EVALUATION OF TELEHEALTH ADOPTION IN PRIMARY HEALTHCARE FACILITIES IN NIGERIA

CHAPTER ONE

INTRODUCTION

Background of the study

Access to healthcare is a fundamental human right that should be available to all individuals, regardless of their geographical location or socioeconomic condition, when they require it (Samir et al., 2022). In a densely populated country such as Nigeria, where there are disparities in income, it is imperative to analyse the healthcare system from the perspective of health equality. This entails ensuring that healthcare is accessible, inexpensive, and available to all individuals who require it (Sanusi 2021). This highlights the significance of primary healthcare, which serves as the foundation of every healthcare system and should be the initial point of contact for the majority of Nigerians when seeking medical assistance.

Primary healthcare facilities serve as the fundamental support structure for the Nigerian healthcare system, delivering vital services to the bulk of the population (Oladele, 2020). Nigeria, with a population exceeding 200 million, holds the title of being Africa's most populous nation. Nevertheless, her healthcare system is beset with numerous obstacles, including as inadequate health infrastructure, a scarcity of personnel, and feeble mechanisms (Akanbi et al., 2020). These factors have led to inefficient utilisation of healthcare facilities, namely the primary health clinics (PHCs). This situation is concerning because although Primary Health Centres (PHCs) make up 85% of all clinics and hospitals in the country, only approximately 20% of them are operational and capable of offering essential emergency obstetric services. Moreover, a staggering 75% of Primary Health Centres (PHCs) in Nigeria lack the critical equipment package, which includes vital drugs, sphygmomanometers, glucometers, and personal protective equipment (Akunjobi et al., 2020). Telehealth offers a hopeful resolution to tackle certain healthcare obstacles in Nigeria. Telehealth utilises technology to promote accessibility to healthcare services, improve the quality of care, and alleviate the workload of healthcare personnel (Christopher, 2024).

In the field of research, there is a significant range of terms used to describe projects that utilise various forms of information communication technology in healthcare settings. These terms include telehealth, telemedicine, m-Health, and eHealth. Telehealth is the provision of healthcare or associated services, such as education, while patients or clients are physically separated by distance. This distance is addressed through the use of information and communication technologies (Wilson, 2017). According to Agbaje (2022), telehealth refers to the use of telecommunication technology for various healthcare purposes, such as diagnosis, consultation, treatment, transmission of medical data, education, and broadcast of public health alerts and emergency updates. Telehealth refers to the utilisation of telecommunications technology to provide clinical diagnostics, services, and patient consultations (Wilson, 2017).

The utilisation of Information and Communications Technology (ICT) in the realm of healthcare systems is not a recent phenomenon. For instance, telemedicine services employing video conferencing were initiated in the 1950s. Nevertheless, the adoption of telemedicine experienced a significant surge in the 1990s owing to the enhanced accessibility of affordable, top-notch computers and high-speed internet, alongside the advancement of novel technological aids that facilitate the provision of high-quality and efficient healthcare. These applications are dependent on a fast Internet connection, specifically broadband (Troy et al., 2022). Furthermore, the American Telemedicine Association (ATA, 2017) has shown that telehealth can help bridge the gaps in delivering essential healthcare to underserved individuals, primarily due to a lack of specialised healthcare providers.

Akanainyene et al., (2017) emphasized the necessity of incorporating Information Communication Technology (ICT) in Primary Health Centres (PHC) across rural and urban areas of Nigeria. This integration aims to ensure equal and convenient access to healthcare services. Nevertheless, the rural communities in Nigeria lack adequate access to Information Communication Technology (ICT) in comparison to their urban counterparts (Gold, 2021). The paper highlights the deficiencies in the implementation of primary health care delivery services in Nigeria. It emphasizes the importance of recognizing that ICTs can have a significant impact on healthcare delivery in Nigeria. Therefore, the integration of ICTs in the healthcare industry has the potential to improve the ability to track and report disease outbreaks, distribute guidelines for disease control and treatment, and facilitate the exchange of scientific knowledge and research findings among healthcare professionals (Nsikak, 2022).

Telehealth, the provision of healthcare services through digital communication technology, has been seeing significant global growth (Marshal, 2021). Telehealth implementation can offer significant advantages in rural regions of Nigeria, where healthcare accessibility is profoundly restricted (Obina, 2020). This study aims to assess the implementation of telehealth in primary healthcare institutions in Nigeria, a country grappling with several healthcare system obstacles, such as restricted healthcare service availability, particularly in rural regions.

1.2 Statement of the Problem

Although telehealth has the potential to enhance healthcare access and quality, its implementation in primary healthcare facilities in Nigeria is still below the recommended level (Anjola, 2023). Multiple factors contribute to this challenge, necessitating a comprehensive examination and resolution in order to fully exploit the potential of telehealth. 

Anjola (2023) states that several reasons, such as technological, human, organisational, societal, and individual aspects, can potentially lead to the limited use of telehealth in the healthcare industry. Chinedu (2023) supports this claim by stating that healthcare personnel are likely to encounter difficulties such as opposition to altering their roles and duties, acquiring new skills, and the absence of a telemedicine-integrated business model. Healthcare personnel have challenges in utilising telemedicine services due to the expenses associated with acquiring licences and equipment, as well as a lack of proficiency in operating telehealth devices. Anjola, in the year 2023.

In sub-Saharan Africa, particularly Nigeria, inadequate finance for healthcare is a persistent issue. Many public healthcare facilities in these nations rely heavily on government funding (Peace, 2023). Patients residing in rural or low-income regions may lack access to telehealth devices due to budgetary limitations, as observed by Odinta (2021). According to Solomon (2024), the implementation of telehealth systems necessitates substantial financial commitment. Primary healthcare facilities sometimes have financial constraints, which pose difficulties in allocating funds for telehealth infrastructure and training.

According to Remilekun (2023), patient acceptance and digital literacy are further obstacles to the implementation of telehealth in Nigeria. According to Remilekun (2023), the effectiveness of telehealth relies not only on the preparedness of healthcare personnel, but also on the willingness and technological proficiency of patients. A significant segment of the Nigerian population may have restricted access to digital technologies, which presents a hurdle to the adoption of telehealth. This study aims to assess the implementation of telehealth in primary health centres in Nigeria.

Objectives of the study

The primary objective of this study is to critically evaluate telehealth adoption in primary healthcare centers in Nigeria. Specific objectives of this study are to:

To assess the current level of telehealth adoption in primary healthcare facilities in Nigeria.

To identify the factors impeding telehealth adoption in primary healthcare facilities in Nigeria.

To evaluate the impact of telehealth on healthcare access, quality, and patient outcomes.

To provide recommendations to overcome barriers and promote effective telehealth adoption in Nigeria’s primary healthcare system

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 current level of telehealth adoption in primary healthcare facilities in Nigeria?

What are the factors hindering telehealth adoption in primary healthcare facilities in Nigeria?

What is the impact of telehealth on healthcare access, quality, and patient outcomes?

What are the recommendations to overcome barriers and promote effective telehealth adoption in Nigeria’s primary healthcare system?

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 telehealth adoption in primary healthcare facilities in Nigeria is low 

Ha: The level of telehealth adoption in primary healthcare facilities in Nigeria is high

1.6 Significance of the study

Nigeria faces challenges in maintaining adequate healthcare accessible, particularly in rural and marginalised areas. Telehealth can mitigate this discrepancy by enabling remote consultations and healthcare delivery, hence augmenting the accessibility of medical services. This study will serve as a primary point of reference for the general public, legislators, health professionals, students, and scholars.

Nigeria faces significant obstacles in terms of healthcare accessibility, particularly in rural areas. Telehealth can overcome obstacles by enabling remote consultations, reducing transit costs, and improving healthcare outcomes. Implementing telehealth in Nigeria's basic healthcare facilities is crucial due to challenges such geographical barriers, limited specialist availability, and inequitable allocation of healthcare resources. Understanding its acceptance provides valuable information on improving healthcare delivery. Moreover, the evaluation of telehealth adoption can be utilised to measure its impact on health outcomes, such as patient satisfaction, treatment adherence, and the management of chronic diseases. This can provide empirical evidence of its effectiveness in improving healthcare service.

Moreover, these discoveries can offer useful insights to policymakers and healthcare practitioners regarding the most efficient strategies and ways to enhance the adoption of telehealth, thereby ensuring the realisation of the complete benefits of telehealth.

Furthermore, future scholars will utilise it as a thorough examination of the current body of literature. Consequently, other students with an interest in studying this subject will have the opportunity to utilise this work as preexisting information that can be exposed to critical evaluation. This study adds to the scholarly discussion on the acceptance and use of Telehealth in primary healthcare facilities in Nigeria. 

1.7 Scope of the study

Broadly, this study focuses to critically evaluate telehealth adoption in primary healthcare centers in Nigeria. Specifically, this study seeks to assess the extent of Nigerians' knowledge on telehealth, assess the current level of telehealth adoption in primary healthcare facilities in Nigeria and identify the barriers to telehealth adoption in primary healthcare facilities in Nigeria. 

Further, this study will focus on evaluating the impact of telehealth on healthcare access, quality, and patient outcomes and it also seeks to provide recommendations to overcome barriers and promote effective telehealth adoption in Nigeria’s primary healthcare system.

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 evaluation of telehealth adoption in primary healthcare centers 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