By Betsy Amsalu
As access to healthcare becomes more challenging due to the rising costs and in many cases, the lack of health care professionals, telemedicine has become an integral aspect of health care delivery in health systems globally. It is now possible for patients to connect with a physician, get a diagnosis, and order prescriptions all from the comfort of their home. The importance of telemedicine cannot be overstated, especially in the era of Covid-19. However, the conveniences of telemedicine do not apply or operate in most developing countries like Ethiopia. Despite overall gains in healthcare access and quality, the majority of Ethiopians are still unable to obtain medical care due to the high out-of-pocket costs for health services, inadequate access to transportation, and mistrust of modern medicine and healthcare providers caused by the inability to understand and analyze health information required to make informed health decisions. The incorporation of telemedicine is arguably the most viable solution to the dire health care problems in Ethiopia. There are several proven telemedicine models in different countries that can be replicated with minimal investment, which can yield improved health outcomes.
Ethiopia’s health system is unable to meet the demand for care, causing prolonged wait times to see primary care providers and specialists. Instead of waiting, patients choose to see private providers, despite the immense financial strain. Limited access to care, in addition to the lack of resources to manage the prevalence of disease, the Ethiopian life expectancy is a mere 66.95 years. Although the maternal mortality rate has shrunk significantly since 2000, the maternal mortality rate sits at 412 per 100,000 live births and child mortality rate at 67 per 1,000 in 2020 according to USAID. Additionally, a 2018 study by the World Bank found that there is only one physician per 10,000 people in Ethiopia. Few nations, most of which in Africa, have a lower physician-to-population density compared to Ethiopia. These poor health statistics can be reversed by implementing telemedicine as a vital component of the health system. Ethiopia has one of Africa’s most sophisticated telecommunications industry as well as one of the fastest-growing economy. Information and Communication Technology (ICT) has seen remarkable growth in the last few decades. Although, development of telemedicine on a grand scale requires serious financial and human resources, Ethiopia’s growth in the ICT sector is a promising development for telemedicine’s prospect.
There are proven models that have successfully managed to bridge the healthcare gap and can be replicated in Ethiopia. For example, MedicallHome, a telemedicine program in Mexico provides telephone access to licensed doctors 24/7, coupled with sizable discounts at a national network of more than 10,000 healthcare providers. The program mainly serves low- and middle-income households and costs $2 to $5 per month. The implementation of this model has led to the dramatic reduction in inefficient utilization of health services. The program successfully reduced the number of users that utilize emergency room services, which resulted in significant savings for patients and the overall health system. In addition to the potential for cost reduction, this model relieves some pressure in an overstrained healthcare system. With over 80 million mobile subscriptions in Ethiopia, the country has the capacity to adopt this model and expand health care access to millions of citizens. The primary goal of telemedicine in Ethiopia should be the expansion of healthcare access with the objective of improving the poor health statistics.
Although telemedicine is an important component of a healthcare system, there are immense application challenges and barriers. There are several factors that will affect the proper implementation and utilization of telemedicine in Ethiopia. These factors include, but not limited to, the government’s willingness to provide sufficient funding to coordinate and administer high quality telehealth services, active collaboration between academia and health care providers to train new healthcare professional entering the workforce on the proper use of telemedicine, and securing foreign investments and expertise to support costs. According to the Word Bank, Ethiopia spent a mere 3.3% of GDP on health care in 2018 compared to the 5.47% health care expenditure in 2010. Restructuring the existing healthcare delivery workflow to include telemedicine will require a robust collective effort from all stakeholders, including the unwavering financial backing of the federal government and the Ministry of Health.
Ethiopia has achieved significant health improvements in the last few decades, such as lowering infant and maternal mortality, but more work is required-particularly in rural areas. Telemedicine alone will not solve the crumbling health care system in Ethiopia. However, with the proper guidance from the government and much needed investment from the private sector, telemedicine can play a significant role in improving the health of the nation. The implementation of telemedicine on a grand scale will undoubtedly meet many challenges along the way. However, it can be achieved with a collective collaborative effort of various sectors. The Federal Ministry of Health along with organizations like the Bill & Melinda Gates Foundation, should develop a strategy to implement telemedicine in Ethiopia’s health infrastructure.
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