Assignment 2 Option A: Summarising eHealth/Telehealth
SUBJECT: Public Health Informatics
This report is based on the article by Bedian et al. (2014) focus on Réseau en Afrique Francophone pour laTélémédecine (RAFT) network. This article is all about the combination of eHealth and telemedicine benefits in health system and critique the project in terms of pilotitus and neo-colonialism along with introducing the challenges of the project in health system and infrastructure challenges.
low and middle-income countries (LMICs) are struggling with poor infrastructure of health system, lack of sanitation of equipment, lack of health specialists in remote areas (Bedian et al., 2014). Because of developing urban areas and poor wages, poor work condition, low income in rural areas, professional do not want to work in rural areas that make worse condition in health care in these places. Addition to it, poor structure of financial resources and poor accessibility, geographical availability of health services also tend to poor health care in these countries (David H. et al., 2008). Hence, ehealth and mhealth programmes are implemented to enhance the quality of health in low and middle-income countries (WHO, 2011).
The RAFT is a telemedicine network that is formed by the University hospitals and the University of Geneva (HUG and UNIGE) for the support of health specialists who are working in remote areas and to tackle the challenges of health care (Bedian et al., 2014). Firstly, this network is introduced in Africa and then French, English and Portuguese speaking countries. But it is more known world-wide by implemented in Bolivia and Nepal as well as connected with 60 active sites by attached health professionals. The RAFT is also working with cooperation of World Health Organisation (WHO) for eHealth and telemedicine and collaborates with other organisations such as Université Numérique Francophone Mondiale (UNFM) (Bedian et al., 2014).
The roles of RAFT have been showed in educational, clinical and public health activities. RAFT is involved in live video-lectures of discussion and to educate the health experts for continuing medical education (CME). By these conferences, they introduced number of medical topics such as Malaria, HIV-AIDS, diabetes etc. Similarly, in French speaking Africa, the post-graduate medical education (PME) goals are residents in universities and hospitals to educate by local academic authorities about the field of surgery, internal medicine, gynaecology etc., by video conferences. It also provides virtual patients which suits for learners who have some previous knowledge for training on clinical decision-making and elaborate their clinical skills. (Bedian et al., 2014). Weekly video lectures also transported by the RAFT to support the ICATT project.
Additionally, RAFT is used in tele-expertise tool for discussing between professionals and doctors of rural areas to urban areas to handle complex cases and to avoid the complications. In hospitals of Africa, RAFT has been in growing demand for enhance the collection and management of clinical information system and utilization of mHealth project to support healthcare. In this project, mHealth is used for the data collection by use of SMS service at district hospitals in public health actions (Bedian et al., 2014). Mobile health or mHealth is defined as a practice of medicine and public health by using mobile devices, mHealth is the part of eHealth which used for health information and communication technology such as computers, mobile phones, communications satellite, patient monitors, etc. to educate the consumers about health care services (“what is mhealth – Bing”, 2018). As well as, two mHealth projects include the SMS for data collection at health district level in Mali and impact evaluation of SMS reminder in tuberculosis cure and Altiplano project in Bolivia and Nepal in the RAFT (Bedian et al., 2014).
‘Pilotitis’ is defined as disappointment (of service funding agencies, government departments and service providers) with isolated pilot projects which may have been successful but were not moved out into continuing changes in broader service provision or policy within health services development (Kuipers et al., 2008). In this RAFT project, it was successful network in the area of telemedicine and eHealth for educating and management of patients and to implement of eHealth activities and telemedicine. The RAFT used different tools to work and operation system and communication on video conferences, but other safer software could be used for the patient privacy and other documentations. After doing activities for many years, financial issues still faced by RAFT. To implement these projects, long-term funding is necessary for the involvement of experts, users and providers. But RAFT has two years’ price of connection fees. These two years utilized by the government to document the benefits of the activities (Bedian et al., 2014). A business model is needed to achieve the goal of financial independence, but RAFT had inadequate type of business models. Due to poor infrastructure and economic reasons, local needs of health system did not complete (Bedian et al., 2014).
Neo-colonialism is the control of less-developed countries by developed countries through indirect means, according to Henary. In this article, we observed that neo-colonialism is occurred in the RAFT project, because it is started mainly in the Africa, but it developed more under the Geneva who was responsible for the coordination of activities in the Africa on national level and with the collaboration of World Health Organisation (WHO) (Bedian et al., 2014).
The RAFT is organised in order to fulfil basic and general needs of the people all around the world. This was proved when RAFT get succussed in the Bolivian Altiplano and progress made in Nepal that this project is not only for African (Bedian et al., 2014).
To conclude, because of existence of neo-colonialism RAFT was not only African’s project, it is used globally in low and middle-income countries by using of telemedicine and eHealth and it is beneficial for the people in rural and remote areas in Africa. But this project faced number of challenges and become failure in terms of having major challenges such as learning during life, recognition and valorisation of teaching or learning activities (Bedian et al., 2014). The challenges of privacy issue, financial accessibility, funding and lack of decision makers and donors also faced by RAFT network.
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David H. Peters,Anu G., Gerry B., Damian G. Walker, William R., M. Hafizur(2008). Poverty and Access to Health Care in Developing Countries. Retrieved from https://nyaspubs.onlinelibrary.wiley.com/doi/full/10.1196/annals.1425.011
Kuipers, P., Humphreys, J. S., Wakerman, J., R., Jones, J., & Entwistle, P. (2008) Collaborative review of pilot projects to inform policy: A methodological remedy for pilotitis? Australia and New Zealand Health Policy, 5(1), 17. https://doi.org/10.1186/1743-8462-5-17
Bediang, G., Perrin, C., Ruiz de Castañeda, R., Kamga, Y., Sawadogo, A., Bagayoko, C. O., & Geissbuhler, A. (2014). The RAFT telemedicine network: lessons learnt and perspectives from a decade of educational and clinical services in low- and middle-incomes countries. Frontries in public Health. Retrievd from-https://doi.org/10.3389/fpubh.2014.00180