The infrastructure bottleneck could be overcome more quickly if investments were supported by proactive and publicly subsidized policies. Considering the level of Internet usage and the quality of connectivity, it will take several years before virtual outreach services are implemented in remote areas. Liberalization of the African market, together with partnerships between the public and private sectors, has the potential to improve the situation. These data, coupled with those on the availability of the health workforce, indicate that both sub-Saharan Africa and South Asia are regions where ICT growth will be the greatest in the coming years, as these regions are not yet engaged in virtual activities. South Asia usage also remains at a low level, but the higher annual growth rate demonstrates a better penetration of ICT (see Table 5).
Sub-Saharan Africa has the lowest rate of Internet usage in the world. For this reason, a francophone telemedicine network in Africa (RAFT) 12 is funding the initial two years of Internet subscription for each country coordination team so that they can engage in continuing education activities for doctors in remote areas (see Annex 4).
The weak purchasing power of populations implies a much lower return on investment than in more developed regions. In sub-Saharan Africa, equivalent access costs US$ 55 on average, which is higher than the nominal gross national income per capita in 26 countries of the region.Īs regards the challenge of weak infrastructure, without public subsidies international telecommunication companies have no incentive to invest in equipment. In the United States, the cheapest monthly tariff for 20 hours of Internet use (50% peak time and 50% off-peak) is US$ 15. These elements explain why the cost of Internet connectivity in Africa is the highest in the world – some US$ 250–300 per month, according to the World Bank ( 33). In addition, due to poor infrastructure, 70% of Africa's Internet traffic needs to be routed outside Africa. In 2003, 60% of local and international call services in Africa were monopolies and 10% of African countries still allowed monopolies for VSAT, 11 the Internet and mobile telephones. Telecommunications are not fully deregulated in Africa ( 32). Nevertheless, there are still several issues to contend with, in particular the cost of telecommunications and the level of infrastructure. The Internet, satellite communication and mobile telephones can overcome geographical and socioeconomic divides. ICT offers fast communication and virtual tools that support both the strengthening of HRH and the provision of services to populations living in remote or rural areas. Information and communication technology support The three discs represent the different modalities:Ĥ.2.1. The Rwanda case study ( Annex 2) is a good example of a hospital-based strategy supported by the Government at local and national level.įigure 1 illustrates the large set of programmes that can be put in place to involve health workers in underserved areas. The rationale for the intervention is linked to a medical technique that brings rapid results at low cost. cataract surgery supported by nongovernmental organizations dedicated to eye health. Specific projects are often described, linked to a specialty or a pathology and promoted by those involved in treating the condition, e.g. Modalities of intervention vary because outreach services cover a large scope of activities. Quantitative health outcomes are usually positive, because people living in remote areas would not have benefited from the health care they needed without outreach services. numbers of patients who received surgery) are not always relevant on a national scale. mobile clinics in Brazil provided surgery services to Indigenous people for eight days, several times a year (see Annex 1).įor this reason, quantitative data (e.g. Very often, the services are localized and are for a fixed period, e.g. In fact, this study contains few initiatives on a national scale. Most of the above strategies are small-scale. As mentioned above, stakeholders vary and strategies also differ according to the country its health needs and priorities and the level of health service supply in the area. The case-studies illustrate two types of physical strategies: facility-based models and mobile strategies. Summary of case-studies: physical outreach services.
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