Starlink, the internet service operated by Elon Musk's SpaceX launched in Nigeria three weeks ago with a lot of excitement and expectations. In a tweet, President Muhammadu Buhari noted that the new service would bring Nigeria's internet penetration to 100%. This suggests that no matter where people are in Nigeria, they can, potentially access a reliable and fast internet service.
The internet has become an integral part of our lives, and almost every industry now relies on it to sell goods and provide services. The health sector has been heavily impacted by the wide proliferation of the internet enabling remote access to services that were previously only accessible in a health facility. This has the potential to improve both physical and mental health.
However, modern communication channels are less accessible to people in Nigeria's rural areas, and according to the World Bank, as of 2021, an estimated 36.5% of the Nigerian population use the internet.
Universal access to the internet and its impact on health
Nigeria, like other countries is taking action to achieve Universal Health Coverage (UHC) by 2030, however, issues such as inequitable access to health services, particularly for vulnerable populations, threatens the country's ability to meet this goal.
Now, Starlink and its promise to allow users the ability to connect from anywhere in the world is not a 'panacea' or universal solution to fix Nigeria's challenges improving access to health services. However, if Nigeria were to capitalise on the benefits of the internet penetration potentially reaching 100%, it could bridge the access gap -- particularly for health workers and patients in rural and hard-to-reach communities -- by providing health workers easy access to medical research, guidelines, and training resources. It could also enable the more efficient storage of patient data, improving connectivity with other health facilities and more importantly, strengthen the referral process across the different structures of the healthcare system.
Doctors would be able to conduct remote consultations and patient monitoring in hard-to-reach areas. Internet-based health education programmes and digital health tools could improve health literacy and empower people to take an active role in managing their health. This could improve the efficiency and effectiveness of health services, while also lowering costs and improving patient outcomes. The possibilities, while not endless, are quite broad.
Here are five ways that access to fast and reliable internet could improve access to quality health services for vulnerable people, as well as those living in hard-to-reach areas.
(1) Remote access to telemedicine, telemonitoring and telepsychiatry
Despite ongoing efforts at national and subnational levels to improve access to primary healthcare services, for people living in rural or hard-to-reach communities, access to quality care when needed remains a major challenge. Therefore, the option of internet enabled access to telemedicine, telemonitoring, and telepsychiatry services where health workers can offer more personalised care and quickly identify potential health issues before they become critical is especially beneficial.
People suffering from mental illness can also benefit from remote consultations and counselling from mental health professionals such as psychologists and therapists. This could help to reduce the stigma associated with mental illness and improve access to mental health services.
(2) Improved storage of medical records
Delayed access to a patient's medical records can result in long wait times in hospitals and reduce the efficiency of referrals when patients must move from one facility to another. Medical professionals can access and retrieve a patient's records using Electronic Health Records (EHRs), which enables faster decision-making. This can be critical in an emergency.
EHRs also aid the storage, sharing, and analysis of patient data, which could also be used for diagnosis and improving the quality of health care delivery, enabled by the faster and more reliable internet service because data can be easily retrieved even in remote locations or when patients move from one state to another.
(3) Efficient human resources for health starts with capacity building
The shortage of human resource for health is a significant challenge confronting Nigeria's health system. While it is important to have an adequate number of health workers, it is also critical to ensure that they have proper training and are up to date with recent advancements in their respective fields. Organisations have leveraged digital technologies to improve the capacity of health workers, however one of the challenges they face is a reliable internet service to ensure access to training materials.
With access to a reliable internet service, regardless of their location, health workers can easily access training content. They can also receive mentorship and support from professionals anywhere in the world.
(4) Real-time tracking of medical supplies
The medications and consumables required to provide health services to patients must be kept in the best possible condition. An effective and efficient supply chain and logistics system is critical for the delivery of health services because it ensures that medical supplies such as drugs, vaccines, and other consumables are kept in the best possible condition, while being transported from one location to another.
With a reliable internet connection, it is easier to track the movement of these supplies and access real-time data to ensure that they are transported at the proper temperatures. It is also possible to track their distribution down to the last mile to ensure that hard-to-reach areas are not left behind. Increasing efficiency and reducing wastage of medical supplies.
(5) Disaster response, coordination, and public health surveillance.
Access to fast and reliable internet services in rural communities can help ensure that these communities receive the necessary assistance during emergencies, and they are better prepared to respond to future health emergencies. Information about disease outbreaks and other health emergencies can be rapidly disseminated, which would enable health workers and the public to promptly respond. Community members can also quickly report suspicious incidents to relevant authorities in real time and receive updates on relief and other efforts.
Speaking during a panel session at the 2nd Conference on Public Health In Africa (CPHIA 2022), Dr Chikwe Ihekweazu, Assistant Director General, WHO Hub for Pandemic and Epidemic Intelligence, said that while he was the Director General of the Nigeria Centre for Disease Control (NCDC), during the height of the COVID-19 pandemic, Nigeria struggled to have a coordinated process of collecting, analysing and then, using the data to make rapid decisions . Reliable internet access can aid the collection and analysis of data on public health and disaster response. This can assist authorities in identifying patterns and trends and effectively responding to emerging threats.
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But is it really 100% internet penetration?
While Starlink may attempt to achieve 100% internet penetration, there are still obstacles to overcome before the health sector can reap the benefits. Affordability may be an issue as the hardware currently costs $600 and the monthly subscription costs $43.
Limited digital literacy may be another major hindrance, as health workers and patients in rural areas may lack the digital literacy skills required to effectively use digital health tools and platforms. Digital inclusion requires that everyone, particularly the most vulnerable has access to digital skills that allow them to participate effectively in society. Mindful of possible data breaches which may compromise patient data and undermine trust in digital health solutions, the government should make efforts to strengthen data governance and ensure right to confidentiality as included in the Patient Bill of Rights.
The cost of internet connectivity and digital health solutions can be a major barrier to the adoption and use of technology in Nigeria's health system, particularly in resource-constrained settings. Health facilities and patients may not be able to afford the cost of internet services required to access such solutions. To make digital health solutions more affordable, innovative financing models, public-private partnerships, and government intervention will be required.
