Zimbabwe: Telemedicine Revolutionises Zim Healthcare

The recent launch of a new digital health application by the Zimbabwe Telemedicine Network (ZTN), that is expected to provide health education and other digital tools for use by health professionals, is a step in the right direction as the country moves to enhance health care service delivery and access to health for all. The mobile application called MyCpdZw was launched last week by the ZTN as part of efforts to promote the growth of information and communication technology in the country's health sector.

Health experts define telemedicine as the provision of healthcare over a distance using information and communication technology (ICT), and includes the provision of health education over a distance.

This, they say, involves monitoring the health of people in their homes or some remote rural healthcare centre by devices that send information back to a central site by telephone or through the internet.

Telemedicine, experts further say, can also be conducted by live interactive video-conferencing, with the patient seeing the doctor face to face, over a distance, with special devices used to assist clinical examination.

Health experts also say another form is store-and-forward telemedicine, where a photograph is taken of a skin lesion, for example, and attached to an email containing the relevant history, clinical findings and results of special investigations, and sent by a doctor or nurse to another doctor or specialist for diagnosis or a second opinion.

Principal technical lead for the ZTN Dr Admore Jokwiro says the launch of MyCpdZw app will certainly ratchet up the modernisation of the health profession in the country which is facing numerous constraints in the healthcare sector.

"We are quite excited about the launch of this app," he says. "We have developed this platform to help health workers especially those working in remote areas to be able to access standardised and up-to-date trends, guidelines and clinical tools which are relevant for their continuous professional development."

With this MyCpdZw app, he says, healthcare professionals will easily share and disseminate information with those far-flung areas in the country.

Dr Jokwiro says some of the key features of the application include continuous professional development activities (CPD), drug indices (EDLIZ), emergency protocols, a library, clinical support tools like TB, malaria and HIV guidelines.

The telemedicine network has since launched a digital health pilot project in Manicaland which has been run successfully helping disadvantaged patients from remote areas to access health services in a cost effective way

This project is the first in the country.

The Postal and Telecommunications Regulatory Authority of Zimbabwe (Potraz) in partnership with the International Telecommunications Union (ITU) has supported this initiative to address the issue of low doctor-to-patient ratio in rural clinics and hospitals.

At least 12 sites in Nyanga district and others in Manicaland province have been identified by the Digital Health Department within the Ministry of Health and Child Care which were connected to major referral hospitals at Mutare General Hospital and the Parirenyatwa Group of Hospitals.

Government digital health expert Mr Trymore Chawurura says his ministry is now mobilising resources to set up infrastructure, computers, network and broadband to roll out the telemedicine initiative to other parts of the country.

Of course, budgetary constraints are a major problem and other experts at the launch say it's important for the Government to first set out policies and the regulatory framework for the telemedicine sector.

E-health expert Dr Marlon-Ralph Nyakabawo says telemedicine must be accompanied by successful business models to ensure its sustainability.

"Digital health was a subject that was on the fringes in the past but now it's in the mainstream. Governments on their own cannot roll out the initiatives and this requires the private sector to take this up to ensure sustainability. Even the World Health Organisation supports this," he says.

Mr Chawurura and Dr Nyakabawo believe strongly that the private sector must complement Government efforts to promote the growth of telemedicine in the country.

"Youth participation is very critical for the growth of telemedicine in the country," says Mr Chawurura. "We must involve our youths in the incubation of start-ups and conduct symposiums to empower youth in digital health."

"We have to create the space for our innovative youth to participate in the digital space in Zimbabwe. This will make it possible to enhance efficiency and the effectiveness of digital health systems in the country."

Dr Nyakabawo says the Government must create a conducive environment for digital health to thrive through the establishment of sound policies and regulatory frameworks.

"A policy is critical. A policy can play a catalytical role in the development of digital health in the country," he says. "A policy brings sanity and guidance to the industry. Empowering the youth through start-ups and creating a conducive environment can attract investors into the country's digital health sector. Our regulators should have an open door policy and embrace innovation in the healthcare sector."

Zimbabwe, like most other African countries, still faces numerous problems in the healthcare sector.

Clinics and hospitals in rural areas lack resources, drugs, manpower and accessories, something that hinders the delivery of quality healthcare to people.

Health professionals in remote parts of the country still lack opportunities for training and career advancement, up-to-date information and digital applications to help address challenges they face in their work.

Africa carries 24 percent of the world's burden of disease and is served by only 3 percent of the world's health workers, who have access to 1 percent of global health expenditure, according to the WHO.

Its population continues to grow rapidly and is expected to nearly double by 2050, something which makes telemedicine an urgent priority.

Health experts say telemedicine holds great promise for Zimbabwe and most other African countries.

They say it can provide rural health care in the most remote areas, a move which can help drive the access to health for all campaign forward.

All that is needed is a good network and broadband for most rural clinics and hospitals.

This will certainly reduce the long journeys that people have to make to access the nearest healthcare centre.

Telemedicine also increases access to scarce medical specialists in bigger centres and academic institutions.

A case in point is the Nyanga pilot project which has since linked up to specialist doctors in India, where most Zimbabweans spend millions of dollars to go and receive treatment.

Such collaboration can help the country to save on foreign currency and share medical expertise.

Through telemedicine, doctors in rural Zimbabwe can receive support from their peers in India, helping to overcome the shortage of experts and address the information gap.

Ms Ronia Chitura, a midwife in charge at Nyanga District Hospital, says telemedicine provides a platform for the delivery of education by the leading experts in health and medicine to others far afield with minimum disruption to the delivery of healthcare services.

Telemedicine, she also says, helps to provide a platform for effective sharing and dissemination of information among health professionals.

"With telemedicine it's possible for us to bridge the information gap, build the confidence and offer clinical tools for the management of certain conditions at least cost in rural areas," she says.

The Nurses' Council of Zimbabwe also says it will soon move to establish e-registration systems and modernise its logging systems to move with the times.

All this, it says, will be done under efforts to embrace digital health systems and the Nursing Now campaign.

Most experts say telemedicine will certainly help the Zimbabwean health sector which is reeling under the current economic difficulties and has resulted in the lack of adequate drugs, and specialist health personnel to serve the people. Despite the merits of this digital health system others, like Dr Edwin Muguti, fear that the adoption of telemedicine will raise some concerns over patient confidentiality.

"Yes, IT is crucial, it's now a crucial part of our lives, but you cannot replace doctors," he says.

"Issues involving the confidentiality and protection of a patient's need to be addressed if we are to full embrace telemedicine. It's a major worry. If you upload my personal details -- who has access to them and this is where there is concern."

Addressing confidentiality issues will certainly determine the success or failure of telemedicine.

While telemedicine is an important tool for improving healthcare access, it requires adequate safeguards, policies and regulatory instruments to manage it successfully.

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