TELEHEALTH TECHNOLOGY INFRASTRUCTURE AND CONNECTIVITY ISSUES IN NIGERIA

CHAPTER ONE

INTRODUCTION

Background of the study

Medical services encounter numerous obstacles and bottlenecks, including a shortage of skilled and experienced workers, inadequately equipped facilities, and limited utilisation of advanced technologies in the provision of healthcare (Eli, 2022). Many governments, particularly those from developing economies, are seeking more cost-effective methods of providing healthcare to their citizens. The emergence of Information and Communications Technology (ICT) has introduced innovative approaches to delivering healthcare that are affordable and have a greater likelihood of reaching a larger number of people, particularly those in remote areas. Adewale, in the year 2024

Nigeria's population exceeds 200 million, with a significant proportion residing in distant rural regions that lack adequate access to contemporary healthcare amenities (Ukpaka, 2018). Factors such as geographic remoteness, a shortage of physicians and hospitals, and challenges in travelling to larger cities where healthcare is accessible, contribute to the limited availability of healthcare in this area. Government entities at the federal, state, and local levels have prioritised improving healthcare in remote rural areas. The aim is to ensure that both rural and urban citizens have equitable access to medical services and clinical healthcare, regardless of geographic isolation. However, this endeavour has only achieved limited success (Charles et al., 2022). Hence, implementing a healthcare system that enables doctors to reach patients in remote locales is imperative and highly effective in fulfilling the government's objective of providing essential healthcare to these underserved rural and impoverished communities (Park et al., 2019). Implementing this measure would enhance the healthcare standards in rural and distant regions, reduce healthcare expenses, and enable physicians located far away to provide consultations for any patient's condition (Oboli, 2019).

Evidently, the utilization of telehealth has experienced substantial expansion in recent years, facilitating the provision of more efficient healthcare services. Telehealth refers to the delivery of healthcare services remotely through mobile technology such smartphone applications and the internet (Justin et al., 2021). Telehealth has been widely employed in recent years. Telehealth functions as a mechanism for facilitating excellent healthcare and improving interaction between healthcare practitioners and patients (Alex et al., 2020). Telehealth improves the capacity for monitoring, treatment, and guidance of patients. Telehealth became the main means of providing healthcare during the epidemic, when face-to-face services were limited. Research conducted by Bart et al. (2022) has demonstrated that Telehealth, in contrast to community care lacking digitalized tools, significantly reduces the duration and costs involved in health status monitoring. 

Howbeit, telehealth has become an essential tool for enhancing the accessibility and quality of healthcare (Gareth, 2022). Telehealth presents a viable approach to overcome the limitations of healthcare access in Nigeria, which are mostly caused by geographical, economic, and infrastructural obstacles (Makinde, 2021). Nevertheless, the successful execution and extensive acceptance of telehealth services in Nigeria are greatly impeded by challenges associated with technology infrastructure and connection. As of 2021, the Nigerian Communications Commission (NCC) reported that internet penetration in Nigeria was over 50%. The statement suggests that a considerable segment of the population continues to face a shortage of dependable internet connections, especially in rural and isolated regions (NCC, 2021).

According to Udeme (2022), the distribution of telecommunications infrastructure, including mobile networks, is not equal, with rural areas having inferior coverage in comparison to urban centres. The existence of this digital divide hampers the accessibility of telehealth services for people who are most in need of them. Akpan (2023) supports this claim by asserting that even in regions with internet access, the available bandwidth and connection speeds are frequently inadequate to sustain high-quality telehealth services. These services necessitate stable and fast connections for video consultations and data transmission, thereby impeding their effectiveness. The erratic power supply in Nigeria worsens the problems with connectivity. Regular power outages can cause interruptions in telehealth services, rendering them unreliable for both patients and healthcare practitioners (Henry et al., 2024).

Although telehealth offers great potential for enhancing healthcare accessibility and outcomes in Nigeria, the existing condition of technology infrastructure and connection poses considerable obstacles. To fully harness the potential of telehealth in the country, it is essential to tackle these problems by making strategic investments, implementing effective policies, and launching educational efforts. Nigeria can achieve substantial progress in improving healthcare provision and guaranteeing universal access to high-quality medical services by surmounting these obstacles. This study will investigate the infrastructure and connectivity concerns related to telehealth technologies in Nigeria.

1.2 Statement of the Problem

Telehealth offers a revolutionary chance to improve healthcare accessibility and delivery in Nigeria, especially for populations in distant areas and those lacking adequate services (Oku, 2023). The successful implementation and general acceptance of telehealth services in Nigeria are greatly hindered by challenges associated with technical infrastructure and connection. 

Research has indicated that a significant obstacle to the adoption of telehealth in Nigeria is the limited availability and usage of internet services (Kunle et al., 2022). Despite the progress made in internet penetration in Nigeria, almost half of the population, particularly in rural and remote regions, still lacks access to dependable internet services (NCC, 2021). The digital divide hinders the accessibility and efficiency of telehealth services. In regions where internet access is accessible, the bandwidth and connection speeds are frequently insufficient to offer telehealth services of high quality. Reliable and high-speed connections are crucial for video consultations and the transfer of medical data. The lack of such connections impairs the dependability of telehealth platforms (Akpan, 2023).

In addition, Njoku (2024) states that the exorbitant expenses associated with internet services and digital devices pose a significant barrier for a large number of Nigerians, especially those belonging to low-income groups. The economic barrier hinders the capacity of many potential users to afford and access telehealth services, hence preventing them from benefiting from these services. Remilekun (2023) identifies patient acceptance and digital literacy as further barriers to the adoption of telehealth in Nigeria. Remilekun (2023) asserts that the efficacy of telehealth is contingent upon the readiness of healthcare professionals as well as the willingness and technological aptitude of patients. The population's limited digital literacy impedes the efficient utilisation of telehealth systems. A significant number of potential users lack the requisite skills and knowledge to effectively navigate digital health services, hence limiting their capacity to derive advantages from telehealth developments (Silas, 2023). Therefore, this investigation is necessary.

Objectives of the study

The primary objective of this study is to critically investigate telehealth infrastructure and connectivity issues in Nigeria. Specific objectives of this study are to:

To investigate the level of digital literacy among healthcare providers, patients, and other stakeholders in Nigeria.

To assess the technological readiness of healthcare facilities across Nigeria to adopt and integrate telehealth solutions.

To evaluate the condition of existing telecommunication infrastructures in Nigeria.

To analyze the challenges related to internet connectivity in Nigeria.

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

What is the level of digital literacy among healthcare providers, patients, and other stakeholders in Nigeria?

What is the technological readiness of healthcare facilities across Nigeria to adopt and integrate telehealth solutions?

What is the condition of existing telecommunication infrastructures in Nigeria?

What are the challenges related to internet connectivity in Nigeria?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: The level of digital literacy among healthcare providers, patients, and other stakeholders in Nigeria is low

Ha: The level of digital literacy among healthcare providers, patients, and other stakeholders in Nigeria is high.

1.6 Significance of the study

The research findings and recommendations can have significant consequences for several stakeholders, such as legislators, healthcare professionals, patients, and technology developers.

Firstly, drawing attention to the deficiencies in the existing technology infrastructure might stimulate investment in internet and telecommunications networks, specifically in areas that are lacking adequate services. This has the potential to stimulate overall technical progress and promote digital inclusivity in Nigeria. Gaining a clear understanding of the particular difficulties in establishing connections might stimulate the creation of inventive telehealth solutions designed specifically for the Nigerian environment, hence improving the usability and efficacy of these technologies.

Furthermore, the study's findings can provide policymakers with valuable information regarding the essential infrastructure and connectivity requirements for telehealth. This can help guide the formulation of specific policies and investment strategies. Robust regulatory frameworks are essential for ensuring the safety, security, and quality of telehealth services. These frameworks can help develop trust among both users and providers.

To the society, the study might emphasise the necessity of digital literacy programmes, enabling a greater number of Nigerians to proficiently utilise telehealth services. Disseminating knowledge about digital health to the people can result in improved health behaviours and the ability to make well-informed decisions.

Empirically, scholars will utilize it as a thorough examination of the current body of literature. Consequently, other students with an interest in this subject will have the opportunity to utilise this work as existing material that may be critically examined. This study adds to the scholarly discussion on the telehealth technology infrastructure and connectivity challenges in Nigeria. 

1.7 Scope of the study

Broadly, this study focuses to critically investigate telehealth infrastructure and connectivity issues in Nigeria. Specifically, this study seeks to investigate the level of digital literacy among healthcare providers, patients, and other stakeholders in Nigeria, assess the technological readiness of healthcare facilities across Nigeria to adopt and evaluate the condition of existing telecommunication infrastructures in Nigeria. 

Further, this study will focus on analyzing the challenges related to internet connectivity in Nigeria and it also seeks to provide recommendations to enhance telehealth technology infrastructure and connectivity in Nigeria.

1.8 Limitations of the study

As is typical in any human endeavour, the researchers faced minor limitations during the investigation. The main limitation was the lack of extensive literature on the subject, due to the limited availability of data for telehealth technology infrastructure and connectivity issues in Nigeria. Hence, a significant investment of time and effort was necessary to locate appropriate materials, publications, or information and gather data.

 Moreover, this study is constrained by its small sample size and narrow geographic scope, namely focusing solely on Nigeria. Therefore, the conclusions of this study cannot be extended to other situations, thus requiring further investigation. 

Furthermore, the researcher faced a time constraint due to the need to do this research while still fulfilling the obligations of attending lectures and participating in other educational activities.

1.9 Definition of terms

Telehealth: Telehealth involves the delivery of healthcare services using digital technologies and telecommunications.

Primary Healthcare: PHC is a whole-of-society approach to health that aims at ensuring the highest possible level of health and well-being and their equitable distribution by focusing on people's needs and as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation and palliative