Home telehealth: Transforming Healthcare in Developing countries

Namugenyi Loi Mirembe (Ms)

Science Officer in charge of S&T Information Management

Uganda National Council for Science and Technology

The presentation looks at the current status of health care in developing countries and in particular Uganda and the role ICT and home telehealth can play in transforming the current situation.

Part A- current status of health care in Uganda

Part B- Role of ICT and Home telehealth Recommendations Conclusion.

IntroductionIn every country, health is a major concern

for government, citizens, businesses, and providers of information and communications technology (ICT) services. Each country faces key healthcare issues, with developing countries carrying the greatest burden of disease and the fewest resources to deal with the problem.

A. Health care in UgandaLooking at the statistics it's easy to see why

despite record investment over the past five years, Uganda's healthcare performance is still ranked as one of the worst in the world by the World Health Organization. The country is ranked 186th out of 191 nations.

A Ugandan's health and life expectancy is among the lowest across the globe. In Uganda, one in every 200 births ends the mother's life, around 1 million people are living with HIV and although malaria accounts for 14% of all deaths, less than 10% of children under five are sleeping under insecticide-treated nets.

Only 38% of healthcare posts are filled in Uganda. Those healthcare staff who are working, have little incentive to work in poor rural areas. Some 70% of Ugandan doctors and 40% of nurses and midwives are based in urban areas, serving only 12% of the Ugandan population.

Many hospitals and health centres in the country are running on less than ¼ of the required budget. As a result, they are always short of funds to ensure an uninterrupted delivery of services.

Most equipment in the hospitals are bought with no clear maintenance plan. Eight months after delivery the machine runs down usually from a simple mechanical problem but because no prior plan was put in place it is grounded forever.

As a result, despite having the equipment in hospitals the majority cannot even do the basic laboratory investigations referring patients instead to private labs or clinics. Contrary to what is widely believed, many of the privately owned pharmacies, labs and clinics belong to business people and politicians playing to exploit the gaps in the system.

ICT and home telehealthThe use of ICTs has grown relatively rapidly

in most urban areas in Uganda. Five years ago, only a handful of districts had local Internet access, now it is available in most of the districts. In the same period more mobile cell phones have been deployed and hundreds of new local and community radio stations have been licensed, and satellite TV is now also widely available.

The ICT landscape has changed dramatically over the last few years and the huge diversity of the continent means the averages given above obscure many pockets of significant developments.

Although the relatively low level of ICT penetration amongst the public in Uganda has so far limited the use of ICTs for governance purposes, many administrations are beginning to streamline their operations and improve internal efficiencies by adopting ICTs within their organisations.

Changes in the the telecommunication sector in Uganda have perhaps been even more marked than in broadcasting. A substantial increase in the rate of expansion and modernisation of fixed networks is taking place, along with the explosion of mobile networks.

With the current growth in ICT, developing countries need to take advantage of the ICT infrastructure to address the health challenges in this case by investing in home telehealth.

Home telehealth.Home Telehealth in general has been

especially associated with rural areas/states because of the difficulty in attracting and keeping physicians in rural communities.

There is increased demand of healthcare due to an increased number of elderly and changed life styles leading to an increase in chronic diseases

The challenges facing the health care sector in many developing countries which ICT and Home telehealth can address include;

Difficulties of recruiting and retaining personnel

in the healthcare services in general and in home and elderly care in particular.

Demand for increased accessibility of care out side hospitals, moving health services into the patient’s own homes;

Promoting patient self-management is a fundamental component of the Home Telehealth and the messaging devices are key to this, helping identify adverse symptoms, knowledge deficits and negative health-related behaviors that can be responded-to before progression to a need for hospital admission or emergency department visit.

Delivery approachUse a bottom-up approach

"Users are involved right from the beginning and are put in the driver's seat throughout the design, standardization, development and implementation process . Engaging the users from the outset and allowing the whole process to be driven in a bottom-up manner by user groups-which is painstaking and time consuming. this process is worth it because "it secures the buy-in and ownership of the users themselves to the need for change."

By implementing this new system of care in the management of chronic diseases and wellness programs, we are already seeing and we expect to see many valuable benefits.

For example, Treatment outcomes and patient care are

improving in many developed countries and we expect the same to happen in developing countries once this system finds root and support from Government and other well wishers.

Expected benefitsUsing the Connected Health infrastructure,

healthcare advice, guidance, diagnosis, and treatment can be delivered at a distance from the provider.

Health workers can access the resources and information they need even when working at a patient’s home. Primary healthcare can be delivered online.

Routine communication between patients and caregivers can be exchanged through messaging systems, and patients can partake in Web-based visits to caregivers or specialists working many miles away.

With broadband connectivity, people and communities can have multichannel access to a wide range of healthcare services.

Helping individual patients with chronic diseases to manage their care at home, for example, can save significant hospital costs as admission rates are reduced substantially.

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The future of home telehealthThe impact of telehealth on the delivery of

care appears to be very promising. Patient empowerment, cost reductions, improved efficiencies and quality of care are benefits to be gained through its implementation in the home setting. So far, advancements in home telehealth have been focused primarily on disease management centered on the elderly. Nonetheless, a wide array of management programs, such as asthma control, can also be implemented within the pediatric population.

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With chronic diseases affecting such a broad patient population base, many have come to believe that the future of disease prevention and management lies within the realm of e-visits.

Recent advances in information and communication technology have made home telehealth both feasible and affordable. The results of this literature review clearly show that research from the early 1990s could be transformed into working products by now. Consequently, ICT has been recognized as a potential tool to provide high quality healthcare in the home.

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conclusionIn developing countries, Home telehealth offers

the opportunity to take tested processes that work well in developed countries and extend them into new areas. The ability to deliver improvements in healthcare—particularly in primary care—as part of a concerted effort to provide communities with an information infrastructure will enable people to make better decisions. Fewer unnecessary visits and referrals to hospitals will reduce workload pressures and costs, while improvements made to the population’s health will enable greater contributions to economic development and poverty reduction.

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Thank you for your attention.