Telemedicine: The Untapped Goldmine in Nigeria’s Healthcare System

According to the World Health Organization (WHO), telemedicine is the delivery of health care services by health care professionals, using information and communication technologies (ICT) for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research, and evaluation, and for the continuing education of health care providers, all in the interest of advancing the health of individuals and their communities [1]. In recent times, significant advancement in ICT has accelerated the field of telemedicine globally [2]. The use of telemedicine in Nigeria dates to 2007 when the National Space Research and Development Agency (NASRDA) and Federal Ministry of Health (FMoH) inaugurated its pilot project in two teaching hospitals and six Federal Medical Centres across the country [3]. Telemedicine can serve as a viable means of making up for the shortfall in the number of health care professionals available to serve Nigeria’s fast-growing population [4]. This article briefly discusses the state, prospects, current challenges, and recommendations for telemedicine in Nigeria. 

Telemedicine is broadly divided into two main categories based on the timing of interaction between the healthcare providers and patients. The first category, known as asynchronous telemedicine, stores and disseminates messages from healthcare providers to patients at anytime.  It does not require real-time communication between patients and healthcare providers, as does the synchronous telemedicine, which leverages video conferencing facilities to achieve real-time audio-visual communication [5]. Both synchronous and asynchronous telemedicine have been in use across Nigeria , with the COVID-19 pandemic and the resultant restriction of movements encouraging remote consultations with patients across many hospitals in urban centers like Lagos and Abuja [6]. Telemedicine in Nigeria can prospectively improve the health and well-being of the population by making up for the deficit in healthcare professionals in the country, reducing delay in accessing health care due to transit time to health facilities in urban cities like Lagos, and increasing access to quality health information and services in rural and hard-to-reach communities. 

Despite the prospects of telemedicine in Nigeria, there have been challenges limiting its adoption across the country a few of which are highlighted below:   

Provider Challenges 

Provider challenges include inadequate iinfrastructural development,  high cost of set up, and resistance to change. 

  • Inadequate infrastructural development: Telemedicine requires some infrastructural commitment including but not limited to high-resolution digital camaras, specialized medical examination tools, computers, customized software, data storage hardware or servers that is neither fully available nor equitably distributed across health facilities in the country [7]. Furthermore, many hospitals do not have steady electricity supply whether from the national power grid or from alternative power sources [8], and without steady electricity supply, telemedicine becomes near impossible to implement. Other infrastructural challenges reported by early adopters of telemedicine in Nigeria, include limited broadband and internet connectivity.   
  • High cost of setup: This is a significant barrier to the adoption of telemedicine in Nigeria. The cost of specialized medical equipment, computers, cameras and screens for video conferencing can be daunting and is usually deprioritized for more urgent or even higher priorities in health care budgetting and procurement. It is also important to highlight here that many potential entrepreneurs considering investing in/setting up telemedicine facilities, do not readily have access to reasonable single-digit credit facilities that could help cushion the high set-up cost [9, 10].  
  • Resistance to change: According to a report on telemedicine adoption in Nigeria, although significant in terms of absolute cost, technology represents only 10 to 20% of the total cost of implementing a telemedicine system. It is estimated that 80 to 90% of the challenges are related to people. This includes amongst others, rigid organizational structures, the paucity of skilled professionals in new technology, complicated change management systems that make it almost impossible to change the status quo [11]. 

Patient Challenges 

Patient challenges include lack of access to required gadgets and lack of affordability of telemedicine services.  

  • Lack of access to required gadgets and internet connectivity: The use of telemedicine is dependent on internet connectivity and electronic gadgets such as android phones and tablets, through which patients access health information and services. Although there is an increasing penetration of phones and internet facilities across the country, people in remote communities still have limited access to these facilities and are therefore at a disadvantage to benefit from the ease of access to healthcare that telemedicine promises [12]. 
  • Lack of affordability of telemedicine services: The high cost of setting up an effective telemedicine system and the fact that the system is technology-driven makes makes financial cost both a real (providers-perspective) and perceived (patient-perspective) barrier to adoption of telemedicine in urban slums and rural communities [13]. While there is no publication on standard cost of care through telemedicine, the pervasive cultural perception of telemedicine is that, telemedicine is for the wealthy [14].  

Although there is a dearth of data on the population-level benefits of the existing telemedicine services in Nigeria, findings from literature show that telemedicine has high prospects in Nigeria. Considering the prospects of telemedicine in Nigeria, the following recommendations will help the country to extract the goldmine in telemedicine. 

Recommendations 

Short Term: 

  • Financial incentives: Considering the high cost of set up for providers, and the financial constraints to access for patients, immediate/short-term solutions to address financial challenges in the provision of telemedicine services could include, the  provision of single-digit loan facilities to providers to support set up costs and incentivize the provision of telemedicine services. In the same vein, integrating telemedicine services in health insurance packages for patients who have insurance cover and innovative affordable payment plan such as payment through airtime for those without cover, can alleviate the financial risks to patients and encourage uptake of telemedicine services.  

Medium Term 

  • Infrastructural development: Medium term interventions to improve adoption of telemedicine in communities with limited infrastructural development like hard-to-reach communities could include setting up kiosks or mobile facilities powered by solar energy and equipped with basic gadgets. Through this kiosks or mobile facilities,  telemedicine service providers can deliver remote health care to members of the community who do not have access to phones and internet services required to uptake telemedicine services. . Such kiosks or mobile facilities should be built and situated in locations agreed to by the community to ensure community ownership, protection of the facility and sustainability.   

Long Term 

  • Integrated health system: Telemedicine can be integrated into the conventional healthcare delivery system such that all patients potentially get information and services remotely and only show up for physical appointment if required after initial assessments through the telemedicine platforms. This would however require sector-wide policy reviews, adoption and implementation with its attendant budgetary implications, behavioural change communications and community acceptance. 

In conclusion, telemedicine is providing healthcare information and services remotely with the aid of modern technology. Its adoption has been very low due to challenges which are both provider-related (include inadequate iinfrastructural development,  high cost of set up, , and resistance to change) and patient-related (lack of access to required gadgets and lack of affordability of telemedicine services). Introduction of financial incentives, infrastructural development and integration of telemedicine into the existing health service delivery system are some recommendations to improve the adoption of telemedicine in Nigeria.  

References 

1. Kruse, C.S., et al., Measures of effectiveness, efficiency, and quality of telemedicine in the management of alcohol abuse, addiction, and rehabilitation: systematic review. Journal of medical Internet research, 2020. 22(1): p. e13252. 

2. Organization, W.H., Global diffusion of eHealth: making universal health coverage achievable: report of the third global survey on eHealth. 2017: World Health Organization. 

3. Adekunle, Y., Evolving usage and access to ICTs in the Nigerian health care sector: challenges and prospects. 2016, University of Westminster. 

4. Epundu, U., et al., Medical tourism, public health and economic development in Nigeria: Issues and Prospects. Asian Journal of Medicine and Health, 2017. 7(2): p. 1-10. 

5. Talal, A.H., et al., A framework for patient-centered telemedicine: Application and lessons learned from vulnerable populations. Journal of biomedical informatics, 2020. 112: p. 103622. 

6. Ekanoye, F., et al., Telemedicine diffusion in a developing country: A case of Nigeria. Science Journal of Public Health, 2017. 5(4): p. 341-346. 

7. Meyer, C., et al., Rural Telehealth Use during the COVID-19 Pandemic: How Long-term Infrastructure Commitment May Support Rural Health Care Systems Resilience. Journal of Agromedicine, 2020: p. 1-5. 

8. Nkordeh, N., et al., Nigeria’s Power Generation: Analyzing the Cost Implication of Poor Generation on the Running Cost of Telecom Business in Nigeria. 2017. 

9. Adenuga, K.I., N.A. Iahad, and S. Miskon, Towards reinforcing telemedicine adoption amongst clinicians in Nigeria. International journal of medical informatics, 2017. 104: p. 84-96. 

10. Nwosu, C. and R. Ochu, Small and Medium Enterprises Financing in Nigeria: Benefits, Challenges and Way Forward. Journal of economics and sustainable development, 2017. 

11. Kamal, S.A., M. Shafiq, and P. Kakria, Investigating acceptance of telemedicine services through an extended technology acceptance model (TAM). Technology in Society, 2020. 60: p. 101212. 

12. Smith, W.R., et al., Implementation guide for rapid integration of an outpatient telemedicine program during the COVID-19 pandemic. Journal of the American College of Surgeons, 2020. 231(2): p. 216-222. e2. 

13. Scott Kruse, C., et al., Evaluating barriers to adopting telemedicine worldwide: A systematic review. Journal of telemedicine and telecare, 2018. 24(1): p. 4-12. 

14. Bajowala, S.S., J. Milosch, and C. Bansal, Telemedicine pays: billing and coding update. Current Allergy and Asthma Reports, 2020. 20(10): p. 1-9

10 thoughts on “Telemedicine: The Untapped Goldmine in Nigeria’s Healthcare System

    • Adebisi Adenipekun says:

      Thank you @Victor.
      Yes, we can facilitate the implementation of telemedicine. At Sydani, we work with governments, private sector and development partners to deliver sustainable high-impact solutions that strengthen health systems, improve access to basic health care and advance socio-economic development.

  1. Oluwatobi Omotosho says:

    This is lovely.
    Telemedicine may soon be a widespread approach to healthcare as more people are beginning to enjoy and adapt to the world of remote activities.
    One challenge that can however be identified with telemedicine has to do with diagnosis and tests. I believe a larger proportion of consultations may be done halfway because the doctor is unable to physically examine the patient and this poses a challenge to the final treatment mode and choice. However, I also believe that this barrier has been somewhat overcome in some terrains with more sophisticated technology so ultimately, the establishment of a solid telemedicine structure will require adequate funding.
    Also, it’s one thing to establish a structure and it’s another to have people with the technical know-how so as not to have the structure rotting away while those it was built for still suffer.
    In all, telemedicine is a great approach and if HMOs can adopt that into their health plans, it can also facilitate the spread of it
    Great article!

    • Adebisi Adenipekun says:

      Thank you for your insightful comments @Oluwatobi.
      I agree with your comments on how the barriers of diagnosis and tests have been addressed in some climes and the need for adequate funding to establish telemedicine.
      Also, an important component of a robust plan to adopt telemedicine on a larger scale across the country is the capacity building of health care professionals. A long term recommendation will be to include it in the curriculum of health care professionals.

  2. Jeffrey Bassey says:

    This is a really great job. I hope more practitioners, as well as the government, would look deeper into Telemedicine especially at a time such as this whereby we’re trying to limit/reduce physical engagements.

    • Adebisi Adenipekun says:

      Thank you for your comment @Jeffrey

      Telemedicine offers a lot of advantages to individuals, healthcare service providers and the government. COVID-19 pandemic has helped reinforce this fact even more.

  3. Ayokunle FANIKU says:

    This is quite very insightful. No doubt telemedicine has come to stay, with time it will be everywhere in Nigeria though the practice requires synchronization of medium from both the health provider and the patient. No doubt, COVID-19 has confirmed to us that so much many things can be done remotely. So many sectors have experienced increase in productivity, saved time, reduce human resources (though not friendly to some), saved cost, among others.
    Telemedicine will help improve quality of data, change the status of health seeking behaviour, confidentiality will be protected especially the adolescent that would want health care, among others.

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