Telemedicine – a Panacea for Nigeria’sHealthcare Ills?

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By Tunji Adegbite

As the world continues to adapt to the limited physical interactions following the COVID-19 pandemic, several business sectors have adapted to carrying on their activities remotely by leveraging Information & Communication Technology (ICT). However, an essential industry – the Health industry more than ever needs to adapt to the ‘new normal’ of rendering services without being physically present. Hence, the growing importance of Telemedicine.

Globally, the telemedicine market size stood at $41.63 billion in 2019. The global impact of COVID-19 gave an unprecedented positive demand shock to the industry across all regions. Telemedicine was poised to grow by a staggering 91.7% to $79.79 billion in 2020 and also grow at a 25.8% CAGR between 2020 – 2027. For example, during the early days of the pandemic in Nigeria, between 2nd February and 3rd May 2020, Hudibia, a mobile health application, got a 400% increase in downloads.

The Nigerian healthcare system has few doctors attending to several patients, leading to long waiting lines and delays. Hospitals are packed and understaffed, resulting from the meagre 40,000 doctors taking care of c.200 million people, which is nowhere near the recommended doctor/patient ratio of 1:600 as prescribed by the World Health Organization.

Source: World Health Organization’s Global Health Workforce Statistics.

To further depict the level of Nigeria’s available healthcare infrastructure, the latest figures for hospital bed per thousand stands at 0.5 beds per 1,000 people in Nigeria compared with 2.3 per 1,000 in South Africa, 0.9 per 1,000 in Ghana, 2.5 per 1,000 in the United Kingdom or 5.9 per 1,000 in France.

Bridging the gap between patients and physicians is essential, especially in regions with a high rural population and poor healthcare infrastructure to accommodate the population pressure. Case in point – Nigeria.

Nigeria’s telemedicine sector is expanding with players specializing in real-time audio-video telemedicine services. As Nigeria’s digital culture improves, it is expected that telemedicine’s adoption in various forms would increase as well. The several forms of telemedicine are likely to expand from what is available to newer forms due to innovation from the ICT sector.

Although the case for the adoption of telemedicine is strong, there are several challenges to be fixed. The first is the regulatory framework of the industry. As it stands, anyone can pose as a telehealth provider as there are no agencies or regulations set aside specifically for telemedicine in any of its forms. There is an urgent need for a legal framework explicitly addressing cross-border service provision via telephonic means, a framework addressing clinical liability and indemnity of telehealth providers, a legal system for practitioners’credentialing to ensure patient safety, and importantly, a governance model to address legal and ethical issues.

Nigerians have a high self-medication tendency due to the ease of getting drugs over-the-counter without a prescription and easy access to herbal medicines and drinks that have not undergone clinical trials. A survey conducted in 2011 across urban Lagos residents showed the popularity of these herbal medicines as 2 out of 3 respondents consume them. While these drugs are popular, consumers appear to be ignorant of potential toxicities. Nothing quite captures the populace’s responsiveness to health care products and the government’s perceived nonchalance towards improving the health care sector as the abysmal 4% ratio of the entire populace covered by the National Health Insurance Scheme (NHIS).

Existing stakeholders like pharmacies and other health providers can be critical players in the telemedicine scene. Incorporating telemedicine into community walk-in clinics and pharmacies could improve the adoption of telemedicine services. This could be done by registering patients who walk-in to a particular telemedicine service provider. With the increasing non-communicable disease burden, like hypertension and diabetes, these partnerships could be pivotal to improving management.

Another sector critical to the value chain that must be linked is the telecommunications sector. The industry’s strength in reaching those without access to infrastructure like finance and proper healthcare could be seen with mobile money’s massive adoption and success in many African regions and USSD for payments.

A USSD interface for telehealth services would largely help make it more mainstream, as its simplicity would allow those that are less technology savvy and with challenging internet access that needs these services to access them.

The country’s health sector grapples with many infrastructural issues, one of which is the continued mass exodus of healthcare specialists to other countries where labour supply is better compensated.

Telemedicine brings the possibility of reducing the consequence of this brain drain by providing access to professionals across the globe, using bots and Artificial Intelligence to communicate with patients who need these services.

The industry is likely to boom as medical tourism, which Nigerians contribute to by spending around $1 billion abroad; with 60% of this spend on four specialties: oncology, orthopaedics, nephrology, and cardiology. Two of these are already popular specialties in telemedicine, and a rapid adoption would translate to improved revenue in these areas.

In conclusion, Telemedicine might just be the silver bullet to solving Nigeria’s healthcare deficits despite the challenges. A lot of work is still required from stakeholders within its value chain though.

•Tunji Adegbite, a thought leader in Strategy and Supply Chain, has worked with leading organisations like PwC and an IOC. He also founded Naspire, a business research platform using African business insights to help entrepreneurs and professionals succeed. He can be reached via tunji@naspire.com