Technology has improved healthcare delivery and patients’ access to timely and quality services over the years as healthcare providers transitioned from paper-based documentation of patients’ records to storing records electronically. However, patients and healthcare providers in Nigeria still grapple with paper-based medical records, which make access to medical records difficult and compound the challenge of seeking care in a country with an acute manpower shortage. SODIQ OJUROUNGBE writes on how these antiquated practices affect healthcare delivery and compound plights of patients
It is a hot, humid morning in Abeokuta, Ogun State. In a small, crowded room at the Federal Medical Center, Bolanle Adegoke was waiting to see a doctor.
She has been waiting for hours for her paper medical record to be retrieved by the medical officers who are overwhelmed with work amid brain drain and lack of facilities. She was eager to see her doctor which will still be decided by the paper medical record also known as folder.
Looking at the number of patients in the queue before and wondering when it would get to her turn to see the doctor, Adegoke wished she was never sick.
Adding to her frustration is the failure of the country’s health system to embrace telemedicine which makes access to healthcare seamless and timely.
Telemedicine is a term that covers the use of technology to deliver clinical care at a distance. It ensures that a person receives healthcare when needed, especially for those with limited access to care.
Though her folder is not missing, paper medical records often cause delays in providing timely care to patients.
Without access to her record, it would be difficult for her to get the care she needs as the doctor would require the folder before administering care.
Endless delay
As she sits there, restless and anxious, she wonders if there could be a better and easier way of seeing her physician without travelling far or seeing one-on-one and without waiting for long hours.
According to her, all the hours she spent travelling to see her doctor and waiting endlessly for her folder were unnecessary and could have been averted simply with technology.
Both resources and time, she said would be saved if technology is effectively deployed in information management of patients’ medical records.
Adegoke told our correspondent during her last visit to FMC that she is becoming exhausted looking at the risk and financial realities in the country.
She said, “You know fuel price has increased which has made travelling more costly than it used to be. I spent double the amount I used to spend to come to this FMC every three months for a doctor’s consultation.
“If there is any other way someone can access some of these records online, it makes it easier to see doctors without having to wait for several hours.
“With the way technology is taking over the world, I believe there should be a way I can still access such health care without having to go through this old way.”
Adegoke’s story is not unique. At the FMC and many other medical centres across Nigeria, patients face long wait times and limited access to care. In many cases, patients have to travel long distances to get to medical centres. This can be very expensive, especially for those who live in rural areas.
The lack of telemedicine centres and the difficulty of accessing health records online are just some of the barriers that people like Adegoke face.
But these challenges are not limited to rural areas, people in cities like Abeokuta, the Ogun State capital also face difficulty accessing healthcare.
In many cases, the barriers to healthcare access are even greater for people with low incomes, for those who speak a language other than English, and for those who have other challenges that make it difficult to get the care they need.
For some people, the challenge of getting to medical centres is more than just a financial burden. It can also be a major source of anxiety and stress.
Patients may worry about missing work, finding child care, and arranging transportation. This can take a toll on people’s mental health, which can affect their overall health.
This lack of access to patient records has far-reaching implications for the quality of care, the efficiency of the healthcare system, and ultimately, the health and well-being of patients.
These challenges are preventing patients like Adegoke from getting the care they need and keeping providers from using the most effective and efficient methods to deliver care. This can lead to delays in diagnosis and treatment, as well as costly and unnecessary duplication of tests and procedures.
But there is a solution on the horizon. Telemedicine, the use of technology to deliver medical care, has the potential to revolutionize healthcare in Nigeria.
Doctors express concerns
Some healthcare professionals who spoke with PUNCH Healthwise lamented that they are being held back by the lack of access to health records digitally.
A doctor at FMC, Abeokuta, who spoke on condition of anonymity, said, “It is frustrating to know that we have the technology to provide better care, but we can’t use it because of these barriers. I just want to be able to give my patients the best possible care, and right now I am not able to do that.”
This sentiment was echoed by other healthcare professionals, who said that the lack of access to health records is a major source of stress and frustration.
The consequences of the lack of access to health records go beyond the individual patient level. The inability to share data between providers also has a significant impact on the efficiency and effectiveness of the healthcare system as a whole.
For example, it can lead to duplication of tests and procedures, which not only wastes time and resources but can also cause unnecessary distress for patients.
Another doctor identified as Lanre Ogundapo maintained, “I have seen patients who have had to undergo multiple tests because their previous test results were not available to the doctor who was seeing them. This not only causes additional stress for the patient but also wastes valuable time and resources.”
Health workers are also concerned about the impact of the lack of access to health records on patient safety.
In some cases, the inability to share information can lead to critical information being overlooked, which can have serious consequences for the patient.
Leveraging digital health services
Telemedicine in global health has been considered ideal by health stakeholders, including the World Bank and World Health Organisation.
WHO maintained that telemedicine can reduce the impacts of limited healthcare workers and long hours spent on routine health cases in clinics, which promotes efficiency and reduces stress on healthcare workers.
The global health organisation stressed that the innovation ensures scheduling flexibility, speed, timeliness, and easy delivery of health services through mobile applications and other technological devices shared by clinicians and patients, limiting regular physical contact that could otherwise increase health risks.
A report by the United Nations Development Programme estimates that by leveraging telemedicine, 186 million people across sub-Saharan Africa could get affordable health insurance.
According to the report, this constitutes almost half of the people without access to health care in the region.
The UNDP Insurance and Risk Finance report noted, “Leveraging telemedicine in sub-Saharan Africa is not a small thing. It can be a game-changer. Health is a driver and outcome of development and critical to getting back on track to achieving the Sustainable Development Goals. This is a moonshot that is almost certainly worth investigating further.”
Telemedicine has the potential to reduce the cost of healthcare by as much as 40 per cent in Nigeria, according to estimates from the World Bank. This is because it eliminates the need for travel and eliminates the need for costly hospital stays. Telemedicine can also reduce the need for unnecessary tests and procedures, saving both time and money.
A study found that telemedicine could create over $5 billion in economic benefits for Nigeria by 2030. This includes savings on healthcare costs, improvements in productivity, and reductions in the cost of absenteeism from work.
Telemedicine could also create new jobs, as the country needs more people to work in this field. And it could attract investment from abroad, as foreign companies look to tap into the growing telemedicine market in Nigeria.
Establishing a telemedicine centre in Abeokuta
An investigation by one of our correspondents discovered that N222.22m was given to Ogun Central Senatorial District to build a telemedicine conference centre at Idi-Aba, Abeokuta South Local Government Area.Related News
The project, which was facilitated by Lanre Tejuosho, is a multiple telemedical and multipurpose conference centre, expected to include the equipping of six telemedical apartments for a 24-hour virtual health desk with a state-of-the-art monitoring device.
Tejuosho was a former senator representing Ogun Central between 2015 and 2019.
The Medical Director of the institution, Prof. Adewale Musa- Olomu in a chat with newsmen after the completion of the building said arrangements were in top gear for the commencement of ‘telemedicine’ at the hospital.
As part of the preparations, the Medical Director claimed the centre was already partnering with some international health institutions in European Countries, including the Royal College of Edinburgh.
He said the initiative will provide opportunities for the health care practitioners in the Centre to exchange professional ideas on patient care across the globe.
Over N200m telemedicine turned into event centres, offices
When many residents of Ogun State heard about the new telemedicine centre opening in the state capital, they felt a surge of hope. After all, this was supposed to be a revolutionary development that would finally give them access to their health records and improved medical care. But for Adegoke and many others, that hope quickly faded.
Investigation showed that the telemedicine centre, which was built with much fanfare, remained largely unused.
Despite all the purported arrangements, the hospital claimed to be making for the use of the over two hundred million telemedicine centre, new findings by PUNCH Healthwise revealed that the building has been turned into an event centre, and some parts of it are used as offices.
On different occasions that our correspondent visited the hospital, it was observed that the large, modern building is now being used as an event centre, with regular weddings, funeral parties, and other events held inside.
At the same time, a number of the offices in the centre have been converted to official use by the workers at the hospital.
Further Investigations showed that the telemedicine conference centre reportedly broke down 24 hours after it was inaugurated in 2020.
A reliable source said the centre which gave access to physicians from any part of the world was opened for use but broke down the day after its inauguration. It was learnt that some gadgets were not functioning at the centre.
The source added, “This place has not been working, there was never a day they used it for its purpose. People only rent the place for their parties.
“Everything stopped working the second day after the inauguration and nothing has been done to resuscitate it.
“They have converted some of the places to offices. The medical director has relocated from his former office to this place and nothing is being done to make sure the building is useful to the people.”
When contacted for comment, the Public Relations Officer of the FMC, Abeokuta, Segun Orisajo lauded the project.
According to him, the centre affords people the opportunity to seek medical attention via technology, which is well-installed in the telemedicine conference hall.
He said, “You can communicate with physicians, a diagnosis can be made, and a necessary prescription can be made also.
“It saves time and it saves cost. Anywhere you are in the country, you can access a healthcare facility. That’s the joy of it, the beauty of it.”
While confirming the state of the centre, Orisajo said, “Apart from a few things, there are hiccups along the line, but the donor and the management are trying to surmount them.
“It has once been in operation, but I think there are certain facilities and gadgets that are still being expected that would make it more functional, than the present state of it.”
Hospital struggles with staff shortage
The Association of Resident Doctors at Federal Medical Centre, Abeokuta, Ogun State, has called for urgent action to address the serious shortage of medical staff at the institution.
The association urged the federal government to provide additional resources and support to the institution, to improve the quality of care and reduce the burden on staff.
He lamented that the shortage of staff has been a longstanding issue at the hospital, adding that it is leading to increased waiting times for patients, reduced access to care, and longer stays in the hospital.
The ARD president also raised concerns about the physical and mental health of the staff who are working long hours to provide care to patients.
He said, “All over the country, the situation is very bad. FMC Abeokuta is not just having this situation in isolation. So, if you search through almost all the hospitals in Nigeria, you will discover that the number of doctors that we have is not adequate to carry out the daily routine and daily service for humanity and for the health of all the patients who visit FMC Abeokuta.
“FMC Abeokuta also needs doctors and presently, we are short of staff, we are using this opportunity to call on relevant stakeholders to also look in the direction of FMC Abeokuta so that more doctors can come to the centre and we can render adequate service in terms of health to every citizen and every Ogun state indigene.
“One of the things that can be done to curb the incessant exodus of doctors out of the country is to ensure that the welfare of doctors is looked into.
“When the government ensures that the welfare of doctors is given top priority, I believe that things will change for the better.”
How telemedicine can be optimised
Digital experts have stressed that telemedicine can be an essential innovation to cater to the shortage of doctors that is currently being experienced at the hospital.
While noting that telemedicine can play a major role in providing health access to many, especially within rural communities, the digital experts said several factors are responsible for the low adoption of telemedicine in the country.
The Chief Executive Officer of a digital health platform, Uthman Sanni said telemedicine will significantly lower healthcare costs while also enhancing quick access to care if Nigerians adopt it.
He added, “Telemedicine will reduce the cost of hospitalization, minimize patients’ patronage of quacks, reduce long-distance travel to access good healthcare, long queues at healthcare facilities, and make healthcare attractive to people.
“To address the challenges facing the telemedicine centre, several things needed to be tackled. These include improving the infrastructure, such as upgrading the internet connectivity and providing reliable electricity. Additionally, there is a need to train and deploy more skilled personnel to operate and maintain the centre.
“Finally, there is a need for better coordination between different government departments to ensure that the centre is properly funded and supported.
“Improving access to digital public infrastructure is not just important for communities like this one. It is part of a larger effort to close the digital divide and improve the quality of life for all citizens. It is also an important step towards achieving the government’s goals of economic development and poverty reduction.
Similarly, the founder of Cyberwarrior, Igbagboyemi Oladele said the hospital must incorporate telemedicine into its workflow and offer thorough training to both staff and patients.
He added, “To fully reap the benefits of telemedicine, it is crucial to provide comprehensive education to both staff and patients. Clinicians, doctors, and other medical care providers should all be trained on telehealth software — its functionality, integration into their workflow, effective communication during consultations, and where to seek technical assistance. They should also be equipped to address patient concerns about virtual visits.
“Telemedicine has the potential to greatly impact and improve access to healthcare delivery in Nigeria, especially in rural areas. First of all, a physician who lives in the city will most likely not want to travel to the middle of nowhere to work.
“Every country in the world has some form of difficulty in getting healthcare access and delivery to rural areas.
“To develop this aspect of medical care, the government can work with medical companies and non-governmental organisations to establish the necessary infrastructure and technology. By doing so, healthcare providers can remotely access their patients.
“To me, telemedicine is a plus for every country in all situations. It improves healthcare outcomes and also reduces healthcare costs. For a person who is not technology literate, a virtual messaging system or a text message service could be deployed to enable them to reach the services of a medical practitioner.”
