Reports of technology use in providing medical service date back 1879 when an article in the Lancet Journal talked about using the telephone to reduce unnecessary doctors’ visits.
The first modern day use of telemedicine was at the University of Nebraska in 1959. This accelerated the introduction of telemedicine uses in emergency medicine, particularly for populations in rural areas where there was limited access to specialists.
In Kenya, as early as 1985, satellite links were used to communicate patient ECG results to healthcare practitioners from remote areas and these practitioners also made use of walkie-talkies to aid their communication.
Given that telemedicine is a relatively recent medical service in Africa, there is a lack of data that clearly delineates the adoption of telemedicine services. However, two factors may be used in assessing adoptability: perceived ease of use and perceived usefulness. Adoptability will be measured by the way in which telemedicine will provide solutions to current healthcare needs.
However, comprehensive, large, multiple-point data will be required to determine adoption patterns, that will then inform regulation. At Valentis Health and Dial Daktari, we anticipate that our recently announced partnership with integrated telecommunications services provider Telkom will facilitate the collection of this data in Kenya.
Across the world, challenges have been experienced in telemedicine, key among these being a lack of government funding policy. In many instances, it is due to competing health system priorities and a lack of policy governing the broad spectrum of telehealth programmes. Locally, there is also the lack of service awareness, accessibility and reduction in costs.
Therefore, if patients are not aware of your telemedicine service, they will not use it. They will continue to visit to their clinic or hospital, whenever they fall sick or when a scheduled visit is due.
In Africa, the benefits that favour telemedicine over face-to-face consultations include improved access due to increased mobile phone penetration, increased convenience in both urban and rural areas, and more affordable healthcare provision, due to the reduced need of brick and mortar infrastructure. Telemedicine could dramatically reduce the overall costs of health services because of its potential to allow a fundamental restructuring of the way healthcare is delivered. This would principally result from redistributing resources from the hospital environment into primary care.
A study of the uptake of telemedicine was presented to the EU in 2018. What was the result? They found that advances in information technologies accelerated telemedicine adoption in the EU.
The market potential of telemedicine was demonstrated to be strong and expected to grow at a compound annual growth rate of 14 percent. In places where telemedicine has been in use for over five years, a stable demand with potential for investments and growth has been noted. Here in Kenya, we have conducted several surveys of the patients who have used Dial Daktari and the satisfaction rate is consistently above 96 percent.
Kenya, like the rest of the world, is currently in an economic downturn due to the Covid-19 crisis. Dial Daktari and telemedicine in general will have an important role to play in the provision of healthcare, where the costs of the current healthcare system are not sustainable. There is also a significant shortage of healthcare providers, particularly in rural areas, and Dial Daktari can provide remote services to those areas.
There is also a growing concern that patients are not seeking medical advice in hospitals for non-Covid-19 conditions that could be potentially serious. Telemedicine could serve patients who are apprehensive of going to hospital. In addition, there is growing stigmatisation around Covid-19, and telemedicine is able to provide an alternative avenue for healthcare.
There are some considerations for operators when it comes to telemedicine. Key amongst these would be the efficiency, availability and reliability of the mobile network. Successful telemedicine requires appropriate equipment and a telecommunications partner with a high penetration infrastructure thus bridging a geographical gap to medical access. There is potential for telecoms operators to have an even greater impact on healthcare based on partnerships with telemedicine providers.
The coronavirus pandemic has driven a surge in telemedicine consultations. This change in health seeking behaviour should be converted into a real option for healthcare that will be sustained beyond the Covid-19 pandemic.
From where I sit, the future of telemedicine will be in three potential areas. First, with the increase in mental health conditions in Kenya, over the last few years and more so in this crisis, mental health practitioners will be brought closer to the population. Telemedicine will then be a powerful tool that we can use to tackle this second “pandemic” of mental health.
Secondly, with the powerful position that mobile phone technology presents to telemedicine, there will be an increased access to healthcare for the millions of people who cannot easily get it.
Lastly, telemedicine will be an avenue through which the highly trained Kenyan medical personnel can be absorbed into the medical workforce, thus increasing the number of health practitioners per capita. Legislation should therefore be put in place to facilitate telemedicine and relieve the pressure on the current infrastructure.
Dr Othoro is the Founder and CEO of Valentis Health.