Low bandwidth and limited Internet access are curbing technology advances in healthcare which could drastically improve medical services delivery, according to Yashik Singh, lecturer at the University of KwaZulu-Natal's department of tele-health.
There have been several local advances in the field of ICT-related healthcare recently, including a tele-psychiatry service, mobile pathology lab with satellite links for data transfer, and an artificial intelligence algorithm that predicts which HIV drugs a patient is resistant to.
However, these and other advances could remain underutilised, says Singh, as the challenges of incorporating ICT into healthcare are a real stumbling block in terms of providing improved health services delivery.
Craving connectivity
“SA has not really experienced the benefits of the recent ICT boom in terms of telecommunications and infrastructure,” notes Singh. “Access to the Internet is of paramount importance when considering the convergence of ICT and medicine.”
Access to the Internet is of paramount importance when considering the convergence of ICT and medicine.
Yashik Singh, lecturer, University of KwaZulu-Natal's tele-health department
He adds that Internet charges are relatively high in SA as compared to other industrialised countries. “Wireless coverage is limited by legislation but we hope that WiMax will provide better coverage to more municipalities.”
Another major problem SA faces is bandwidth, especially in rural areas. “In KwaZulu-Natal (and I am sure this holds for most of SA) most hospitals operate at a bandwidth of 128Kbps that must be shared between all the users in a hospital,” notes Singh. “This makes the use of IP difficult. As a result, stakeholders turn to ISDN or ADSL, which are not always easy to obtain and install.”
Tukisang Senne, health executive at Mindset Health, which develops digital educational material, and has a daily satellite broadcast to 200 hospitals, says access to technology is still skewed unfairly towards the greater metro areas. “This means large communities within the rural areas of SA stand to be left behind when it comes to accessing digital content.”
He says Mindset Health has enlisted the support of Sentech, MultiChoice, and Intelsat to ensure it can provide the public with a satellite broadcast which is not dependent on terrestrial broadcasting, while at the same time is not Internet-dependent. “We all know Internet connectivity is really poor for a country like SA, even compared to other African countries.”
Seeking technicians
According to Senne, the inaccessibility of some of the more remote rural communities also presents a challenge in terms of maintaining the equipment used to transmit the broadcasts.
“This is largely due to the shortage of appropriately skilled local individuals and SMEs that can be contracted to locally maintain faulty equipment. This would both create and catalyse a very highly localised economic development through employment creation, but also skills transfer to local technicians,” says Senne.
Singh agrees: “There is a shortage of qualified personnel required to design, implement, install and maintain ICT solutions to healthcare problems. These personnel need high-quality, advanced, domain-specific education.”
He adds there are very few people with these skills in SA and they are quickly absorbed into industry, adding another hurdle of not having suitable staff to teach these skills at tertiary institutions.
“Like with all emerging technologies, government needs to spend money on training people, create more legislation that encourages the use of tele-health, and use its political might to advertise posts more widely,” he argues.
At present, the Department of Health is rolling out projects such as primary healthcare telemedicine workstations, in conjunction with the various provincial health departments, as part of its telemedicine programme.
Great expectations
Senne hopes that in future, better connectivity and lowered costs will make tele-health a reality for the majority of the population. “We anticipate a greater buy-in for higher speed Internet connectivity, greater convergence of technologies, and cheaper access to IT, Internet and mobile phones.
“From a healthcare point of view, there's greater emphasis from the government for e-health and tele-medicine, which seek to ensure technology gets deployed more to support healthcare in resource-limited settings.”
He cites the scarcity of radiologists in the country as an example, with patients in some provinces having to travel over two days to access a facility with X-ray capabilities, should they need to test for pulmonary TB (one of SA's leading causes of death).
“With telemedicine, a patient's X-ray image could be taken by a local nurse using a computer-based scanner, with the image being sent to a specialist or radiologist in a major hospital and a prognosis confirmed while they wait in their local clinic,” explains Senne.
“This way services will be brought to people in a significant and sustained manner, without further impoverishing them through the need to travel long distances, taking many hours or even days just to access a service you and I take for granted.”
Singh notes that currently, uptake of tele-health and medical informatics is slow due to these challenges and the lack of champions in the area.
“We are, however, at the verge of change. There are many groups, consortiums and partnerships being formed with the purpose of creating and propagating ICT-related healthcare solutions. We are definitely moving towards a bright future in terms of healthcare.”
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