Evidence from low- and middle-income countries suggests that digital and mobile communication technology can improve management of diseases. It is also particularly useful in medical emergencies. It has the potential to increase access to healthcare where resources are scarce and systems are under stress.
One aspect of this technology is “mConsulting”: mobile phone consultation with healthcare providers. mConsulting has been found to improve management of chronic and non-chronic communicable diseases. Other research shows that it increases use of maternal and neonatal services and expands vaccination coverage among hard to reach communities.
We conducted a study to explore whether mConsulting has the potential to improve healthcare in Nigeria, where the use of mobile communication technology has expanded rapidly. We looked at what’s already available and how users and providers perceive this mode of healthcare consulting. We interviewed mobile consulting providers, policy makers, users of mobile health and other stakeholders. The study explored perceptions, availability and operations of mConsulting services in Nigeria.
We found that mConsulting is likely to improve accessibility to healthcare. But it was introduced into Nigeria without a policy and regulatory framework to assure quality.
Mobile health consulting in Nigeria
The concept of mConsulting is still relatively new. But various forms of healthcare delivery through electronic platforms have been gradually introduced into the Nigerian scene with labels such as eHealth, ehealth4everyone, digital health, telemedicine and others.
In Nigeria, there are 15 functional mConsulting services operated by groups of private doctors. There are different ways of using the services. These include web chats, text messages, specialised apps, video calls and audio calls. The services include drug prescriptions, patient referrals, patient follow-up and provision of information about hospitals.
Only a few of the mConsulting services in Nigeria do not charge fees. Charges range from as low as N147 ($4) to as high as N344,000 ($950).
Respondents in our study perceived mConsulting to have a number of benefits. Access to healthcare was one. This is not only about getting medical help at any time: it’s also about the availability of quality and specialist services and bringing emergency care within reach.
Some stakeholders said that health facilities and resources were overstretched. They believed that mConsulting could reduce the burden on health workers and increase the income pipeline of physicians. This could strengthen the healthcare system.
It could also reduce the costs of using medical services, such as transport to facilities and waiting time.
They said it could contribute to better health outcomes, with better diagnosis and management of conditions. It could also reduce exposure of patients to risks associated with hospital visits, such as infections.
Perceived risks and barriers
Despite the benefits of mConsulting, participants mentioned some barriers too.
Some expressed distrust about this approach to medical consultations. They believed that physical interaction between physicians and patients was the most credible and reliable way of assessing a person’s health.
Lack of technology infrastructure and the digital divide, especially in rural communities, was another barrier. Where the facilities for mConsulting were not available and affordable, only a limited segment of the population would have access.
The human resources capacity for mConsulting was another concern. Many service providers rely on doctors who split their time between regular and mobile consultations. With the shortage of doctors in the Nigerian health system, dividing the time of the hospital workforce with mConsulting engagement puts more pressure on existing human resources. Some service providers also opened their platforms to both local and international clients, making it difficult to supply the demand.
The danger of misdiagnosis was seen as a barrier to mConsulting. Important information could be missed and errors could be made. Also, clients could mislead mobile consultants by not divulging all the relevant information. Even when using mConsulting in emergency care or for first aid, there could be a danger of receiving the wrong advice.
Data security and privacy is a major problem in Nigeria. Some participants believed that online materials and platforms were susceptible to abuse.
There were variations in stakeholders’ awareness of policy and regulations governing mConsulting in Nigeria. There have been suggestions at the National Council of Health that states should introduce eHealth into their healthcare delivery framework. Yet, after more than a decade of deliberations about it, policies are yet to be formulated specifically to govern this sector of healthcare.
Policy gaps and the way forward
The participation of the private sector has made it an imperative to have clear-cut policies to protect the public as users of mobile consulting services. The entrepreneurs who invest in these services also need protection.
mConsulting policies must cover training, credentialing, quality control, maintenance of electronic infrastructure, remuneration and protection against fraud.
Training curricula for healthcare professionals, especially doctors, nurses and pharmacists, must incorporate digital literacy and interaction with patients at remote sites. In the interim, short term training programmes can be organised for those already in the workforce. The agencies that regulate different cadres of health professionals should have clauses in their codes of ethics about mConsulting and eHealth in general.
Adequate remuneration is vital to sustaining mConsulting services and protecting members of the public against fraud or price gouging.
An effective policy environment is key to ensuring that mConsulting expands equal access to healthcare. A vision for mConsulting and eHealth needs to be integrated with the framework of the Abuja Accord to drive the achievement of healthcare for all.