Thought Leadership Series

The fuss about telemedicine

OK…I confess….I do not think that this is the solution to Africa’s health care problems…but I stand to be convinced.

Recently…experts from various parts of the country on Monday converged the College of Medicine of the University College Hospital (UCH), Ibadan to evaluate the success of the Telemedicine Pilot Project and design the way forward to advance the healthcare delivery. more in the Champion

recently reported on a memorandum of understanding (MOU) between the governments of India and Nigeria enabling partnership for providing services in telemedicine and tele-education between both countries.

Now University World News reports that telemedicine has finally arrived in Nigeria via a pilot project recently launched at Lagos University. This interactive electronic mode of teaching, research and provision of medical services has been embraced by lecturers, students and patients.

These are all great projects and will inevitably get good press. But we must come down to earth and face the challenges of our people. In the car park of the Federal Ministry of Health in Abuja – you will find a big bus with the emblem of Telemedicine – a project of our FMOH in collaboration with our National Space Research and Development Agency (NASRDA)!

In a country barely able to provide electricity for its people, unable to provide the most basic health care services, in which our own president cannot be managed; telemedicine seems like one of those big ideas that we love to shout about. We need to get real and face our problems – the maternity units where women die from the most basic of problems, our neonatal units without mosquitoe screens, without clean water, without a functional blood bank, without power! without power!

Lets get real and face our problems…telemedicine is not the solution, will not be in a long time to come.

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

By Chikwe Ihekweazu

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

4 replies on “The fuss about telemedicine”

I have been following Telemedicine in Africa since 2006. I Was opportune to run a review of project of this (Nigeria’s)nature all over Africa. I should share my opinion here.

Telemedicine as it is being portrayed and practiced in some parts of Africa is synonymous to SUPPLY WITHOUT DEMAND. The reason that an average healthcare worker, hitherto, do not see the direct and even indirect impacts yet.

While Telemedicine has a very strong role to play in advancing healthcare in sub-saharan Africa, we may need to prioritize properly in its diffusion process.

I have always proposed an initial face of proper introduction of the concept to the end users. This will lead to informed demand from the and infact appropriate utilisation of these tools.

The time its penetration is meant to have started is probably beyond a decade ago. If you can consider the potential impact of the messages Nigeria Health Watch on the consumer of the information, then you are simply applying Technology (internet) for healthcare purpose (advocacy in this case).

However, when ideas are not properly prioritised and implemented, it progresses this way and may end up the way its semblances have.

I am very close to the Indian project and how it is progressing in Nigeria and I am watching and documenting. That will be a subject of discourse sometime in this decade.

Telemedicine is great with an unimaginable potential and benefits that Sub-Sahara Africa desires, Nigeria inclusive. But! we need proper National action plan.

While I agree, intoto, with your comments about the whole system failings of Nigeria’s health system and indeed Nigeria itself as a society, and mind you in the midst of plenty ( Yes, plenty God-given resources- human and material), I think you ‘threw the baby out with the bath water’ in writing-off telemedicine altogether.
Yes, our country lacks focus and sincerity of purpose at the Leadership level ( aka the Big Bus in the car park at FMOH Abuja which I have entered to see the waste), and power remains largely a mirage for everyone including Aso Rock ( otherwise why will they budget BILLIONS for diesel and generator repairs every year), but because Telemedicine is a continuum and offers a pot pouri of possibilities from basic ICT to sophisticated educational training and learning opportunities, we should, even with our ‘primordial’ level of development, imbibe it and start gradually. In Cross River state in 2005 we set up an Integrated Emergency Medical Service with eleven new fully equipped ambulances and one mobile clinic, manned initially by a core of 65 personnel trained in basic and advanced life support . When we failed to convince the three main GSM companies in Nigeria to agree to one emergency call number ( e.g. 999; 666; 333; etc), we supplied each ambulance with a dedicated mobile phone number ( each number depended on which GSM was available in each ambulance territory). It became possible for the public to call an ambulance if they needed one, just as they could call fire engines and police in an emergency. Only that in the case of the ambulances we achieved a call-to-arrival time of twenty minutes ( and improving). The connection was used to monitor the monthly Drills that each ambulance crew (driver, nurses, doctor) was mandated to conduct to ensure that the vehicles were properly maintained to manufacturers directives (GM Motors in Lagos); the phones were used for mobilising ambulances across local government borders in times of crisis. The cross river state ambulance service ( three of them from the Obudu Ranch resort, Sankwala hospital in Obanliku LGA, Ogoja hospital) was the first to arrive at the tragic Senior Military officers crash in 2006 across the border in neighbouring Benue State, several hours before the solitary NEMA ( National Emergency Management Agency) helicopter got to the remote site of the crash scene from Abuja.. By then, the Cross River crew had conducted triage, saved lives and started evacuation of survivors from the mountain top to the roads in the valley. Even when the Deputy Governor of CRS and myself got there the day after, it was still only the CRS ambulances that were on ground. In 2008, we secured, through competitive bidding, a substantial grant from the MDG office of the President to install ICT in 130 PHCs using solar power to ensure 24/7 functionality. The project was 60% complete when my tenure ended in June 2008. If completed, the potential for a seamless integration of PHC to secondary and tertiary care is enormous, including possibilities for basic telemedicine. With ICT, the few senior doctors at the state capital would not necessarily traverse the state each time a junior colleague, located many miles away in some remote clinic wants advice or just support.
Basically, I am saying that there are parts of the continuum called Telemedicine that our country can use NOW!, while leaving the more complicated stuff for when we overcome the irritating challenges of development, especially electricity from fossil fuels, roads, and personnel shortages.

( Please note that I have covered some of this in my book, “Whole System Change of Failing Health Systems” now available from the BMJ West Africa Edition office in Luton, Bedfordshire, UK. We hope to launch the book in Nigeria on Tuesday 6th April 2010. The publicized launch last week in Abuja was postponed for reasons beyond our control).

Joseph Ana.

Another point, when is this site going to do away with moderation of comments? Total freedom is the reason we are able to publish and such like moderation a fuss from yesterday.

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