INVESTIGATION INTO APPLICATION OF TELEMEDICINE IN PROVISION HEALTHCARE SERVICE IN UNDESERVED AREAS

CHAPTER ONE

INTRODUCTION

Background of the study

In many African countries, healthcare systems are often under-resourced and struggle with inadequate infrastructure, a shortage of healthcare professionals, and limited access to essential medicines and medical technologies (World Health Organization, 2022). These deficits are particularly pronounced in rural and underserved areas, where geographical barriers further limit access to healthcare services. As a result, residents in these areas face higher rates of morbidity and mortality from preventable and treatable diseases such as malaria, tuberculosis, and HIV/AIDS (Africa Health Agenda International Conference, 2023).

Contextually, Nigeria, as Africa's most populous country, exemplifies these challenges. 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 (Eze & Onwujekwe, 2021). The World Bank (2021) highlights that in rural Nigeria, there are significant shortages of healthcare workers, and existing facilities are often inadequately equipped. Moreover, factors such as poor infrastructure, including bad roads and unreliable electricity supply, exacerbate the difficulty in delivering quality healthcare services to these regions (Aregbeshola & Khan, 2018). Many individuals in underserved areas cannot afford healthcare services due to high out-of-pocket costs, leading to a reliance on traditional medicine or foregoing medical treatment altogether (Adeloye et al., 2017). Additionally, public health initiatives often fail to reach these populations due to logistical challenges and limited funding.

In a bid to bridge the gap of healthcare access for undeserved areas, government across nations has leveraged on information commuication tools by infusing it in to healthcare provision now known as telemedicine. 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 rural Africa. 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 rural communities.

 Akinwumi (2021) highlighted thatthese initiatives utilize mobile phones, internet services, and other digital technologies to offer medical consultations, diagnoses, and treatment plans to patients in remote areas. This approach not only improves access to healthcare but also reduces the need for patients to travel long distances to urban centers for medical attention. According Adeolu (2023), 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 Problem

In recent times, The healthcare landscape in underserved areas is nothing to write about as it has been characterized by the disparity between urban and rural healthcare services is stark, with rural areas suffering from severe resource constraints and limited healthcare facilities (World Bank, 2021).These challenges contribute to poor health outcomes and increased morbidity and mortality rates from preventable and treatable conditions (Africa Health Agenda International Conference, 2023). 

In response to these issues, telemedicine has emerged as a potential solution to bridge the healthcare access gap.In a study by Benedict & Alexandra (2021) Information and Communications Technology (ICT) has emerged as a significant catalyst for the development of many nations across various sectors and especially useful for Nigeria, where there is a notable shortage of healthcare professionals relative to its over 150 million population. Orimoko (2022)  pointed that the inequitable distribution of health workers has been a significant hindrance to developing the Nigerian health sector over the years with approximately 35,000 doctors but needs 237,000, which indicate a ratio of about 1 physician to 5,500 patients in a population of over 200 million people hence, telemedicine depicts "healing at a distance. Where health personeel utilizes digital devices such as mobile phones and computers to facilitate remote access to healthcare services, enabling patients to consult with doctors via video and voice calls. 

Conversely, Adebayo & Adedoyin (2020) observed that although telemedicine in urban Nigeria has shown promising results in managing chronic diseases, providing maternal and child health services, and offering specialist consultations  and ensuring continuity of care and timely medical interventions. However the potential of telemedicine to improve healthcare delivery in underserved regions remains underexplored and underutilized especially since the area is challenged with poor internet and power supply.  More so, Anayochi and Ifunnaya (2023) mentioned that telemedicine is scanty in some rural areas and hence the level of its effectiveness is understudied. Therfore investigating the application of telemedicine in these areas is crucial to understand its effectiveness, the challenges faced in its implementation, and the potential benefits it could bring to the healthcare system. Upon this premise, this research seeks to address application and integration of telemedicine in the provision of healthcare services in underserved areas of Nigeria. 

1.3 Objectives of the Study

The objectives of this study is focused on investigation into application of telemedicine in provision healthcare service in undeserved areas with reference to Ekiti West Local Government Areat in  Ekiti State. Specifically, the study seeks:

To evaluate the extent to which telemedicine services are currently being utilized in underserved regions of Nigeria. 

To identify the types of telemedicine technologies in use in underserved regions of Nigeria. 

To explore the various challenges hindering the widespread adoption and implementation of telemedicine in underserved areas. 

1.4 Research Questions

I What is the extent to which telemedicine services are currently being utilized in underserved regions of Nigeria?

ii. What is the types of telemedicine technologies in use in underserved regions of Nigeria?

Iii What are the various challenges hindering the widespread adoption and implementation of telemedicine in underserved areas?

1.5 Research hypotheses

Ho: The level of application of telemedicine in provision healthcare service in undeserved areas is low.

Hi: : The level of application of telemedicine in provision healthcare service in undeserved areas 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 in low-resource settings. It enriches the existing body of literature by offering empirical evidence on the impact of telemedicine on healthcare outcomes and service delivery in rural Nigeria, thus informing future research and theoretical frameworks on digital health interventions and their applicability in similar contexts globally.

1.7 Scope of the Study

The study will focus on nto application of telemedicine in provision healthcare service in undeserved areas in Nigeria. IN content,  the  will provide comprehensive understanding of telemedicine  utilization,  technologies in use for acessing telemedicine. It aims to assess the accessibility of telemedicine services to rural populations  identifying factors that influence their utilization. Additionally, the study seeks to examine how telemedicine affects healthcare delivery and patient outcomes in rural Nigeria, contributing valuable insights into the practical implications and effectiveness of telemedicine interventions in improving healthcare access and outcomes in underserved rural areas. Geographically, the study will draw its repondent from to Ekiti West Local Government Areat in  Ekiti State.

1.8 Limitations of the study

Several limitations could affect the findings and generalizability of this study on telemedicine in rural communities in Ekiti West Local Government Areat in  Ekiti State.e, Nigeria. 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.

Rural Area: A rural area refers to a geographic region that is typically characterized by a low population density and is located outside urban centers or cities. Rural areas often have agricultural or natural landscapes, limited infrastructure compared to urban areas, and may face challenges in accessing essential services such as healthcare, education, and transportation.

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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