body can be seen in order to make a proper diagnosis as needed (Wilson, 2015). With the use of this high quality mobile collaboration, there can be multiple health care providers who are in different locations as well as they are all trying to diagnose a patient or come up with the best treatment plan based on the condition.
Sometimes, telemedicine may even involve the use of remote prescription usage in the event that a patient needs medicine in a rapid manner. If this is the case, the health care provider will call in the prescription to a local pharmacy and that medicine will then get shipped to the patient’s location. If that patient is not able to receive mail directly, the health care provider will send it to the closest location in which he or she is able to pick up mail in a proper manner (Wilson, 2015).
As telemedicine is used throughout rural Africa, there are many professionals and patients who find the entire process very beneficial because there is an allowance for a decrease in transmission of highly contagious diseases such as MRSA. If there are clinics that are found in locations surrounding rural Africa, there are strong concerns that patients will be able to transmit their diseases to other people who are otherwise healthy. With the use of telemedicine, the patients and the health care providers can see each other through a confined space and there is no possibility of the transmission of any negative condition (Wilson, 2015). When a patient is home bound, the physician or the nurse can monitor the individual through the camera and the proper type of medication can be sent in an applicable manner without drawing close attention.
1.1 SCOPE OF THE STUDY
This study will be in the form of literature review, a comprehensive study, analysis of past and up-to-date researches on the use of ICT/Telemedicine and also recommendations of what might be needed to improve healthcare in these areas. Also interviews will be done to find out about the level of awareness and how the residents perceive telemedicine in the area of healthcare.
1.2 SIGNIFICANCE OF THE STUDY
The purpose of this project is to analyze the specifics of telemedicine, specifically in the rural and remote parts of Africa. Specifically, a literature review will be developed in order to analyze how the process can ultimately benefit the entire process of health care within the area. As time progresses, there is hope that telemedicine will continue to advance so that patients can be treated in a proper manner or also receive good and affordable healthcare like their counterparts in the urban areas. Furthermore, there is hope that the negative controversy about introduction of ICT can decrease, the barrier can be broken and that the entire concept can expand in order to help more people in these areas on a daily basis to live an awesome life.
1.3 PROJECT ORGANISATION
Chapter one introduces the study by giving a general overview of the research project, the background of the study as well as its problems, scope, and significance; basically setting the foundation of what the study is about. The rest of the study is arranged thus; chapter two presents a comprehensive review of past works that are related to the study including role technology plays, theories associated with how technology is accepted in these areas, etc. Chapter three entails the methodology, which will be a systematic review of various works done by previous researchers on the topic. Chapter four concludes the study and gives some directions for future research.
CHAPTER TWO
LITERATURE REVIEW
2.1 TECHNOLOGY IN RURAL AREAS
According to Wamala & Augustine (2013), telemedicine has been used predominately in the remote areas in order to improve the progress of health care within the realm of the many countries that exist in Africa. As a whole, there have been many health care providers as well as researchers who have taken the time to try to overcome the many barriers that have been seen within areas that are considered rural. Unfortunately, Wamala & Augustine (2013) also states that locations such as Ethiopia and Rwanda are very far behind in terms of technology which is why the implementation has been very difficult throughout the past several years. Although this is the case, there have been many advances in which people from the United States have volunteered to go to specific small towns and set up the Internet as well as commerce so that patients would be able to speak to physicians and nurses through mobile devices and computers.
Mars (2013) has also noted that there have been several countries within the entirety of Africa which have signed an agreement with the Robertson Global Health Solutions Company. This business ensures that high quality telemedicine will be provided to the people of communities so that they are able to receive help in terms of preventive care and in the event that a detrimental condition takes place (Hartmann, 2014). Specifically, the health care has been provided to the underserved because there are many people who are suffering due to the fact that they do not have advances in health care.
2.1.1 COMPONENTS OF TELEMEDICINE CURRENTLY USED WITHIN RURAL AFRICA
Remote monitoring: This involves cameras and other devices that are set up to computers and mobile phones where health care providers are able to see the patient. They are also able to speak with the patient and if a translator is needed, that can be done as well. For the most part, monitoring is essential, especially if the patient has a detrimental condition. While the provider can facilitate recommendations, there may be some instances in which he or she needs to monitor the patient just in case the situation worsens, for instance conditions that require monitoring like heart disease, diabetes, asthma and other severe implications (Mars, 2013).
Real-time interaction: This is one of the most significant features of telemedicine because it allows the patients and the health care professionals to speak directly to each other without a large lag time. This has improved greatly because before the invention of telemedicine, patients often waited days before seeing a qualified professional and when they did see them, they may be surrounded by other patients with contagious diseases. This created many problems within the health care sector among Africa (Mars, 2013).
Storage: This is another main component that is used on a daily basis, because the professional must keep track of each patient that is being seen. There is a specific mechanism that is used in order to store biometrics, medical images, etc. so that the provider can look back as at when needed. There is also an ability for the professional to have an electronic health record which indicates pertinent data regarding the patient (Dyk, 2014).
Based on the components that have been outlined above, the use of telemedicine has caused the overall process of health care to improve drastically within rural Africa. For example, Mars (2013) has stated that the following has taken place thus far:
Improved quality of care that is delivered
Prevention of medical errors among rural areas (there have been instances in which people have treated patients in remote areas, but they were not technically qualified to do so).
Reduction of costs in terms of health care (there are many patients who do not visit health care providers because they are concerned that they do not have enough money to pay for the care).
Expansion of care that is affordable (for example based on the fact that many communities have signed an agreement with the Robertson Global Health Solutions Company or other companies, there has been an allowance for patients to receive care without worrying about the specific costs. Moreover, with the advancement of telemedicine, there are more conditions and diseases that are treated on a daily basis).
Early detection of diseases that may be infectious: If there are patients who set up telemedicine appointments periodically, there is a chance that the health care provider will be able to detect if there are any negative conditions that may develop in the future. Prior to telemedicine, the patients were not able to prevent themselves from negative occurrences, which took a toll on their health. Today, the use of telemedicine allows for both prevention as well as proper diagnostic factors (Gulube, 2011).
Fortunately, the use of telemedicine allows researchers and health care providers to allow for the expansion of communication so that the proper type of health care can be delivered in a proper manner. The health care professionals can also take the time to share medical information with other health care providers if there is a need for additional opinions based on the parameters of a patient’s condition (Geissbuhler et al., 2013). In locations such as communities in Uganda, there are reference centers that are developed in which local physicians may also speak to the health care providers through the use of a computer or another technological device. Throughout the past ten years, many of the rural areas have tried to set up small centers so that there can actually be a real time physician, but this has not worked well in all locations. This is why the advancement of telemedicine has improved in such a broad manner.
As stated by Wootton and Bonnardot (2015), the use of telemedicine is especially prevalent in areas in which there are low resources. As a whole, there are many communities in Nigeria, Uganda and Ethiopia in which there is a very limited amount of medical supplies which makes it very difficult for people to attain access to care. Some of the most common conditions that people should be aware of within rural parts of Africa include the following: malaria, sickle cell anemia, Ebola, tuberculosis, jaundice and syphilis. Unfortunately, these are very detrimental conditions which should be treated with repeated care. As a whole, this can typically be done with telemedicine as long as there is proper monitoring and patients are able to receive adequate amounts of medication (Dinesen, 2015).
2.2 THE PENETRATION OF ICT IN THE HEALTHCARE SYSTEM IN AFRICA
The penetration of information and communications technology in rural Africa contributed in the prevention and control of diseases in the region. Specifically, ICT became an effective tool in the process of communication which is a vital element in promoting best public health practices. The health care sector in many progressive countries has always depended on information and communication technologies in the prevention, diagnosis and treatment of diseases. However, this expanded form of quality health care has not yet reached its utmost potential in many rural areas, and this can be attributed to the under-financing of these projects in most countries. Nevertheless, the advances in ICT in the past decades resulted in better revolutionizing the provision of health care. The benefits derived from the use of ICTs cannot be measured accurately, though it has certainly created opportunities for capacity building that ensure its constructive use, especially in regions such as rural Africa.
2.2.1 THE DEVELOPMENT OF TELECOMMUNICATIONS IN RURAL AFRICA
The development of telecommunication is considered as one of the fastest growing infrastructure sector in Africa. In the past two decades, innovation in information and communication technology resulted in the unprecedented developments in telecommunication services. Reports revealed that the telecommunication sector has dramatically grown from only about 2 million people who own mobile phones in 1998, to over 400 million mobile owners by 2009 (Chavula, 2012). The increased growth in the telecommunication sector can be attributed to the large number of people who have access to mobile technology and the internet as well as those who have permanent main lines installed. Consequently, the mobile technological growth in Africa resulted in dramatic impact in the rural areas.
In recent years, the information technology system in urban societies in African has significantly improved, and health care system in developed regions has integrated ICTs in their system. However, studies reveal that this advancement in ICT in the urban areas is not the same in rural Africa, which is considered to have lagged behind in terms of adopting technological innovations. Nevertheless, despite having been left behind by other progressive countries in terms of the use of ICT, developments have been underway to aid with the implementation of ICT-aided health care.
Growth of ICT/Telemedicine Projects in Rural Africa
One among the telemedicine projects in rural Africa includes the agreement entered into by Robertson Global Health Solutions Corporation and Montana Health-care Solutions Pty Limited with Telemedicine, Africa (Wamala and Augustine, 2013). The goal of these projects is to deliver cost-effective, yet high quality healthcare to members of the African populations who are underserved. The implementation of the project is facilitated through the use of telemedicine extensions supported by mobile applications. The system will help support the development and sustenance of a timely and efficient healthcare services to be provided to both rural and urban communities in Africa.
The promotion of Telemedicine in rural Africa is facilitated through the use of mobile phones. The high cost of call costs in the region results in the reluctance of a large number of people from using in non-emergency medical cases, thus the need for the introduction of innovative systems to resolve the issue. It was reported that only a small part of Africa is taking advantage of Telemedicine. Nevertheless, despite their slow response, the different African regions have certainly progressed toward the use of telemedicine. Researchers pointed out the potential of telemedicine infrastructure in the Africa region due to the abundance of power supply from the sun. For example, Kenya adopted telemedicine to advance her health care programs, and plans have been premeditated in this region for the introduction of smart cards that are designed to be used in health care institutions.
Another example by which ICT and Telemedicine has penetrated the rural regions of Africa is through the creation of the Pan-African e-network system which is considered as the largest project in distance learning and telemedicine in Africa. This projected emanated from the development of a fruitful partnership between India and Africa (Wamala and Augstine, 2013). The growth of telemedicine in Africa can also be demonstrated by the development and use of internet supported connections among health care institutions in Mali. There is also the continuous evaluation of the viability of distance health care learning and teleconsultations. Specifically, the project in Mali resulted in the successful collaboration of health care institutions, and the creation of medical teams who were trained through the use of internet-based learning tools.
Other African regions that actively participated in the use of information and communication technology in their health care system include Sudan, Rwanda, Uganda and Nigeria among others. In Sudan, the crusade towards the promotion of telemedicine was demonstrated through the initiative of its health care providers to bring consumers and health care professionals through telecommunication. Rwanda, on the other hand, had been suffering from a shortage of medical doctors and health care providers, and the introduction of telemedicine is expected to resolve the issue. There is already a substantive telemedicine infrastructure in Uganda, while efforts to implement these infrastructures are already underway in Nigeria. Nevertheless, there are still many countries in Africa that suspended the adoption of ICT and telemedicine due to diverse reasons.
2.3 ROLE OF ICT IN IMPROVING HEALTHCARE IN RURAL AFRICA
a. An Important Tool used to Reduce Costs
Health care costs are one among the major hindrance that prevent the provision of quality health care system in regions such as the rural parts of Africa. Many in this region, there healthcare system lacks transparency, are inefficient and costly. Information and communication technologies are among the best options to transform the health services across rural Africa “in ways that not only increase efficiency but also improve accountability” (Shekar and Otto, 2012). With the earlier introduction ICTs in the region, the quality of information technology services in Africa increased in recent years, which include the improvement of the health care sector.
b. ICT as a means to address shortage of funds
Fund shortage is a primary barrier in the provision of health care in rural African areas. Analysts reported that the achievement of the Millennium Development Goals requires a 12% GDP expenditure on the delivery of health care. This was validated in a previous report where it was estimated that about $30 billion should be invested in health care physical assets alone (Vital Wave Consulting, 2012). One of the challenges faced by the public health service models is the inability of fee-based programs to adequately address health care, as well as the region’s high dependence on funding from external sources. It is with the need to address these concerns that many equity groups, organizations and agencies encouraged the integration of ICT to meet the enormous health care needs in African countries.
Information and communication technologies are helpful in resolving the different challenges in the health care system of rural African regions. For example, it was found that in many African countries, “out-of-pocket expenditure makes up more than 40% of total health expenditure” (World, 2016). As shown in Figure 1, regions that have a lower investment in health have higher out-of-pocket expenditures in health care, which demonstrates that cost is a hindrance in accessing quality health care. The resolution of these challenges requires interventions such as the promotion of health financing and other forms of insurance programs that are deemed necessary. Accordingly, the Institut Francais des Relations Internationals (IFRI) vouched for the use ICT, not only to support the promotion of health insurances, but also in getting over the other challenges faced by the health care industry in African regions (Vital, 012). For example, the development of a mutually beneficial cooperation between the health care and financial sectors can be facilitated with the use of information and communication technology.
Figure 1: Government expenditure per GDP (Source: World Health Organization, 2016)
c. ICT ROLE IN THE EFFICIENT PROCUREMENT OF HEALTHCARE SUPPLIES
The use of ICT in the procurement of health care supplies will significantly simplify and expedite the process of acquiring and delivery of these materials and equipment. It is noted that one among the challenges faced in the procurement of supplies is the prevalence of irregularities in the process. The integration of information technology can help reduce the possibility of committing this fraudulent activity. For example, mobile devices and other forms of ICT improves communication, gathering of data and the allocation of resources. Further, there is the introduction of e-procurement which is a newly introduced method of obtaining supplies through the assistance of information technology software and devices. In line with the adoption of an e-procurement strategy, the different countries in Africa must establish a system where this method can be fully integrated, in a way that it can help save time, costs, and effort. The development of a system that integrate e-procurement in within the health care industry of rural regions in Africa can do so much enable “competitive bidding while avoiding corruption” (United, 2011).
Information technology can also improve access to essential drugs and medical supplies due to the development of better supply chain management. In the health care sectors of rural Africa, an efficient supply chain management can significantly reduce costs through the reduction of intricate steps of ordering supplies. The operational efficiency of supply chains results in better cost savings that can otherwise be used in achieving the overall goal of the health care sector.
d. ICT ROLE IN INFORMATION DESSIMATION
Another important role of information and communication technology is in helping in a speedier information dissemination in rural Africa. Information technology helps in the systematic gathering of public health concerns; for example, the development of health information systems in Limpopo, South Africa helps in improving health care, due to the increased management efficiency that resulted in the improvement of the quality of health care services (Chetley, 2007).
Particularly, information technology is vital in the promotion of policies and programs that affect the health and wellbeing of the people. For instance, the creation of health information dissemination centers in parts of East and South Africa plays a significant role in allowing the different agencies and the population as whole to have access to research findings. Through the different ICTs, institutions in these regions were able to “collect, collate and distribute relevant health and nutrition information in a timely manner” (Chetley, 2007). The use of information softwares and devices contributed to the ease by which the information dissemination centers were able to circulate information in the different provinces. Further, ICT help in the collection of regional-specific data that can help policy makers develop better health care programs in these regions. One way in which ICT can help in data collection is through the use of databases where important information is stored for easier retrieval
f. ICT AND THE PROMOTION OF LEARNING
The education and training of the healthcare workforce are important if they are to provide quality care to their patients. There are diverse internet-based learning that allows the health workforce to advance their learning, even without having to quit their jobs. A common predicament among rural health workers is the limited training in their area, which require them to travel distances to gain further training. The introduction of information technology, specifically through e-learning can help health care providers to learn and upgrade their skills. However, the challenge does not stop there because reliable internet remains to be one among the most common problems among users in the rural areas of Africa. In line with this, African Medical Research and Education Foundation (AMREF) built e-learning training facilities where health care workers are given the opportunity to upgrade their skills through online learning (Mwangi et al, n.d). The replication of AMREF’s system through information technology can help in improving health care quality in many African rural regions. That is, nurses and other medical staffs will be able to upgrade their qualifications, and will be better equipped to handle different medical cases. These are just among the diverse initiatives that improve the health care quality in rural Africa.
2.4 STIPULATED THEORIES ASSOCIATED WITH THE SPREAD OF ICT
a. THE DIFFUSION OF INNOVATION THEORY
The diffusion of innovation is referred to as a research form where innovative concepts, products and behaviors are encouraged through the development of new social frameworks (Rogers, 1983). The adoption of fresh ideas depended on the attribute of the innovation, communication channel used as well as the existing social structure, as shown in Figure 2 on the next page.
(Source:Rogers, 1995)
The development of this model is in line with the idea of the need to spread vital information as well as the use of innovations in information technology. This is especially so in the health care industry, where organizations as well as health care providers must have a clear goal to achieve in the delivery of health care services. The research model starts off with the identification of different elements that apparently influence the speed by which ideas are adopted. The diffusion of innovation model serves to highlight the reservations connected with new ideas and behaviors. Further, it also supports the implementers of public health programs, especially on how they should address these uncertainties, and win the approval of targeted users in the earliest time possible.
Under the concept of diffusion innovation theory, people tend to be slow in the adoption of new ideas and behaviors. However, as demonstrated in Figure 1, the eventual familiarization and acceptance of the idea or behavior leads to an increased rate of practicing it. The idea becomes common, with a large number of people adopting it with only a small number of new adopters. According to Rogers, this S-curve shows how innovations are spread and adopted in social systems. Consequently, information technology plays a significant role in how fast an idea or knowledge is shared within a community. In addition to that, this approach of information dissemination works best in instances when they are used in spreading issues that have a considerable impact on a large members of the society.
Figure 3. Some of the Features of Innovation
Source: Rogers, (1983)
ICT can help build familiarity about health care interventions, and its extensive reach of communication technology can speed up an increased appeal of health care programs.
The use of ICT can disseminate information on how some members of the society have accepted or rejected a certain behavior or idea, such as how women may have adopted new health care interventions.
In the past few years, the rapid growth of information technology and the innovations that had been spiraled through it resulted in the emergence of greater interest in the effect of diffusion. The proponents of innovation adoption claimed that the innovators, early adopters, early majority, later minority and laggards all play a role in the diffusion of telehealth innovation (Dyk, 2014). The application of Roger’s diffusion of information in the health care sector has been widespread among many medical care agencies. In recent years, the application of this theory in the health care industry was narrowed down to focus on telehealth services, where diverse factors that determine its acceptance and rejection were noted by several scholars. Some of the barriers to the adoption telehealth includes, a) technical, b) behavioral, c) economical, and d) organizational (Dyk, 2014). These barriers have prevented clinicians and their patients from adopting innovative ways to achieve better health care.
The technical barriers emerge due to the lack or even absence of the needed technology, as well as the appropriate knowledge and competence in its application. Consequently, behavioral barrier refers to the negative attitude of the affected individuals against the innovation. There are some people who may be threatened by the introduction of innovative ideas, and the proponents of telehealth must be prepared to handle these behaviors. There is also the economic barrier that concerns the costs of the implementation of this service, and the ways and means by which to secure patient markers. That is, there is a need to have a secure market for telehealth patients in order to sustain continuous operations. Lastly, is the organizational barrier which is most concerned with the integration of telehealth in different organizations. The challenge is not only in the proper integration of telehealth, but also with in getting assurance that it is well accepted by the members of the organization. Further, it is also crucial that there is a predetermined method to execute institutional management and support to ensure proper provision of services.
b. UNIFIED THEORY OF ACCEPTANCE AND USE OF TECHNOLGY
The unified theory of acceptance and use of technology (UTAUT) suggests that behavioral intention that leads to the eventual acceptance of technological innovations is predicted by performance expectancy, effort expectancy, and social influence (Taiwo and Downe, 2013). The development of this theory paved the way for its extensive use in facilitating the assessment of the use of different applications. As shown in Figure 4 below, there are four main constructs of the UTAUT, these are, performance expectations, effort expectancy, social influence and facilitating use, all of which have an impact on the user's intent. According to this theory, the facilitating circumstances and behavioral intents play a role in predicting user behavior that demonstrates their acceptance of new information technology.
Figure 4
Source: Ami-Narh and Williams, 2012
UNIFIED THEORY OF ACCEPTANCE AND TELEMEDICINE
a. Performance expectancy
Telemedicine, which is a popular form of health information system aims to provide a better and accessible health care service while decreasing costs. In line with this goal, the performance expectancy under the UTAUT theory suggests that health care providers believed that using telemedicine and other forms of health care information technology can improve their ability to deliver quality services. In a study conducted by Cillers and Flowerday (2013), they established that health care workers assigned in rural areas find the use of Telemedicine as more efficient and useful. However, this is not the case among health care staffs working in medical institutions located in urban areas. The likely reason for this is that health care professionals in rural areas have the highest tendency to experience the benefits of using telemedicine.
b. Effort expectancy
The effort expectancy refers to the “degree of ease associated with the use of the system” (Cillers & Flowerday, 2013), and this is demonstrated when health care workers who use the information technology do not find any difficulty in the process. A user-friendly technology tends to have a wider and speedier acceptance among its target users, compared to those that involved complex operations. The ease by which users can navigate a certain information technology platform can mean so much in determining the level of acceptance. It is therefore important that organizations such as the Department of Health must work towards the training and education of the health care workers on the use of Telemedicine. Further, they should realize that technological advances are meant to make their jobs easier, and it only entails familiarization of the specific program.
c. Social Influence
Social influence in the field of information and technology refers to the extent by which a decision to adopt a system is affected by the opinion of other people. For example, there is the Technology Acceptance Model which explains the manner in which people accept a specific technology (Ventakesh and Davis, 2003). That is, their decision to make use of an information technology such as Telemedicine, may be influenced by several factors, such as the perceived ease of use (Ventakesh and Davis, 2003).
d. Facilitating Conditions
This factor that affects the decision of potential users involved the availability of resources such as “technical assistance, knowledge of the system, and compatibility with other systems already in use” (Cillers and Flowerday, 2013).
c. ACTOR NETWORK THEORY
Actor Network Theory (ANT) refers to an approach where objects are treated as an essential member of social networks (Cresswell, 2010). It suggests that objects, have the ability to be actively involved in networks; thus, objects become a “source of an action, regardless of its status as a human or non-human” (Cresswell, 2010). A distinct feature of this theory, however, is that an actor will only have the ability to act when combined with others in a specific place and period of time. In contrast to other theories such as the diffusion of innovation theory where the technological influence can be felt as an outside force, the ANT theorizes that the emergence of technology is inspired by social interests. More than that, technological innovation has the potential to affect social interactions, and this theory is in line with the concept that the world largely consists of networks, which may include humans and nonhumans. This theory assumes that the combination of human and nonhuman components within a network will lead to the development of social phenomena.
The actor network theory explains why the introduction of innovations, such as a new information technology system in an organization can have a considerable impact in changing the system. Consequently, the acceptance of information technology such as Telemedicine by many health care workers can be attributed to its positive impact on changing social networks (Cresswell et al, 2010). The active role of technology in facilitating Telemedicine helps in the emergence of a new form of social relationship. For instance, the medical practitioner and the patient may be able to convey important information from one another through telecommunication. The system of Telemedicine demonstrates how health care can be delivered between actors through the use of an inanimate object which is, in this case, the information technology (Efarikumah, 2013).
Health care technology can be perceived as an integration of a new element into an already existing system as exemplified in Figure 5 below.
Figure 5: The potential network and the use of electronic health record
Source: Cresweell, 2010
In Figure 5, the different actors play a significant role in maintaining the system as a whole. The relationship of each component with the other shows that each actor must fit into the system in order to ensure the stability of the whole social network. The actor network theory can be used as a tool in the development of a “user-centered design for rural community information systems” (Wayi and Huisman, 2012). Consequently, rural communities such as those in African regions may be encouraged to adopt information and communication technology for better health care provision through the use of ANT for the designing of the system.
CHAPTER 3
Systematic Literature Review
There are several studies conducted on the impact of information and communication technology in enhancing health care in Rural Africa. Diverse field works were held to focus on the result of health care information systems, the result of which are important in helping medical workers use ICT for the promotion of better health care services in Rural African regions. There are eight articles used in this review, all of which are focused on the study of ICT, Telemedicine and their integration in the healthcare industry. These articles include, a) Wamala and Augustine (2013), b) Mars (2013) and 2014, c) Breen and Matusitz (2011), d) Hartman and Van Dyk, (2014), e) Darkwa (2000), f) Afarikumah, (2014), and g) Miller (2015).
The methods used in this review include selecting related literature about the impact of information technology in promoting the use of Telemedicine in Africa. The articles are taken from reliable sources such as the National Center for Biotechnology Information, which is government funded resource for molecular and biological studies. The use of reliable sources is vital in this study, as they provide an assurance about the validity of the findings. In this research, the main focus is on the interrelationship of ICT, Telemedicine and the quality of health care, especially in the rural African regions. Some of the difficulties encountered in selecting literatures for review are the limited number of studies conducted on this topic. There are some studies about the impact of ICT in Telemedicine, but much of them are focused in regions other than in rural Africa.
Consequently, this study used articles that relate to ICT and Telemedicine and how these factors are vital in promoting healthcare quality. Further, other articles used include those that discussed the difficulties encountered in the introduction of Telemedicine in the specific region. Moreover, the research studies that were integrated in this paper are generally taken from recent scholarship. The goal of using recent scholarly works comes with the need to align the current status of healthcare and information technology in rural Africa.
3.1 INTEGRATION TELEMEDICINE IN THE HEALTH CARE SYSTEM
In the article entitled A Meta-analysis of Telemedicine Success in Africa, it was found that the use of ICT facilities positively impacted the efficiency of the health care providers. Telemedicine has been integrated in the health care sector and this allowed for better opportunities for care providers to reach out to their patients. It should be noted that in many parts of Sub Saharan Africa, the provision of health care is met with several challenges, and this is especially so with the inadequacy of ICT infrastructures in most of these regions (Wamala and Augustine, 2013).
Nevertheless, despite the fact that many parts of Africa are fundamentally lagging behind in terms of their ICT infrastructure, there are several government and international organization efforts that are made to promote better health care. For example, the Robertson Global Health Care Solutions and the Montana Healthcare Solutions are just among the organizations that entered into an agreement with Telemedicine (Wamala and Augustine, 2013). These efforts in improving Telemedicine in this region serve to provide a timely and better health care services in the marginalized communities. While there was a slow response among Sub Saharan members, the steps for the promotion of Telemedicine are taken as positive indicators for future success.
In line with the goal to reduce the non-technological and technological barriers to Telemedicine, many researchers developed systematic models to introduce e-Health solutions (Wamala and Augustine, 2013). They identified the lack of communication infrastructure as one among the main barriers to Telemedicine. Consequently, it was suggested that the internet can be used as an innovative tool that facilitate a more efficient global exchange of vital information in Telemedicine.
The extreme scarcity of health care in Africa was discussed in an article entitled Telemedicine and Advances in Urban and Rural Health Care Delivery in Africa. The shortage of health care professionals has a considerable impact on the health care system, and this article pointed out, how Telemedicine can serve to bridge the gap between the patient and specialist care. There are several factors that lead to the slow adaptation of Telemdecine in Africa. Some of these are the absence of adequate communication infrastructure, the lack of knowledge to use them and the unstable supply of electricity in these regions (Mars, 2013).
Further, there are critical issues that must be considered in the implementation of Telemedicine in the African region. Some of these issues include the legal, regulatory and ethical implications. There is the concern over licensure and the medical practice in general since Telemedicine consultation will require the coordination of the referring doctor and the consulted physician. For example, while the consulted physician will be offering a second opinion, it is upon the discretion of the referring doctor to either accepted or reject the advice. Further, there is the challenge associated with cross-border practice, where the issue of licensure is raised, thus the existence of registration and licensure serve as an impediment in Telemedicine consultation. There is also the concern over privacy, confidentiality and data security in the use of Telemedicine (Jack and Mars, 2013).
Consequently, there are pragmatic solutions that are aimed at reducing the impact of these obstacles. For instance, the European Union issued a directive that aims to enable cross-border Telemedicine among member states. There are specific guidelines that outline the best way to practice Telemedicine. The key is in seeing this ICT as a tool that requires adequate study and support, as this form of health care can help improve the health care system in Africa (Mars, 2013). In South Africa, the Health Professions Council of South Africa created the National eHealth Strategy, which was aimed at developing the guidelines in the Telemedicine practices.
3.2 LACK OF EDUCATION
Education in the health care industry is vital in the promotion of better health in the community. In Sub-Saharan Africa, the shortage of health care professionals demands an increase in providing access to education, where students and even medical professionals can better equip themselves with the skills and knowledge needed in health care. In an article entitled, Tele-Education in South Africa, tele-education programs are gradually gaining popularity (Mars, 2014). This form of support for health care professionals and those who are aspiring to for a career in the health care system in Africa can gain a better perspective through an access to Tele-education. Research showed how the use of Tele-education helps in improving access to trainings within constrained setting, and while the initial steps were not perfect, they are indicators of positive results in the future.
In the An Evolutionary Examination of Telemedicine, the authors pointed out how the lack of trained staff to use new technological equipments can compromise Telemedicine (Breen and Matusitz, 2011). The limited knowledge, skills and expertise in Telemedicine services add to the constraints in the development of this innovative technology in health care. Further, this scarcity of know-how and skills in Telemedicine serves as an obstruction in generating and thinking up a more effective approaches of Telemedicine applications. This scarcity of technical know-how also results in the inability of local medical practitioners to gain further education and skills. For example, fresh graduate physicians who may need to increase their medical knowledge are hindered from further learning. This prevents them from gaining skills and access to innovative techniques in delivering high quality health care services. As a result, this difficulty led to the slowing down to the implementation of Telemedicine health services (Breen and Matusitz, 2011).
The government, global organizations and health care professionals recognized these challenges in the integration of Telemedicine. Thus, the initiative to find ways and better approaches to overcome them. In line with the concept of improving Telemedicine, “scholars, researchers, spokespersons, and others have dedicated their efforts to attempting to resolve these hindrances” (Breen and Matusitz, 2011). This is with the objective that Telemedicine will soon advance as one among the most effective ways to improve health care. Currently, researchers must proceed with further investigation on how best to use technology in advancing health care, while keeping up with ethical considerations.
The current struggle in the public health care system in South Africa calls for the implementation of a new system to support government programs and health care professionals. In the article entitled The Utilization of Mobile Devices for Telemedicine Services, the use of mobile devices to facilitate Telemedicine was discussed. It was found that mobile devices are helpful in promoting health care, however, only a small portion of health care professionals use it in Telemedicine services (Hartman and Van Dyk, 2014).
The health care system in African should take advantage of the growing mobile revolution by using these devices in Telemedicien. This device can help in levelling up the access to quality health care. There remains to be a “great lack of understanding in the utilization of mobile devices in conjunction with Telemedicine services (Hartmann and Van Dyk, 2014). Thus, further study should be conducted to validate the importance of mobile devices in Telemedicine, and in how best to implement this communication technology to increase its use of the health care system of Africa.
As pointed earlier, the implementation of the Telemedicine is not without constraints, because the use of ICT for health requires consideration of many aspects. In the article An Exploratory Survey of the Applications of Telemedicine in Ghana, the use of Telemedicine was examined in two health care institutions in Ghana. The medical doctors and hospital administrators were interviewed to determine their familiarity with computers and Telemedicine. The assessment includes an examination of their ability to use information technology tools within the health care system. It was found that while the majority of the participants were knowledgeable with computers, they were not highly familiar with its use in the Telemedicine setting (Darkwa, 2000). Further, it was found medical professionals in the urban areas are more interested in the utilization of Telemedicine than those who are located in the rural regions of Africa
3.3 RESOLVING THE LACK OF EDUCATION
. The importance of well-trained and better equipped health care professionals in using information technology are vital in settings such as those in rural Africa. This is because the reliability and effectiveness of communication are critical factors “in individual health institutions, disease monitoring and prevention, public health systems, and health care generally” (Afarikumah, 2014). In line with this is the need to resolve barriers such as the lack of adequate skills in using technology in Telemedicine. Thus, further training should be conducted among health workers to allow for the acquisition of needed skills.
The use of ICTs in health care presents a wide-ranging opportunity, and it has always been tempting to transfer technological tools even without a prior examination of the local needs and other possible barriers. In an article entitled Kenay Launces Telemedicine Initiative for the Poor, the introduction of Telemedicine in Kenya was coupled with a user friendly platform (Miller, 2015). The platform was aimed at enabling a better interaction between the patients and the health care providers, specifically in the main hospitals of Kenya. This program was conceptualized and implemented to promote research, medical education, and community awareness about the diverse communicable disease. For instance, the administrator of Kenyatta National Hospital welcomed the introduction of satellite systems in education. This is to ensure that the efficient use of Telemedicin in Kenya and other parts of Sub-Saharan Africa (Miller, 2015). Further, project funding was implemented with the support of the diverse international organization to help foster education and learning among health care providers in rural Africa.
CHAPTER 4
Recommendations
A systematic examination of diverse literatures in ICT, Telemedicine and health care resulted in the development of the following recommendations. Many of the literatures provided that Telemedicine is one among the best approaches to better health care in rural Africa. However, its implementation requires the consideration of many local circumstances and barriers. This form of information technology in the health care system requires several preparations, a) establishment of information and communication infrastructure, b) skills and technical know-how to operate these facilities, c) adequate electricity supply, d) labor force.
The recommendation for establishment of ICT infrastructures in rural Africa is attributed to the findings that only a few households have access to the internet, thus there are only a limited number of people who gets into web-based solution. Further, the introduction of new technology requires the technical know-how among the staff who will be tasked to handle their day to day operation (Miller, 2005). This is also in line with the need to have adequate number of healthcare workers to support the new technology program.
4.1 INFORMATION AND COMMUNICATION INFRASTRUCTURE
One among the most important element in using Telemedicine in health care is in ensuring that information and communication technology infrastructures are established and are efficiently working. It should be noted that in most developing countries such as those in rural Africa, the lack of adequate access to the internet and ICT tools is sufficient to negatively impact Telemedicine. The poor ICT facilities in rural Africa can be attributed to its long history of being engagemed in civil unrest. Consequently, there should be a need to enhance the ICT infrastructure in order to develop a better facility that will help in distance interaction between the patient and the consulted doctor. Some of the suggested steps to improve ICT are:
Foster partnership with institutions and organizations
Improve the decision making within the health care system
Take initiative to improve existing ICT infrastructures
4.2 IMPROVEMENT OF TECHNICAL KNOW-HOW
Skills and technical know-how are also important if Telemedicine must be successful in rural Africa. Reports revealed that some health care workers tend to resist the use of information technology in providing health care. The lack of education and technical know-how in the use of information and communication technology can be addressed through further education and widespread training among health care workers.
Computer literacy should be one among the paramount concern in order to reduce the barriers in the application of Telemedicine. The government and international organizations must foster a training and learning system that aims to meet the educational needs of the local population. This is especially so that local medical personnels may not have the adequate learning materials during their studies, thus they are not sufficiently equipped with the skills and trainings that are needed in many medical cases.
4.3 ADEQUATE ELECTRICITY SUPPLY
Another factor that should be improved in rural Africa in order to facilitate the use if Telemedicine is in ensuring that there is an adequate supply of electricity in the region. The problem in rural Africa is not only with the shortage of doctors and other medical professionals, but also the lack of power supply to support ICT projects. Challenges arise with the shortage of electricity, for instance, power outages can impact the mode of communication between the rural health care worker and the medical specialist. It should be noted that Telemedicine facilitates the interaction between the health care workers and the assigned remote consultant. Thus the need to have a continuous power supply to help support ICTs, specifically, the use of Telemedicine in critical health cases. A viable proposal to address the unreliable power supply in the region is tapping on the solar power. The high speed internet will serve no purpose in the absence of sufficient power supply, thus the government must work towards having a better source of power.
4.4 LABOR FORCE
In line with the provision of adequate training and education, there should be a sufficient number of staffs and medical practitioners to attend to the needs of communities in rural Africa. The members of the labor force, including those who were contemplating to join the health care system must undergo an intensive training, not only in providing health care, but also in operating technological devices. Educational initiatives must be introduced, and this proposal is founded on the principle that the shortage of medical practitioners equates to the shortage of qualified individuals to teach aspiring practitioners. The shortage of health workers in rural areas can be attributed to the fact that only a small number of health care professionals in these regions. Thus, a comprehensive strategy to increase the number of health care practitioners to take care of the health care needs of the rural population must be initiated. In line with the objective of Telemedicine, they should be highly equipped with the skills to deal with diverse health issues, even through remote communication.
4.5 REEVALUATION OF POLICIES AND STANDARDS
Policies and standards imposed by the government can often serve as a barrier in promoting Telemedicine and other efforts of the health care organizations. Unfortunately, these laws are generally outside the control of the health care system. For instance, the regulations about professional licenses can hinder the delivery of health care services in different states. Therefore, there is a need to develop a closer coordination between the policy making bodies and the health care system in order to make possible changes that can make way for better Telemedicine services.
Further, the standardization of the Telemedicine system is also needed in rural Africa. This is to ensure that the training and skills needed in one area, is generally uniform with another region. The introduction of new technology in the health care industry is a bit complex, thus the standardization will help in lessening the difficulties associated with the initiation of a new system. Empirical research should be conducted to evaluate the impact of the initial introduction of Telemedicine in rural Africa. The results will be used to assess the weakness of the system, and to determine possible ways to improve. This is in addition to making Telemedicne as a form of integrated policies, rather than just another medical practice. It is suggested that Telemedicine should not be implemented as a separate project, but as an initiative that is an integrated part of the health care system.
CONCLUSION
It is the purpose of this research to provide a comprehensive study on the impact of information and communication technology, and Telemedicine in the promoting quality health care in Rural Africa. Further, this study also aims to describe the challenges in the adoption and implementation of Telemedicine in this region. Consequently, it was found that ICT and Telemedicine play a significant role in helping health workers in providing health care to rural communities in Africa. While there were significant steps taken to resolve these issues, the barriers tend to be overwhelming. Thus, further study should be conducted on how best to address the barriers to the wide-ranging implementation of ICT and Telemedicine in the rural regions of Africa.
The introduction of progressive innovations in information technology had been helpful in promoting quality health care in many parts of the world. It allowed medical practitioners to readily gain tools, knowledge and skills that are needed in dealing with diverse health cases, and this has considerable improved the delivery of care to patients. Consequently, ICT leads to the development of Telemedicine, which is an innovative tool that can be used to reach out to patients even in remote areas. This new technology allowed patients to communicate and consult their doctors, without having to travel distances.
Overall, Telemedicine is an extraordinary innovation that has been used to help millions of people throughout the years. Since there is a plethora of people who suffer from detrimental conditions throughout rural Africa, the health care providers have been able to make a significant difference. As time progresses, there is a need for more innovation, but the health care process has improved rapidly. Cost effectiveness has been taken care of and the rate of adverse events has decreased, which is a beneficial factor to take into consideration.
There are several challenges that prevents the smooth introduction of Telemedicine in rural Africa. Some of which include the lack of funding to initiate the project, as well as the need for skilled personnel to man the facilities. There is also the deficiency of power supply which is an important factor to consider in using innovative technologies. As a response, further studies should be conducted on how best to resolve the difficulties associated with the use of information and communication technology and Telemedicine in rural Africa.
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