The first is the Tsilitwa telehealth project located in the Eastern Cape region. It uses a system where nurses send live pictures of a patient over a wireless network to a remote doctor, while consulting with the doctor about treatment options using a VoIP connection.
Tsilitwa lies in the Eastern Cape region. The population there is poor. There are only a few jobs, and subsistence farming is for many families the only way of living. There is a little clinic but with no doctor, just a nurse. The clinic is under the jurisdiction of the hospital in Sulenkama, which is roughly 20 miles away. If the nurse cannot deal with the symptoms of a patient, there was previously no other choice than sending him or her to the hospital. There is no regular public transport system in place to connect the two villages, so the patient has the choice to pay for private transport or to walk. Direct communication between the clinic and the hospital is very difficult since no fixed phone lines are installed in Tsilitwa.
These problems were addressed when setting up a wireless local area network which connected the hospital in Sulenkama with the clinic in Tsilitwa (and – in addition – with the local school, community centre and police station). If a nurse feels that she (in this case they are all females) cannot properly address the symptoms of a patient, she would connect to a doctor at the hospital, use a web camera to present the patient and simultaneously discuss the case via VoIP. Together the remotely connected doctor and the nurse decide on a treatment or referral to a specialist. Sending the image over a wireless network has proven to be a cost-effective means of communication that is particularly appropriate to the rural setting in South Africa.
The second project in Cape Town was designed to use texting services improve the medication compliance of tuberculosis patients who had mobile phones. Text messages were sent to the patients, reminding them to take their TB medication on time. The objectives were to increase both the convenience of TB treatment for the patient and to improve treatment outcomes and cure rates overall. Evaluation of the project confirmed that texting is an affordable mobile solution that can improve patient adherence to TB treatment and reduce the associated costs for both patients and clinics—but only if it is linked to other healthcare services.
Measuring the effect of SMS reminders on TB cure rates and treatment completion rates, the social and economic impact, and best practices for the implementation of future similar projects demonstrated that that technology worked well and that mobile reminders could be effective. However, the evaluation also revealed that mobile monitoring and text messages alone were not sufficient to change patient behaviour over time. A lack of clinical monitoring of the patients to make sure that they adhered to their treatment schedule proved to be one of the main problem areas. Benefits from the mobile messaging compliance service were dependent on consistent patient interaction with the clinic staff. If patients felt disconnected from the clinic the success rates dropped drastically. Staff schedules, clinic bureaucracy, and the availability – or better the lack - of sufficient human resources limited the functionality and usefulness of the compliance services.
An important lesson from the Cape Town project is that while mobile reminders can help to improve medication compliance and support a more cost-effective treatment option, they are only part of the solution for both for the health service and patient. It became clear that mobile technology alone does not guarantee successful treatment outcomes. It has to be embedded into a holistic approach with the patient at the center. ‘Ownership’ of the treatment process must lie with the patients since they have to monitor themselves. The technology must be seen as supporting the patient, while reducing the overall costs of the treatment. If such an approach is applied, if patient adherence can be assured, similar concepts for other self-monitored treatments are very much an option that can make use of the limited resources more efficiently.
These projects are two of the many examples where mobiles and wireless networks contribute to improve the health situation in rural Africa. This efficient and innovative approach combines technology and the insight of what is realistically possible within the social and economical context of rural Africa. Health policy makers in these countries must take into consideration the advantages and possibilities cellular technology offers. Laws, rules and regulations must provide the relevant legal framework. Integrated, holistic treatment programs are more successful than high-tech, foreign funded projects, which may disintegrate as soon as the flow of foreign funds dries up. Appropriateness and sustainability are keys to long-term success.
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Autor(en)/Author(s): Harald Himsel
Quelle/Source: Smart Products, 16.04.2010
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