Telemedicine Services for Remote Regions in Cameroon The ...

Telemedicine Services forRemote Regions inCameroonThe Genesis ExperienceJacques Bonjawo, Genesis Telecare

Overview• Introduction• Presentation of the project• Evaluation Methods• Results• Discussion• Conclusion

IntroductionCameroon• Developing country (Central Africa)• About 70% of the population in rural area• Predominance of infectious and parasitic diseases• Progression of chronics diseases• Inequitable access to health care services• Difficulty in financing the health care system• Lack of human and material resources

Presentation of the project• Project conception: Genesis Telecare• Start Date: April 21, 2009• Based on a private initiative

Presentation of the project• Aims at developing a permanent and selfsustainabletelemedicine service• Provides long distance specialized health care• Trains health professionals to allow for morecoverage and effective delivery of healthservices throughout the country

Presentation of the projectPartners• Public Health MinistryEnsures the availability of the publichospital infrastructures, includingequipment and human resources• UNESCOEases the collaboration between national andinternational administrations, and charity organizations• The Cameroon Telecommunication Company (Camtel)Offers easy access to the telecommunicationequipment

Presentation of the projectObjectives• Provide adapted health care to non‐privileged areasby extending telemedicine activities to all thecountry• Reinforce patient‐physician relationship, minimizewaiting time and maximize the effectiveness of themedical consultations• Allow rural and remote areas to have access tosophisticated health services, generally located inurban centers

Presentation of the projectObjectives (cont’d)• Develop appropriate technological andorganizational solutions adapted to the realities ofthe country• Monitor and evaluate the system efficiency duringlong distance consultations

Presentation of the projectNetwork architecture• Inter‐connect the reference centerof the capital to a rural hospital• Servers located in protectedinfrastructures• Required equipment :Redundant power supplyControlled air‐conditioningSophisticated security systems

Presentation of the projectNetwork architecture• Development strategy:Genesis Telecare• Technical system includes:Desktops and laptopsDevices (cameras, printers, etc)Specific softwaresElectrocardiographs (ECGs)Electronic stethoscopesElectronic blood pressuremonitorsUltra Sound equipments etc.

Presentation of the projectServices provided• Distance consultation and diagnosticExchange of video images betweenspecialist physicians and healthprofessionalsExchanges between specialistphysicians and patientsExchange of electronic information(ex: ECGs)• Creation of a patient electronic healthrecord• Collaboration between physicians withuse of e–Communication and Visioconferencing• Training of health professionals

Evaluation methodsEvaluation strategy•Comprehensive evaluation•Outcome evaluationEvaluation is viewed as an interactive processthat informs decisions in the course of a project

Evaluation methodsData collection• Visit of sites• Discussions with the main stakeholdersinvolved in the project• Data analysis of telemedicine servicesutilization• Observation and interviews : validation of theevaluator’s understanding of the strategic andoperational dimensions

Evaluation methodsAnalyses of the results• Evaluation adapted to each step of the project• The evaluation considers these indicators:−Utilization of the different services offeredthrough the system and acceptability−Socioeconomic impact and impact on thequality of the care−Identification and evaluation of the new workprocedures induced by the system

ResultsDuring the study observation period (April 21,2009 –May 2, 2010) 11540 individuals benefitedfrom the telemedicine services• Tele‐cardiology at the urban and distant sites• Tele‐gynecology at the urban and distant sites• Generalist consultations at the urban and distantsites

ResultsThe urban site• 1630 consultations• 64.3% men• Mean age: 36.9 years• 2160 (21,8%) : had high blood pressure• 1440 (14%) patients had an ECG done• 610 (6.2%): consultation in cardiology• 500 (5%): consultation in gynecology• 4200 (42.4%) received medical prescription

ResultsThe distant sites• 9910 patients• 73.9% women• Mean age: 42.6 years• 5300 (32.5%) had high blood pressure• 6400 (39.3%) received a consultation incardiology• 2100 (12.9%) had an ECG• 4800 (29,4%) received drug treatment

ResultsImpacts on patients• Approximately 12000 patients benefited fromthe telemedicine services• The majority of the patients were seen in cardiology• Thousands of patients had high blood pressure• Several of them did not know the risks related to theirconditions• Patients received immediate treatment (cardiology)• Prescription and free distribution of drugs

ResultsImpacts on physicians• Telemedicine:well perceived by the physiciansuseful tool for health professionals• Remote physicians are highlymotivated• Provides opportunities for training• Exchanges between colleagues

ResultsImpacts on nurses• Telemedicine : well perceived by the nurses• Health care services are more accessible to thepatients• Expressed needs: ultrasound, ECGs andradiology• Need to better inform the patients about theservices offered• Problems raised: group work procedure andcomputer skills

ResultsImpacts on the cost of health careservices• Self‐financing• Cost‐effectiveness• Financial accessibility to the services• Geographical accessibility to theservices• Reduction of the costs of treatment• Time savings• Savings for the health care system

DiscussionConditions of adoption and diffusion of theproject• First project of its kind in Cameroon• First site: District hospital with only onephysician at the time of the evaluation of theproject• Huge need for telemedicine• Complements the availability of health careservices for remote and urban populations• Patients agree with the idea to use thetelemedicine

DiscussionConditions of adoption and diffusion of theproject• Sustainability of assets• Development of new clinical services and trainingactivities• Engagement of the Ministry of Public Health• Agreement between the Ministry of Public Healthand Genesis Telecare•Engagement of the Ministry of Economy

DiscussionSuccess factors of the project• Population open to telemedicine and great patientsatisfaction• Participation of health professionals convinced of theimportance of the project• Rigorous definition of the objectives of the project• Judicious selection of the applications appropriate to theneeds• Simple and robust technology and functionalities basedon established applications• Consideration of data security and confidentiality

DiscussionSuccess factors of the project• Mobilization of several key actors at the beginning of theproject• Young and dynamic team led by experienced projectmanagers• Execution of business plan of the project taking intoconsideration the costs of various scenarios• Need to innovate and seek adapted solutions to theneeds of the populations

DiscussionMain obstacles and risks affecting theproject• Resistance and lack of implication of some clinicians withnegative perception of telemedicine• Limited knowledge of patients and population regardingtelemedicine services• Demanding work conditions for health professionals thatcould limit their time for telemedicine• High cost of technologies and connections• Absence of a legal framework regulating the exploitationand the use of telemedicine services in Cameroon

DiscussionConsiderations for the continuation of the project• Guarantee the security and confidentiality ofinformation regarding patients• Ensure adequate training for staff involved intelemedicine services• Support the implication of physicians and professorsalready working in collaboration with distant hospitalsand/or in telemedicine

DiscussionConsiderations for the continuation of the project• Formulate the next objectives of the project in termsof targets to be reached• Take into account the needs of patients andpopulation using field studies and consultation ofepidemiologic data• Choose other pathologies to cover and identify therequired equipment• Consolidate the existing partnerships and establishagreements with decision makers

DiscussionConsiderations for the continuation of the project• Improve the involvement of physicians and other healthprofessionals by identifying and supporting the leaders• Consideration of the aspects of equipment safety and dataconfidentiality• Inspiration from successful experiences in similar contexts• Connection with other telemedicine projects in similarcontexts

Conclusion• First experiment to establish a service of telemedicine inCameroon• One of the first experiments of its kind in Africa• Highly promising initiative to support access to health careservices for the population in remote areas• Favorable perception by the population, healthprofessionals and decision makers• Successful demonstration in Yaounde and Abong Mbang• Extension of services in : Nkoteng, Endom, Nanga andYagoua

Thank you! Contact: jacques@genesistelecare.com