September 25, 2020

Gains and Barriers Before Telemedicine

It’s 2am and you have woken up with a severe toothache. You are in pain and can’t go back to sleep! It’s very early in the morning and you don’t know how or where to get help.

Thanks to the concept of telemedicine, gradually revolutionizing healthcare, you pick up your phone and contact a hospital for an electronic consultation from a dentist, and you will be sure to get a response even at very odd hours of the night. Within minutes, your dentist provides possible on-the-spot care for your throbbing pain, saving you time and energy. This process is fast, easy and reliable.

The pandemic has revealed a lot of our vulnerabilities, amongst other insecurities. It is no longer news that advancements in technology has made life very enjoyable, especially, in communication. People and businesses have had to re-adjust and adapt to measures set in place in an attempt to flatten the curve.


Telemedicine,  Telehealth and Technology.

The healthcare sector, undoubtedly one of the most active in these times has had to be digitally inclusive to ensure members of the community, especially non-infected members, continue to receive adequate healthcare without the risk of contacting the virus by stepping out of the safety of their various homes. This has been attainable through the help of telemedicine, which, simply put, refers to the remote diagnosis and treatment of patients by means of telecommunications technology.

One major goal of telemedicine is to enhance the delivery of health care to geographically disadvantaged and medically underserved populations, thereby providing an improved quality of care while decreasing costs.

Advancements in ICT have been the main drivers of telemedicine over the past decade, and especially since the spread of the novel COVID-19 virus, ensuring sufficient and reliable health services and delivery. The adoption of the Internet and low cost of ICT applications has further contributed to telemedicine to encompass web-based services (phone calls, video conferencing, email) and so much more. Even with the availability of these,  the absence of ambience on both sides can frustrate the telemedicine experience for both parties.

The majority of telemedicine services, most of which focus on diagnosis and clinical management, are mostly utilized in industrialized regions. In addition, biometric measuring devices such as equipment monitoring heart rate, blood pressure and blood glucose levels are used to monitor and manage patients with acute and chronic illnesses. A lot of these devices have been made compact and easy to use, even by patients themselves in the absence of a health care professional. Example, is the glucose and heart-rate monitoring devices.

Some predict that telemedicine will profoundly transform the delivery of health services in the modern world by migrating health care delivery away from hospitals and clinics into homes. This is yet to be seen.

In low-income countries like Nigeria,  and in regions with limited infrastructure, telemedicine applications are primarily used to link health-care providers with specialists, referral hospitals, and tertiary care centers. Even though telehealth is different from telemedicine in that it refers to a broader scope of remote health care services than telemedicine. Telemedicine refers specifically to remote clinical services, while telehealth can refer to remote non-clinical services.

Barriers to Telemedicine

In developing and over-populated countries in Africa, a number of factors pose a major risk to the advancement of telemedicine.

Budgetary constraints pose a major problem. Nigeria’s budget for the year 2020 aims to expend less than N50b on the well-being of about 200m persons.  A further probe shows no allocation to emerging fields in healthcare like telemedicine. It then,  clearly shows the dent made in telemedicine has been out of private efforts.  In Lagos,  startups like Calmspringshealth are but part of a few helping users access health services with the help of technology.

Although it is true that telemedicine can be leveraged to increase access to care and reduce the cost of care,  that is mainly true from the user’s perspective. However, the story is different if we view it from the side of providers or healthcare organizations. For establishing a telemedicine unit, it needs lots of financial investment in training,  retooling and incentives.

Telemedicine relies on stable internet connection to be an enjoyable experience.  In Nigeria, currently with a low internet penetration especially in rural areas where telemedicine is a need,  this becomes a tall dream on both sides.  As providers struggle with finding willing patients,  those in real need of the services are financially excluded or unavailability of internet-ready devices denies them access. Startups like Calmspringshealth  are finding ways around the dearth or absence of internet connections to reach patients by having a dual-facing model to reach patients offline and online.


A sustained and consistent financial allocation towards telemedicine is now necessary.  This can be shown beyond line items in federal and state budgets but also in the medical curriculum with which healthcare providers are taught with.The medical school curriculum as a tool needs an upgrade and review to meet the present medical realities.

In the case of a successful session, patients are either prescribed medications, invited in or referred to a specialist.  This next step opens up another regulatory challenge before telemedicine.  Currently,  there is no legal framework for e-prescription, digital prescription, or mobile-based SMS prescription. Digital prescriptions are not approved and accepted by any regulatory authority.

In developed countries where infrastructure support telemedicine, online prescription policies vary across countries and states within countries. Concerns have been raised over various issues like whether an appropriate patient-provider relationship has been established, lack of an adequate physical examination of the patient, accuracy of the patient’s history given the self- reporting of the patient over a telehealth connection and not meeting state medical board licensing requirements.There is no standardized legal framework to protect practitioners as well as clients for online prescriptions in developing countries.

Following this is the ongoing concern about patient’s data security and privacy using telemedicine.  Unlike a personal visit to a clinic,   telemedicine is facilitated via a medium. Providers of this medium of communication be it chat apps or websites collect and use these data for product development and in some cases,  for commercial uses.  This then swings to either providing wrong information to one’s doctor or being economical with same, which ultimately leads to misdiagnoses.


Silver Linings.

Regardless,  it is not all gloomy.  To spur the growth and steady acceptance of telemedicine beyond the pandemic,  patients need to see this as a medical service with mode of access being the difference.  This attitudinal change may be tough but with tweaks,  nudges,  and removal of impediments to acceptance such as data privacy concerns and right price points, it becomes attainable. The steady onboarding of Gen Z onto the internet and the affordability of internet-ready devices with lite apps especially for data-poor countries,  will be thanked for this in the near future.

Rafiat Aminu
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