It’s time to channel the high phone ownership in Lagos towards telemedicine
Recently, Lagos State, southwest Nigeria, released its 2020 household survey report. Ten thousand households were interviewed. As a public health physician and health equity advocate, I am interested in using the result of the survey to improve the health and wellbeing of Lagosians.
One aspect of the data which caught my attention is the personal phone usage by households. Ninety-seven percent of Lagosians have a personal phone. Furthermore, 75%, 11%, 8%, 2% and 1% of households have two, three, four and five phones respectively. Specifically, 53% of the phones are smartphones; 45% are standard phones while 2% are landlines. There is a lot that can be done with phones to improve health.
Lagos State has a small land mass with an estimated population of more than 22 million. The chaotic traffic congestion in Lagos can mean the movement of people is severely restricted, including to health facilities. Therefore, when I saw the high phone ownership statistics, I saw with it the potential for more telemedicine to improve the health and wellbeing of Lagosians.
Telemedicine is a process which enables video or phone appointments between a patient and their health care practitioner (client-to-provider). It can also be between healthcare providers (provider-to-provider) to ensure that a patient gets the best care. The first step to improving health outcomes is for people to have access to the right information. Through telemedicine, health education can be provided seamlessly. With telemedicine, people do not have to travel long distances or give up their daily income. The latter is pertinent in Nigeria where the economy is mostly informal, and people earn on a daily basis.
Telemedicine could be delivered via text messages, WhatsApp messages, USSD codes, phone calls and video messages. It is best used to hear complaints and provide the best advice to individuals. The best advice could be information on things to do to prevent falling sick; mental health counseling; infection prevention and control; referral to a next level of care; benefits of vaccinations; information on vaccination centers; nutrition counseling; and lots more. When telemedicine is between health care providers, it could be used to supervise service provision such as conduct of surgeries and advice from senior to junior health workers.
These are four things to consider for telemedicine to work in Lagos state.
First, telemedicine must be well regulated to protect clients. The World Health Organization’s Director, Department of Digital Health and Innovation, Professor Alain Labrique, captured the importance of adequate regulation at the launch of the consolidated telemedicine implementation guide. He said, “For telemedicine to have the most impact when and where it is needed, the enabling environment is critical. Investments in national policies, governance, and standards are important to have in place.”
The WHO telemedicine implementation guide has two major recommendations on client-to-provider telemedicine and provider-to-provider telemedicine. WHO recommends the use of client-to-provider telemedicine to complement, rather than replace, the delivery of health services and in settings where patient safety, privacy, traceability, accountability and security can be monitored. In both types of telemedicine, monitoring includes the establishment of standard operating procedures that describe protocols for ensuring patient consent, data protection and storage, and verifying provider licensing and credentials.
Second, the cost of phone calls, SMS and data must be affordable. While phone ownership is high in Lagos state, availability of phone networks across Nigeria could be unreliable in some locations. This affects the quality of call and data, leading to dropped calls and slow internet connectivity. The survey report also shows that 61% of Lagosians use the internet. Most people use the internet for entertainment (18%) followed by those who use it to buy goods and services (16%). Healthcare should be an integral part of goods and services that Lagosians buy on the internet. For telemedicine to work efficiently, data speed must increase, and the cost must be affordable. A way to manage cost could be for the Lagos state government to partner with telecom providers and telemedicine service providers to reduce the cost of data, SMS and calls for telemedicine.
Third, increase the pool of health workers using telemedicine to provide care in Lagos, which is already high. For instance, an online study of 104 doctors at a tertiary health facility in Lagos published in the Journal of Clinical Sciences showed that 93.3% of the doctors used telemedicine. The most commonly used telemedicine option was phone call (27.1%) and WhatsApp video call (27.1%). The main management provided during this period was counseling (56.6%). Seventy-nine percent of the participants were satisfied with the result of the management provided through telemedicine options, but 36.2% were concerned with ethical issues. The ethical issues included fear of patient’s confidentiality being endangered and exposure of health practitioners to litigation. There are also several health tech firms that provide telemedicine services in Nigeria. Lagos state should partner with more health tech firms to increase the use of telemedicine for healthcare delivery. Examples of health tech firms that offer telemedicine services in Lagos State include Doctoora, WellaHealth, Tolu The Midwife and Reliance Health.
Lastly, increase public awareness about telemedicine. The Lagos State Ministry of Health should lead this with its agencies, development partners, public and private health facilities, health tech firms, health maintenance organisations and other entities that provide healthcare. They can begin by tapping into the high mobile phone ownership by sending information material. This is a first step in building public trust while increasing awareness.
In 2020, Lagos state launched Eko Telemed for remote non-COVID-19 consultations. This telemedicine service under the Lagos State Health Scheme should be strengthened.
It’s clear that telemedicine would help Lagos state get closer to achieving health equity for Lagosians.
“Eko òní baje ooo” — “Lagos state will not be destroyed”.
