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Health Care: Delivery, Education, Communication

An Internet-Based Telemedicine System in Nigeria


4. Challenges and Implementation Issues

While Internet-based telemedicine system in Nigeria certainly has promises, there are a number of challenges and implementation issues, which may hinder it from delivering its promises to the citizenry. Therefore, to successfully implement and deploy the above system, the following challenges and implementation issues must be addressed.

4.1 Organisational and Cultural Inertia

Most government entities are not known for their efficiency or willingness to adopt changes. Organisational bureaucracy and lack of clear communication channels or collaboration culture are some of the difficult problems to resolve before this system can become successful. Organisational and cultural changes often are more difficult than technological changes.

4.2 Security and Privacy

Developing an Internet-based telemedicine system allows the exchange of patients data electronically among physicians and hospitals. These exchanges make security one of the highest priorities, that is, allowing healthcare professionals to have access to patients data while also ensuring that their privacy becomes a necessity. Security and privacy have different implications. Privacy is a matter of policy decisions, while security has to do with the tools to implement the policy. Internet security involves the applications of both non-technical and technical counter-measures. The non-technical means of pursuing Internet security include formulating a corporate security policy and educating and training users about that policy. On the other hand, major technical measures consist of access controls, authentication, encryption, firewall, audit, anti-virus tools, and self-assessment. Current e-commerce security technologies such as digital certificate, data encryption, and public key infrastructure methods could be adopted in securing the system presented in this paper.

4.3 Technology and Information Change

Most government entities are not taking advantage of existing information technology opportunities and most existing information systems are inadequate to meet the requirements of the new models of healthcare being deployed in the context of health-reform initiatives. Besides the common perception among physicians that health information systems are mostly a source for scientific and technical information, often public health authorities have a view of clinical-administrative information systems that they are obsolete and frozen in a ''statistical-epidemiological'' archetype, designed for the collection of numerical data representing only counts of events and mostly generating only highly aggregated statistical data and time series related to mortality, morbidity, and to service utilisation and coverage. Those information systems have very little practical interest to direct-care professionals and unit managers and are far behind in providing the logistical and longitudinal individual client-based data required to operate and manage the sort of healthcare models being deployed in many countries.

Worse still, most public health authorities are totally oblivious to the broad variety of possibilities offered by modern information and communication technologies to manage clientbased data, support operations, and mine large databases. Indeed, the health sector has not applied the range of options provided by information and telecommunication technologies effectively and health has been conspicuously under-represented in national technologydevelopment policies and plans.

As a counterpoint to the passiveness of the public sector, private providers and health groups recognised that a "different" type of information system and data elements are required to run their organisations and survive in a competitive environment driven by increasing consumer demands and expectations and to deliver personalised evidence-based services. Besides using information technology resources to boost productive specialisation (such as allowing the efficient use of diagnostic services and consultations, maintenance of integrated records, reduction in the number of specialists, and attainment of economies of scale by linking to national and international markets), there are many new areas of application that are rapidly gaining ground and reducing care costs while improving the continuity and quality of care. The lack of involvement of government at all levels in the use of information technology is worrisome. This may hinder the deployment of the system if government at all levels continues with this kind of lukewarm attitude towards information technology.

4.4 Lack of IT Funding and Human Resources

Some government units (local, state, and federal) are affluent, but most are not. IT spending often is not a priority and one of the most significant barriers to telemedicine implementation is cost. The start-up costs for telemedicine infrastructure are high. Despite a dramatic reduction in per-unit cost over the past years, start-up investment and maintenance costs of a telemedicine network are still high. Also, technology becomes obsolete quickly. Pressure on the appropriate government will surely increase as more people realise the benefits of telemedicine. This will prompt government to set aside a large sum of money for the implementation of the system. Furthermore, IT personnel often lack resources for training and reeducation to update their technical skills. A lot of training is needed to be carried for the health workers in Nigeria if this system is to work. Many of the health workers have never touched computer in their life and are afraid of coming near one; hence the need for a thorough training for the health workers.

Lack of telecommunication infrastructure at the remote rural areas may also be a barrier to this system. In many rural areas, no telecommunication infrastructure is present. To overcome this problem, radiocommunication equipment could be used to connect the remote rural areas to the regional network.

5. Conclusion

Telecommunication technologies are being used to change the healthcare industry in unprecedented and irreversible ways. These technologies are enabling delivery of healthcare to remote patients and facilitating information exchange between generalists and specialists. For many decades now, the use of advanced telecommunications and information technologies has been investigated in an effort to improve healthcare. In this paper, an Internet-based telemedicine system is developed for Nigeria. The establishment of this system is to enhance citizen's equality in the availability of various medical services and clinical healthcare, which are currently being enjoyed by the citizens living in the urban cities where well-equipped hospitals and scarce experts are distributed. It is also to support consultations among physicians over patients' cases and thereby improving the quality of healthcare services in the remote rural areas and provide a secure access to remote patient data. The system is still under development but the author intends to refine the system to enable private hospitals to participate in the consultations and extend the system to include home-based healthcare.


Olumide Sunday Adewale
Department of Computer Science
Federal university of Technology
PMB 704, Akure


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