Abstract
Plans
calls for establishing The International Centers of Excellence for e-health
in Africa at
the Abia State University Teaching Hospital to promote National
e-Health/Telemedicine Policy in Nigeria and throughout Africa, in cooperation with
the World Health Organization (WHO) and Global University System in Nigeria
(GUS/Nigeria).
The
Global University System (GUS) [1] is a
worldwide initiative to create advanced telecommunications infrastructure for
access to educational resources across national and cultural boundaries. GUS is aimed at creating a worldwide
consortium of universities to provide the underdeveloped world with access to modern
education via broadband Internet technologies. Its ultimate goal is to achieve “education
and healthcare for all,” anywhere, anytime and at any pace, as a basis for
promoting global peace.
The
GUS works in the major regions of the globe in partnership with institutions of
higher education and healthcare delivery.
Learners in these regions will be able to take their courses from member
institutions around the world and receive a GUS degree. Both learners and professors from
partner institutions also form a global forum for the exchange of ideas and
information and for conducting collaborative research and development with
emerging global GRID computer network technology.
1. Background
International
trade and global information exchange have led to economic interdependence among
nations and cultures, which spawned a global system typically described as
globabilization. While highlighting international collaboration and
cooperation, this system also entails clashes of divergent cultures and belief
systems, both political and sectarian.
Indeed, we are witnessing increased violence and insecurity in various
parts of the world, despite a continuing hope for world peace and
security. Modern digital
telecommunications have been proposed as appropriate tools to face these
challenges, and to create mutual understanding between nations, cultures, and
ethnic and religious groups. The
Internet would serve as a medium for building world peace.
An
optimal new world order would be based on timely exchange of accurate and
reliable information, and such information would be shared through effective
and efficient networks. Hence, the future global agenda and global
competitiveness in this regard would be based on knowledge and innovation by
skilled human resources rather than the sole dependence on natural resources.
1.1 Critical
Concern in Nigeria:
The Federal Republic of Nigeria,
with an estimated population of about 160 million people represents the single
largest concentration of people of African descent. About 70 percent of this population live in rural areas
typically out of reach of primary healthcare delivery, and 43 percent of the
total populations are youths.
The
proponents of the International Centres for e-health in Nigeria and throughout
Africa are concerned that Nigeria – as several other African countries - has
yet to meet the World Health Organisation’s (WHO’s) recommended ratio of one
doctor to 1,000 people, after 44 years of independence. There are about 26,000 registered
doctors in Nigeria serving a population of 160 million. This is tantamount to a doctor-population
ratio of one to 6,000, a figure that is grossly inadequate by the WHO recommended
standard. The doctor shortage is
also matched by other shortages in human and physical resources and the basic
infrastructure that supports these services, thereby producing a situation of
substantial unmet health needs. Typically, rural residents have to queue at
clinics before they can see a doctor, and some simply forego seeing a doctor
altogether even when they have a serious problem that should be attended to.
The
problem of unmet need exists throughout Africa, with variations in severity
from country to country, and between urban and rural dwellers in the same country. For example, South Africa has an
overall doctor-population ratio of 1 to 650 in the Western Cape. But the ratio is 1 to 30,000 in the
Mount Frere Health District of the Eastern Cape. In Ghana, the ratio is 1 to 12,500. The majority of the countries in the
sub-Sahara Africa also do not meet the WHO’s recommended ratio of 1 to
1,000. Indeed, there are fewer
than 10 doctors for every 100,000 people in 24 of the 44 Sub-Saharan African
countries for which the statistics are available.
In
contrast, Cuba has a doctor population ratio of 1 to 165, South Korea 1 to 337,
the U.K. 1 to 610, the USA 1 to 358, and Italy 1 to 165 (UNDP/Human Development
Report, 2004). As one example of
the brain drain, there are more Senegalese physicians in Chicago than in Senegal!
In
addition to the doctor shortage, due to the AIDS pandemic, life expectancy at
birth in seven African countries has declined sharply in recent years. For example, it is 33.9 in Zimbabwe,
35.7 in Swaziland, 36.3 Lesotho, 32.7 in Zambia, 37.8 in Malawi, 39.8 in
Central African Republic, and 38.5 in Mozambique, etc. (UNDP Report, 2004).
2.
International Centres of Excellence for e-Health in Africa (ICEEHA)
Plans
call for establishing the International Centres of Excellence in e-Health
(ICEEHA) as a strategic asset for Nigeria/Africa’s development. This is based on the premise that
modern medicine and public health are essential components of modern society.
2.1 Concept
It is proposed
that the International Centers of Excellence for eHeatlh in Africa (ICEEHA) would be
established as a part of the Graduate School of the Abia
State University Teaching Hospital (ABSUTH) in Nigeria. The Centers will offer Post Graduate
and Master’s degrees in medicine, and will affiliate with similar institutions
in Nigeria. It will provide educational
opportunities for qualified and interested students from Nigeria, as well as
other countries in Africa and elsewhere.
ICEEHA will enter into
partnerships with educational and healthcare institutions, Information Technology
Providers and Non-Governmental Organizations, particularly interested in serving
isolated remote/rural communities and combating poverty and disease. The headquarters will be located in
Nigeria, and will collaborate with Digital Partners Nigeria (DPN) and
Global University System in Nigeria (GUS/Nigeria), an affiliate with Global
University System (GUS) [1] [2], at the University of Tampere in
Finland.
This
project will be implemented incrementally through workshops and conferences for
the mobilization and promotion of National e-Health/Telemedicine Policy in
Nigeria and throughout Africa, in cooperation with the World Health Organization
(WHO).
2.2
Objectives
Currently,
the central objectives of ICEEHA are as follows. Others may be added, as situations warrant:
- To develop a regional/national policy for
e-Healthcare/Telemedicine.
- To establish functional institutional framework for
e-Healthcare/Telemedicine as a primary source of healthcare to improve the
living condition of the people in rural areas who constitute a significant
majority of the Nigerian population.
- To build the necessary infrastructure and develop the human
resource requirements for e-health/telemedicine.
- To improve the clinical resources for remote diagnostic and
treatment.
- To develop a reliable medical database for use by doctors in a
confidential manner and thereby improve clinical effectiveness.
- To develop cost containment strategies for delivering healthcare to
the rural population.
- To provide healthcare security at critical times of national
emergency and disaster.
- To contribute to world peace through improving living standards and
health status.
2.3 Goals
The ultimate goal of ICEEHA and GUS/Nigeria is,
therefore, to enhance the socio-economic structure and the capabilities of the
healthcare system, thereby hopefully contributing to the promotion of world
peace.
ICEEHA
will mobilize and encourage hospitals and e-healthcare centres to use the Internet
to provide patients online second opinion for various infectious and chronic
diseases, including malaria, sickle cell anaemia, river blindness, HIV/AIDS,
polio, cancer, heart disease and other conditions. It will diminish the dependence on hospitals and unnecessary
travel to such facilities. A key
component is the program for the “Prevention of Mother-to-Child HIV/AIDS
Transmission.”
Doctors
will also be taught (through a train-the–trainers program) how to use
computers effectively to order tests and drugs, which has been shown in studies
to reduce medical errors and flag patient drug allergies. Nurses will also be taught to use
computers to track patients as they go through the primary healthcare centres
and hospitals.
Medical
records will be computerized, including lab results, drug data and records of
office visits in text files – which would be standardized in a format
that can be shared. The ICEEHA
will encourage government and donors to develop incentives to encourage doctors
to use the Internet.
It
has been estimated that medical errors account for about 2 million deaths in
Africa. A great majority of these deaths occur in rural areas, mostly among
children and women. Nelson Mandela
suggested that “giving life is NOT to die,” in referring to the fact that
almost 300,000 women die during child birth annually in Africa.
3.
Special Project: Prevention of Mother-to-Child HIV/AIDS
Transmission
3.1
About
ABSUTH
The
mandate of Abia State University Teaching Hospital (ABSUTH) is primarily
focused on providing and improving healthcare delivery for the entire
community. The HIV/AIDS scourge
now grossly challenges this mandate.
Telemedicine and e-health can serve as effective tools to address this
problem as well as the original mandate of improving healthcare in general.
3.2
Project
Issues & Concept
The long-term
goal is to establish the International Centers of Excellence for e-Health in
Africa (ICEEHA) as a part of the Graduate School of the Abia State
University Teaching Hospital in Nigeria. However, during the initial planning stage, it became
imperative to upgrade the HIV/AIDS Programme – “Prevention of Mother-to
Child Transmission” as a high priority.
This was informed by the pandemic and alarming incidence of the HIV/AIDS
in Nigeria – particularly, the mother-to-child transmission.
3.2.1
Aims and
Policy Thrust
The
project has the following objectives:
- To create accelerated awareness of HIV/AIDS, and help reduce the
infection rate of mother-to-child transmission.
- To apply e-health technology to promote HIV/AIDS education in rural
communities - using local languages.
- To reduce the stigmatization of HIV/AIDS patients
- To develop effective policies to assist HIV/AIDS patients.
- To advocate the fundamental rights of HIV/AIDS patients in having
access to affordable healthcare and treatment – using volunteers
from ABSUTH medical community.
- To establish a special HIV/AIDS Cadre (“Operation Village Health
Cadre”) to champion the sustainability of the project – using
e-health tools.
3.2.2
Graphic Analogy of the Project
Figure 1
3.2.3
Structure
When
fully established, ICEEHA will be a consortium with partnerships in education,
community-health stakeholders, healthcare institutions, ICT Solutions Providers
and Non Governmental Organizations, particularly benefiting those in
isolated remote/rural areas for the prevention of Mother-to-Child HIV/AIDS
Transmission, and the eradication of poverty and illiteracy.
3.2.4
Organisation
The
organisational framework will be designed to carry out the following function:
- Policy and Education: Having resolved to reduce the incidence of
the HIV/AIDS pandemic, the organisation will focus on the prevention of
Mother-to-Child Transmission by developing educational materials and organising
informational workshops. In
this regards, ABSUTH and partners will implement such policies with help
from World Health Organization (WHO) by building medical resource
capacities for community service.
Operation Village Health Cadre (OVHC) will also be established.
- Applying Research and Development techniques in combating the
spread of the disease.
- Promoting sex education in schools, market places, churches and
rural communities.
- Involving and collaborating with NGOs and other working groups
(globally and locally) to sustain the project.
3.2.5
Implementation
Plans
call for establishing a functional framework through international
collaboration. Roles will be
assigned to collaborating partners.
These roles include, among others:
- ABSUTH will be responsible for coordination and policy
implementation. In this regard,
a national workshop on “Mother-to-Child HIV/AIDS Transmission” will be
organised at the larger workshop for establishing ICEEHA.
- Funding the project: As a not-for-profit initiative, external
funding will be required from donors and collaborators to implement and
sustain the project.
- Capacity Building: ABSUTH has adequate facilities and knowledge
base for building human capacity for community healthcare delivery, which
ultimately acts as guarantor for sustainability by the OVHC.
3.2.6
Outcome --
Targets and Expected Benefits
Some
of the major expected outcomes of this initiative include the following:
- Increasing HIV/AIDS awareness at the national and local levels.
- Increasing the prevention quota in HIV/AIDS.
- Reducing the incidence of “Mother-to-Child HIV/AIDS Transmission.”
- Reducing the mortality rate among HIV/AIDS patients.
- Increasing access to HIV/AIDS treatment and healthcare through
adequate program funding.
Establish special program for HIV/AIDS orphans.
- Improving the relationship between HIV/AIDS affected patients,
their family and the community at large.
3.3
Plan of Action
The project is
designed to be gradually implemented in stages and in phases. The first phase of the HIV/AIDS
component – Prevention of Mother-to-Child Transmission - will start at
the workshop for creating ICEEHA and covering 25 villages in 6 regions of
Nigeria.
4.
Global University System in Nigeria (GUS/Nigeria)
Global University
System in Nigeria (GUS/Nigeria) is now being established at the Obafemi Awolowo
University (OAU), which will be a consortium in partnership with four other
frontline educational and healthcare Institutions:
[1]
University of Jos, Jos,
[2] Abia
State University, Aba,
[3] Federal
University of Technology, Owerri,
[4] Rivers
State University of Science & Technology, Port Harcourt.
The Obafemi
Awolowo University (OAU) will act as a Secretariat of GUS/Nigeria, which will
affiliate with GUS at the University of Tampere in Finland.
The
Global University System (GUS) is a worldwide initiative to establish broadband
Internet infrastructure for enhancing e-learning and e-healthcare across
national and cultural boundaries for global peace. (See its development history in the past three decades in
References [1] and [3]). The
GUS/Nigeria employs technological alternatives to promote access and use of the
available technology for e-learning in educational and e-healthcare in medical
fields.
Figure 2
As
diagrammed in Figure 2, the GUS/Nigeria consists of:
a)
NigeriaNet: A broadband Internet network that will enhance
interaction among higher education institutions. The network will connect these institutions among themselves
and with other communities in their vicinity, nationwide and internationally
with the GUS. The network, by
paving the way to communication, will ultimately enable life-long learning and
e-learning in higher education.
NigeriaNet will, by the same token, promote e-healthcare in hospitals,
healthcare centres and clinics.
GUS programs and services
will be delivered via regional satellite hubs, e.g., at the ICEEHA, that
connects via high-speed satellite to educational and healthcare resource cites
in developed countries, e.g., the U.S., E.U., etc. In a sense, the regional satellite hub is to be the major
Internet Service Provider (ISP) for not-for-profit organizations in the region
and the gateway to the outside world.
b)
Local Community Development Networks (LCDNs): Regional hubs will
link to other e-health and telemedicine centres of excellence and educational
institutions, hospitals, and NGOs via microwave or by spread-spectrum wireless
Internet networks. This advanced
wireless communication will make e-learning possible for anyone, anywhere, and
anytime with capabilities of Internet telephony, fax, voice mail, e-mail, Web
access, videoconferencing, etc.
Learners
at higher education institutions affiliated with GUS/Nigeria will be able to
take courses, via advanced broadband Internet, from member institutions around
the world, and receive a GUS degree.
Both the learning (students or lifelong learners) and teaching
(professors) at partner institutions will also form a global forum to exchange
ideas and information and to collaborate in research and development with the
emerging global GRID computer networking technology [3]
[4].
5.
Expected Benefits
5.1
Socio-Economic Benefits
The
project of deploying NigeriaNet and LCDNs of GUS/Nigeria is essentially a
program for community development.
First, it would connect non-profit organizations (higher and secondary
educational institutions, libraries, hospitals, local governmental agencies,
etc.), and, at a later stage, with profit-making organizations (investors in
these sectors), depending on the regulations of the federal government of
Nigeria. This would potentially
establish a global E-Rate.
Subsequently, all applicable groups in the cities of the affiliated
colleges and universities will be included. In the long run, this may attract domestic and international
investors particularly to the healthcare and educational sector. Then participants can share the cost of
an expensive digital satellite or terrestrial optical fibre trunk line. The use of broadband wireless Internet
for the LCDN will make their participation feasible, especially for the
so-called "last-mile" connectivity. This should promote digital literacy among the poor, and
also create job opportunities for university graduates.
5.2
Community Outreach
This
program would provide a range of courses, including short-term training leading
to non-degree certificates and diplomas, as well as regular degrees. Both Nigerian, African and
international students will be required to get involved in community
development services inside and/or outside Nigeria.
The
following organizations and projects may also benefit from the use of the
broadband wireless Internet of NigeriaNet and LCDN.
(a) Nigeria Medical Insurance Scheme.
(b) Nigeria Education Trust Fund.
(c) Operation Village Health project of
Harvard Medical School [5] has already been
successfully conducting with Sihanouk Hospital in Phnom Penh the use of
wireless and satellite Internet for e-healthcare/telemedicine in remote/rural
areas of northern Cambodia. ICEEHA
will leverage on similar experiences to approach global donors whose initiative
may benefit from the use of NigeriaNet and LCDN, together with Harvard Medical
School, which has already indicated their willingness to assist ICEEHA project,
in addition to the University of Michigan Health System.
(d) GUS is now assisting the World Health
Organization (WHO) [6] for the construction of national
e-healthcare policy with GUS/Nigeria with over 6 prominent universities in its
membership. The central aim is to
make Nigeria the African Hub for e-Health and Telemedicine. Similar programs are also in
progress in Ethiopia, Malawi, Kenya, Sierra Leone, Guinea, Liberia, Ivory
Coast, Mozambique, etc., and it is hoped that the GUS in those countries will
collaborate to actualize the ICEEHA mission.
6.
Financing
GUS
During
the Okinawa Summit in July 2000, the Japanese government pledged US$15 billion
to close the digital divide in developing countries and for the eradication of
poverty and isolation. During the
G8 Summit in Canada in June of 2002, and at the Environment Summit in South
Africa in September of 2002, they also pledged US$2 billion to aid education
and healthcare in developing countries, respectively. The Japanese government recently pledged to double their
funds, especially for African countries.
GUS
projects will combine (1) the Japanese government's Official Development
Assistance (ODA) funds and (2) Japanese electronic equipment with (a) the
Internet technology and (b) content development of North America and Europe.
After
successful conduct of the workshop for creating ICEEHA, we plan to apply for
the Japanese government’s ODA fund for further expansion of this program.
7.
Conclusions
It has been estimated that a record 4.8 million people
in Nigeria were infected with HIV/AIDS in 2003. Sub Saharan Africa is the worst affected region with 30
percent of the total number in the region. In parts of Southern Africa, entire village have been known
to disappear from the scourge of HIV/AIDS. This is a human catastrophe.
In Nigeria, the first cases of HIV/AIDS were
identified in mid 1980s and the prevalence rate rose steadily to a peak at 5.8
percent by 2002. The national prevalence
rate decreased in 2003 to 5.0 percent.
This means that 3.6 million Nigerians are still living with the virus. Sadly, out of the 300,000 patients who
qualify to receive the anti-retroviral drugs (ARV), only 20,000 Nigerians are
actually receiving them due to the very high cost of these drugs.
A dynamic
institutional framework is much needed.
It would build the critical mass of new professionals with commensurate
skills in modern medicine. It
would diminish the digital divide, and it would hopefully contribute to world
peace.
The ICEEHA Planning
Committee has already secured assurances from reliable partners for land
allocation and other facilities, which will become the central Headquarters for
the project. The next step is the
formal founding of ICEEHA.
REFERENCES
(All URL below were retrieved on July 12, 2005.)
[1] Utsumi, T., Varis, T., and Klemm, W. R.,
(2003), Creating Global University System,
Global Peace Through The Global University System,
University of Tampere Press, Tampere, Finland
http://makeashorterlink.com/?I2F231019
[2] Varis,
T., Utsumi, T., and Klemm, W. R., (Editors), (2003), Global
Peace Through The Global University System, University of Tampere Press,
Tampere, Finland, November, (ISBN 951-44-5695-5)
http://makeashorterlink.com/?M2D252E09
[3] Utsumi, T., (2003), Globally
Collaborative Environmental Peace Gaming, Global Peace Through The
Global University System, University of Tampere Press, Tampere, Finland
http://makeashorterlink.com/?E1D121E09
[4] Utsumi, T., (2005), Global University System with Globally Collaborative
Innovation Network, Paper to be presented at the World Summit on Information Society
(WSIS) in Tunis, Tunisia, November 14-18
http://makeashorterlink.com/?W155410BB