APPRAISAL ON THE CHALLENGES OF TELEMEDICINE DEPLOYMENT IN NIGERIA: A CASE STUDY OF LAGOS STATE

CHAPTER ONE

INTRODUCTION

Background of the study

Globally, the healthcare system has been over-stretched in the face of epidemics and pandemics as a result, exacerbated the dearth of health workers, signaling the need for innovative means such as telemedicine as an essential tool for reducing the negative effects of shortages in medical practitioners. Steve and Iren (2021) emphasized that the COVID-19 pandemic accelerated the use of technology in healthcare sector and uncovered its opportunities in providing prompt clinical care, education, and healthcare, at a low cost and extensive coverage.  Couple with the fact that physical clinical consultations were restricted, and the higher risk of occupational exposure for medical practitioners when providing patient care. This necessity gave rise to the adoption of telemedicine, a concept coined in the 1970s and defined by Orimoko (2022) as "healing at a distance."

Owen and Onyeama (2020) noted that telemedicine gained broader acceptance in Nigeria during the Covid-19 pandemic, as it allowed Nigerians to seek healthcare remotely, reducing the risk of disease transmission during hospital visits or transit. Bhaskar (2020) defined telemedicine more broadly as the remote provision of healthcare services using digital communication technologies, emphasizing its potential to bridge healthcare gaps in  Africa. Musbahu & Tahil (2022) averred that telemedicine uses technology tools, including messaging platforms, emails, phones, tablets, wireless monitors, teleconferencing, video conferencing, and other telecommunication technologies and the effectiveness of telemedicine services lies on their patient-centered nature, and ability to shield patients, doctors, and the general public from communicable diseases. By leveraging telecommunications, telemedicine supports medical consultations, diagnostics, and training for healthcare professionals, thereby eliminating the need for extensive travel (Haleem 2021). Manasseh and Jakes (2021) highlighted that telemedicine ranges from simple telephone consultations between healthcare professionals to complex real-time interactions using satellite technology and videoconferencing across different countries. This transformative approach holds promise in overcoming geographical barriers, enhancing healthcare delivery, and improving the overall health outcomes of urban and rural areas.

Notably, in some developed and developing nations, telemedicine is a practical growing component of health information systems. However, most sub-Saharan African countries, including Nigeria, lack evidence on proper telemedicine use in healthcare delivery. According to Eze & Onwujekwe, 2021), the healthcare system in Nigeria is characterized by disparities between urban and rural areas. While urban centers may have access to better healthcare facilities and more specialized medical personnel, rural areas often suffer from a severe lack of resources. On the other hand, Adeolu (2023) argued that rural areas in Nigeria is often characterized with poor population who hardly get access to basic amenities burdened with poverty and low standard of living. The geographic isolation, the scarcity of physicians and hospitals, and difficulties of travel to larger cities where such care is available are among the factors limiting this access.  Consequently, Governments at federal, state, and local levels, have been making healthcare in these remote rural areas their focal point over the years to enable citizens in both rural and urban areas to have equal right to medical services and clinical healthcare regardless of the geographic isolation barriers but this effort has only been partly successful. 

Statement of the problem

In recent times, telemedicine have reportedly been used in health facilities in Nigeria. For instance, Munachi & Amanda (2022) observed that some people communicate medical pictures using their mobile devices for remote diagnostics, and electronic medical records are used to reduce paperwork stress.  Robert and Eugene (2021) pointed that there is also evidence of the use of telemedicine services in Nigeria to provide healthcare against diseases like Ebola, hypertension, and cancer. However, Despite the potential of telemedicine to improve healthcare delivery and access, various obstacles remain, some factors, which include technological, human, organizational, social, and individual characteristics, might contribute to the underutilization of telemedicine in the healthcare sector.

In a study by Sanni, Shade and Jafaru (2022) most healthcare professionals in third world countries will likely face challenges such as resistance to change in role redefinition, responsibilities, new skill development, and a lack of a business model that incorporates telemedicine.  More so, the cost of a license and technology and also insufficient knowledge of operating telemedicine devices are problems that healthcare workers encounter when attempting to use telemedicine services. To buttress further, Kumasi and Jackie (2021) highlighted that poor funding for healthcare is a recurrent problem in telemedicine deployment for countries in sub-Saharan Africa, including Nigeria, with many public healthcare facilities depending on government funding. From the perspective of the patients, those living in rural or low-income areas may not have access to telemedicine devices due to financial constraints. Accompanied by financial constraints, technological and infrastructural control threatens the utilization of telemedicine services. Barriers to the adoption of telemedicine in many African countries - including Nigeria - include poor internet connectivity, inadequate and unstable electricity supply, insufficient or inadequate ICT and virtual health infrastructure, and high cost of telecommunication equipment (Hosea, Rita, & Uforo)

Whereas studies have found willingness to adopt telemedicine in countries like Nigeria with resource-poor settings and hard-to-reach populations. However, using telemedicine in Nigeria is still nascent, possibly due to some critical factors. More so, existing literature usually focus on rural and underserved areas when it comes to ICT in healthcare delivery which blur intervention for urban areas in most state. Therefore, against the backdrop, this study explores appraisal on the challenges of telemedicine deployment in Nigeria: a case study of Lagos State.

1.3 Objectives of the Study 

The objectives of this study is focused on an appraisal on the challenges of telemedicine deployment in Nigeria: a case study of Lagos State. Specifically, the study seeks:

To evaluate the extent to which telemedicine services are currently deployed in healthcare sector in Lagos state. 

To identify the types of telemedicine technologies deployed in healthcare sector in Lagos state. 

To examine the impact of telemedicine deployment healthcare delivery in Lagos state.

To explore the various challenges hindering the deployment of telemedicine in Lagos state.

1.4 Research Questions

What is the extent to which telemedicine services are currently deployed in healthcare sector in Lagos state?

What are the types of telemedicine technologies deployed in healthcare sector in Lagos state?

What is the impact of telemedicine deployment healthcare delivery in Lagos state?

What are the various challenges hindering the deployment of telemedicine in Lagos state?

1.5 Research hypotheses

Ho:  The extent to which telemedicine services are currently deployed in healthcare sector in Lagos state is low. 

Hi: : The extent to which telemedicine services are currently deployed in healthcare sector in Lagos state is high

1.6 Significance of the study

The practical significance of this study lies in its potential to improve healthcare delivery in rural Nigeria by identifying effective strategies and technologies that can enhance the accessibility and quality of medical services through telemedicine. By highlighting the barriers and facilitators to telemedicine adoption, the study provides actionable insights for policymakers, healthcare providers, and technology developers to design and implement more efficient telemedicine systems, ultimately reducing healthcare disparities between urban and rural areas. 

Theoretically, the study contributes to the academic understanding of telemedicine's role in healthcare systems, particularly at state level. It enriches the existing body of literature by offering empirical evidence on the impact of telemedicine on healthcare outcomes and service delivery in urban and rural Nigeria, thus informing future research and theoretical frameworks on digital health interventions and their applicability in similar contexts globally.

Scope of the Study

The study will focus on appraisal on the challenges of telemedicine deployment in Nigeria: a case study of Lagos State.  In content, the study is structured to achieve a comprehensive understanding of telemedicine, the extent to which telemedicine services are currently deployed in healthcare sector in Nigeria, the types of telemedicine technologies deployed in healthcare sector in Nigeria, the impact of telemedicine deployment healthcare delivery and the various challenges hindering the deployment of telemedicine. Geographically, the study will focus on Lagos State Nigeria contributing valuable insights into the practical implications and effectiveness of telemedicine interventions in improving healthcare access and outcomes in the state.

1.8 Limitations of the study

Several limitations could affect the findings and generalizability of this study on challenges of telemedicine deployment in Nigeria: a case study of Lagos State. Firstly, the study's geographical scope is limited to a specific locality, which may not fully represent the diverse healthcare challenges and telemedicine adoption patterns across all rural areas in Nigeria. Secondly, the study's reliance on self-reported data from healthcare providers and users may introduce response bias and inaccuracies in assessing telemedicine accessibility, usage factors, and healthcare outcomes. Thirdly, the study's timeframe and resources may constrain the depth and breadth of data collection and analysis, potentially limiting the comprehensiveness of findings.

1.9 Definition of Key terms

Telemedicine: The use of telecommunications technology to provide healthcare services remotely, facilitating medical consultations, diagnoses, and treatment plans without the need for in-person visits.

Healthcare Outcomes: The results or effects of healthcare interventions on patients' health status and well-being, including measures of improvement or decline in health conditions, quality of life, and mortality rates.

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