Nelson Mandela Medical School - University of KwaZulu-Natal

Establishment of a not-for-profit virtual hospital to service sub-Saharan Africa

Lead Organization

Nelson Mandela Medical School - University of KwaZulu-Natal

Durban, Province of KwaZulu-Natal, South Africa

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Project Summary

Africa has a disproportionate burden of disease and an extreme shortage of doctors. The Maropeng Virtual Hospital (MVH) will use the only realistic solution – proven e-consultation solutions (real-time or store and forward) to provide clinical support across all levels, from clinic to academic hospital. In a cooperative approach, MVH and invited countries will mutually determine specific needs, linking skills availability with country need. Importantly, over time, this will build local capacity through upgrading skills. Experience in Africa has shown that a “big bang” approach is needed, to provide the necessary critical mass for viability, and to fund the start-up gap. The service will emanate from the Nelson Mandela School of Medicine, South Africa, and housed within a University, will ensure governance and continuity, with management vested in a non-profit company, within the University, that will operate independently outside of academia, ensuring service delivery through high quality project management.

Problem Statement

Sub-Saharan Africa (SSA) is home to most of the world’s countries suffering from health workforce issues: severe shortages, inappropriate skill-mixes, and inequitable distribution. Contributing to these shortages is the ‘brain drain’ stimulated by low salaries, non-payment of salaries, significant stress, and extreme patient-healthcare provider ratios [1] . SSA must also contend with many other health-related adversities: a growing population (2.4 Billion by 2050)[2), 60% rural populations[3] , chronic ‘Western’ diseases[4], and deficient access to primary and specialist care. [5] [6] This setting is compounded by extreme poverty, leading to still further disease. Despite ‘improvements’ (poverty declined to 41% for those living on less than $1.90 a day in 2013 in Sub-Saharan Africa), this is countered by the region's population growth meaning in reality 389 million people, 113 million more than in 1990, lie below the international poverty line.[7] This also worsens the already poor tax bases [8] for the 27 SSA countries with poverty rates above 30 percent. In such resource-constrained environments, new technology must be used to ‘work smarter, not harder’ and assist in addressing the enormous need for medical care and treatment[9] [10]. Such technology - termed e-health or more specifically telemedicine - could improve the quality of rural healthcare by: increasing access to scarce specialists, reducing the need for transportation of patients to doctors, supporting rural doctors (second opinion; skills development), delivering education, and facilitating research. Judicious and well-planned use must be made of e-Health to achieve these goals and is the fundamental principle of the MVP.

Solution Overview

Establishing a Virtual Hospital will alleviate the burden of disease and shortage of doctors, otherwise unobtainable, managing and directing consultations through telemedicine, either interactively or using “store and forward” techniques. This service will be especially relevant for Primary Health clinics, where the need is greatest and because this is becoming the international norm for the entry point into the health system. The massive roll-out of Skype in the UK indicates that as much health service as possible should be pushed down the health delivery apex.The hospital will attract qualified people, some from lower-cost environments or with lower income needs (such as retired specialists), who will be prepared to offer their skills in a competitive environment, at a cost that is probably the lowest obtainable.Using cellular phone technology with an ever-increasing footprint, services will extend even to the most remote villages. There is exponential growth in diagnostic and other medical devices. The consultation will be paid for via a sophisticated accounting system, integrated with the patient electronic file record, with a database, open source software and IT infrastructure, for measurement of success. Although virtual, the physical base will be at the Nelson R Mandela Medical School in Durban, as an extension of the existing Telemedicine facility. This project will take head-on, at Government level, some of the major challenges in dealing with the implementation of e-Health, such as patient confidentiality, subject to the ethical and other disciplines associated with a teaching medical school, raising physician and community awareness

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