This presentation is targeted at Policymakers and mobile operators in developing countries. The aim of the presentation is to show how mobile phone network can be used to improve healthcare delivery in Rural communities

1. By
Abdulkarim A. Oloyede
Extending Health Care Services to Rural
Communities in West Africa

2. Content
 Introduction.
 Human Development Index.
 Concept of Virtual clinics.
 Technical Requirements of Virtual Clinics.
 Benefits and Services offered by Virtual Clinics.
 The proposed Architecture.
 Challenges of Virtual Clinics in Developing
Countries.
Conclusions.

3. Introduction
 Availability and access to quality healthcare services has been
challenging in most developing economies.
 Over 60% of African population resides in the rural communities,
characterized by poor infrastructure, low income, adversely scattered
buildings, low literacy level, extreme poverty, higher level of inequality
resulting from unequal access to menities, etc.
 Nearly half (44%) of WHO member states (majorly from developing
nations) have less than 1 doctor to 1000 patients. The recommended
is 1:600 (WHO, 2016)

4. Introduction (cont.)
 The ratio of doctor-to-patients in (GMU, 2016):
o Malawi and Tanzania is 1:50,000
o Liberia and Mozambique 1:35,000.
 This has been aggravated by the lack of access to critical
infrastructures such as the health care facilities, roads, electricity and
many others.
 Even if these infrastructures are provided, the number of medical
practitioners to cater with the growing population of the countries is not
sufficient.

5. Human Development Index
 Human Development Index (HDI) is a statistical tool used to measure the
overall achievement in a countries’ social and economic dimensions such as
the health of people, their level of education and their standard of living.
 The main indicators are life expectancy for health, expected years of
schooling as well as the actual years of schooling for education, and the
Gross National Income (GNI) per capita for the standard of living.
 HDI composition also includes life expectancy.
 A household with members sheltered in a well-furnished house; balanced diet
food cooked using clean cooking fuel; with access to stable electricity; clean
and potable water; private toilets would be rated high in terms of HDI index.
 Developing countries are characterized with low Human Development Index
(HDI) relative to developed countries.
 Among the global ranking of the HDI within the developing nations, Sub-
Saharan Africa has the least.

6. THE GLOBAL HDI FROM THE UNDP 2017
REPORT

7. LIFE EXPECTANCY

8. ICT for Healthcare Delivery
 The growing impacts of telemedicine have shown some positive effect in the
healthcare delivery system, particularly for developing countries.
 Mobile phone networks can be used to drive a sustainable and veritable system
such as telemedicine healthcare delivery system through the introduction and
promotion of Virtual Clinics.
 This can also include telemedicine and integration of various health information
systems such as Electronic/Mobile Health and Electronic Health Record
systems using telecommunication/ICT systems.
 For sustainability of these initiative in developing nations the system must
be cheap and reliable.
 Private Sector investment is critical to the success of these platforms because
most government in Sub-Saharan Africa lack the fund, expertise or willingness
to drive the type of initiative proposed.
 The aim of this work is to develop a framework for sustainable healthcare
delivery through development, implementation and promotion of ICT in the
health care systems.

9. Virtual Clinics
 Virtual Clinics are clinics without border, where remote
patients can access medical practitioners, diagnosis can be
undertaken remotely via the help of paramedics within the
virtual clinics.
 Essentially, the virtual clinics will consist of building fully
digitized with video conferencing gadgets and basic
telemedicine equipment.
 Some of these equipment are described in Indian’s
prototype which consist of solar powered tele-centres
equipped with portable telemedicine workstations for

10. Virtual Clinics Benefits and Services
Provision of clinical supports
Clinical Data Transfer
Patient Monitoring
Health Information, education and specialist

11. Technical Requirements for Virtual Clinics
 Network Connectivity
 Video Conferencing and Imaging Technology Facilities
 Health Information System (HIS
 Interoperability, Privacy and Security
 Reliable Power Supply

12. Data Rate Requirement of Common Services and
Devices Used by patients in Telemedicine
Devices/Services Data Rate
Requirements
Feasible
Technology Option
Comments
Real Time Audio
Conversation
7.7 kbps-87.2 kbps Wireless This is VoIP call and depending
on the codec type.
Real Time Video
Conversation
768 kbps- 7 Mbps Wireless Depending on the resolution of
the video
Digital Blood Pressure
Monitor
>10 KB (data size) Wireless Depending on the resolution of
the image
Digital Thermometer <10 KB (data size) Wireless Depending on the resolution of
the image
Magnetic Resonance Image 384 KB (Image size) Wireless Depending on the resolution of
the image
Scanned x-ray 1.8 MB (size) Wireless Depending on the resolution of
the image
Compressed and full
motion video
384 kbps-1.544 Mbps Wireless Depending on the compression
algorithm and size of the video

13. THE PROPOSED ARCHITECTURE
Fig 5: Proposed Green Virtual-Clinics

14. Challenges of Virtual Clinics in Developing
Countries
 Lack of international framework
 Code development
 Economy deficiency
 Lack of adequate knowledge
 Behaviour Change Communication
 Service Delivery

15. mHealth Initiatives and adoption in developing
Economies
S/N mHealth Project Location Source
1 SMS-based community dialogue platform called “U report” Ebola crisis! West Africa (USAID, 2014)
2 Mobile Technology for Community Health (MOTECH) Ghana (Grameen et. al.,
2010)
3 mobile phone short message service on antiretroviral treatment Kenya (Ngugi et. al., 2010)
4 AIDS Patient Care using Mobile phones Uganda (Chang et. al., 2010)
5 health workers text-message reminders to malaria treatment Kenya (Zurovac et al., 2011)
6 open-source short message service-based tool for monitoring malaria in
remote areas
Uganda (Asiimwe et. al., 2011)
7 rural health centres, communities and malaria case detection mobile systems Zambia (Kamanga et. al., 2010)
8 cell phone-based and internet-based monitoring and evaluation of antiretroviral
treatment
Rwanda (Nsanzimana et. al.,
2012)
9 SMS appointment reminders messages in an antiretroviral treatment clinic South Africa (Crankshaw et. al., 2010)
10 mobile direct observation treatment for tuberculosis patients Kenya (Hoffman et. al., 2010)
11 SMS for life Tanzania (Barrington et. al., 2010)
12 remote clinics with laboratory results via short message service (SMS) Swaziland (Jian et. al., 2010)
13 mobile learning system Botswana (Chang et. al., 2012)
14 Agric Mobile Phone Xchange (AMPX) povide platform that connects farmers Africa (VC4A, 2014).

16. Conclusions
 Mobile phone networks can be used to drive a sustainable and veritable
health care delivery system through the introduction and promotion of
Virtual Clinics and integration of various health information systems such
as Electronic/Mobile Health and Electronic Health Record systems into the
healthcare industry in Sub- Saharan Africa.
 The specific network requirements in terms of reliability, bandwidth and
availability need to be assessed properly to guaranteed quality of service
to patients.
 Efforts are needed towards, gathering and analysis of the requirements
necessary for electronic health record system development and
coordinating policy support.
 For successful take-up, an appropriate communication campaign for the
end users for adoption and promotion of virtual Clinics is needed.

17. References Y. A. Adediran, J. F. Opadiji, N. Faruk & O;W; Bello, “On issues and Challenges of Rural Telecommunications Access in Nigeria”, African Journal of
Education, Science and Technology, vol 3, No. 2, 2016, pp 16-26, April, 2016. Published by University of Eldoset, Kenya, Anambra State
University and University of Ibadan, Nigeria. http://coou.edu.ng/ajest/
 WHO, “Global Health Observatory (GHO) Data”. Available online at http://www.who.int/gho/health_workforce/physicians_density/en/ (Last visited
on 28/08/2016).
 “Worldwide Doctor-Patient ratio”, http://www.gmu.ac.ae/careandshare/worldwide.html visited 08/09/2016.
 Krishnakumar, J. Soc Indic Res (2017). https://doi.org/10.1007/s11205- 017-1679-0
 P. J. Kpolovie, S. Ewansiha, and M. Esara, “Continental Comparison of Human Development Index (HDI)”, International Journal of Humanities
Social Sciences and Education (IJHSSE) Volume 4, Issue 1, January 2017, PP 9-27.
 Human Development Report, “Human Development for Everyone”, Briefing note for countries on the 2016 Human Development Report - Nigeria,
United Nations Development Project, 2016..
 UNDP Human Development Report Office Occasional Paper, Training Material for Producing National Human Development Reports, United
Nations Development Project, 2015.
 https://howwegettonext.com/the-nearly-unstoppable-success-story-of-globallife-expectancy-f9451b26b2ec
 Della Mea, Vincenzo, "What is e-Health (2): The death of telemedicine?". Journal of Medical Internet Research. 3 (2): e22. PMC 1761900, June
2001. [10] ICT Applications and Cybersecurity Division: Policies and Strategies Department; ITU Telecommunication Development Sector,
"Implementing e-Health in Developing Countries: Guidance and Principles" (PDF). International Telecommunication Union, September, 2008.
Retrieved 2012-04-15.
 Strehle EM, Shabde N. One hundred years of telemedicine: does this new technology have a place in paediatrics? Archives of Disease in
Childhood, 2006, 91(12):956–959.
 WHO, A health telematics policy in support of WHO’s Health-For-All strategy for global health development: report of the WHO group consultation
on health telematics, 11–16 December, Geneva, 1997. Geneva, World Health Organization, 1998.
 A. Pal, V. W. A. Mbarika, F. Cobb-Payton, P. Datta and S. McCoy, "Telemedicine diffusion in a developing Country:The case of India (march
2004)," in IEEE Transactions on Information Technology in Biomedicine, vol. 9, no. 1, pp. 59-65, March 2005.doi: 10.1109/TITB.2004.842410
 Faruk, N., Bello, O. W. Opadiji, J. F. & Adediran, Y. A. (2017). Socioeconomic Challenges of Rural Telecommunication Access Schemes in
Nigeria. International Journal of Information and Communication Technology (ICT), 14 (1); pp 194-217. Published by the Department of Library
and Information Technology Federal University of Technology Minna Nigeria. Available online https://www.ajol.info/index.php/ict/index
 Olayiwola W. Bello, N. Faruk, Abdulkareem. A. Oloyode, and Segun I. Popoola, “Driving Electronic Health Record System Implementation in
Nigeria: A Proposal”, IEEE Conference on ICT for Communicable diseases, 23rd-26th Nov, 2016, University of Ilorin, Nigeria, pp 200-204.
 Marine Al Dahdah, Annabel Desgrées Du Loû, Cécile Méadel, Mobile health and maternal care: A winning combination for healthcare in the
developing world?, Health Policy and Technology, Volume 4, Issue 3, September 2015, Pages 225-231, ISSN 2211-8837,