Telemedicine - Tanzania

The Telemedicine project aims at introducing telemedicine in Tanzania, and to develop best practices and a platform for awareness raising, knowledge exchange and policy making in this field. The project is closely linked to another project of the project owner,  Evangelical Lutheran Church Tanzania (ELCT), on health management information services (HMIS). ELCT owns and manages 20 hospitals, 5 paramedical institutions, over 160 dispensaries and health centres and various projects and programmes, thus providing health care within a range of about 15% of the national health services in Tanzania.

In Tanzania, most people are based in rural areas where access to health care is poor. Yet the epicentre of healthcare expertise and resources remains in the cities. Isolation from the rest of the medical world, lack of up-to-date reference material and lack of consultation possibilities has led to low quality of diagnosis in rural areas. People who can afford it come to cities for their health care in huge numbers and at enormous cost. Telemedicine is beneficial for patients, because they can get specialist consultations in their own hospital. Patients are willing to pay for quality care in rural hospitals. Also the doctor who is using modern technology is respected. New generation of doctors, who are used to Internet, will change the old practice if they are encouraged in the remote hospitals.

Training was conducted for medical doctors from 14 hospitals in the Northern zone. The training included the use of iPath, a web-based consultation system; digital camera use; and using i-teach for distance learning. In the first two months of operation (March and April 2008) about 60 consultations took place, which is a promising start. Most consultations were in internal medicine, pediatric, radiology and dermatology. Once a doctor starts to use the system, s/he generally continues. the use of the platform increases gradually. A video presentation on telemedicine is realised. In May 2009, the project was evaluated.  A part of the evaluation was through a focus group meeting with users. Some quotes:

• “Enhanced capacity coupled with simplified and streamlined diagnosis and treatment resulting from prompt and friendly expert assistance from other telemedicine users; accurate diagnosis for most of the difficult cases presented to other specialists and streamlined patient care management.”
• “As a result we are able to treat patients where they are, saving transport and related costs; provide skills to those areas where radiology facilities are available but there are no specialists and reduce the number of unnecessary referrals of patients to higher level centres.”

The findings of the evaluation report are encouraging to develop a large telemedicine programme. The project has been exposed to the Ministry of Health, which highly appraciated the efforts.

A platform to exchange experiences between different (planned) telemedicine initiatives is set up. The platform also aims to develop a white paper for a national telemedicine programme in Tanzania. The third platform session is planned for October 2009.

The main objectives are:

• To have an online consultation network operating between 43 health facilities, where about 100 consultations are taking place weekly of which 20% are second opinions. The effect of telemedicine on the quality of consultations of participating health workers will be measured and recommendations developed to improve this quality.
• To integrate telemedicine with e-learning and develop (or join) online Tanzanian Virtual Campus. Based on monitoring and improvements, recommendations will be made to institutionalize the integration of telemedicine and e-learning.
• To provide a platform of exchange and alignment of telemedicine initiatives in Tanzania and to seek their close involvement in the realization of the above-mentioned objectives.
• To develop a set of recommendations to facilitate the integration and further development of telemedicine in the Tanzanian health sector.

Tanzanian communities are impacted, especially those living in rural areas will have increased access to good quality health care.

The main challenge is not technical, but human and organizational. The challenge is how to integrate telemedicine in the current practice of health workers, in the health facilities organizations, in the billing system, in the certification and accreditation. On the longer run also issues like the health policy, including the legal status of telemedicine, will have to be addressed. This action research project is conceived to tap the potential of telemedicine in Tanzania and to develop the relevant technology and practices.

After the first months of implementation, telemedicine services are mainly used by:

• young doctors rather than old doctors who are less computer literate
• doctors in remote hospitals, far away from referral hospitals
• doctors in hospitals run by European missionaries, who tend to promote the use of telemedicine