One of the most critical issues in rural health around the world has been the
lack of access of rural communities to the same level of health services enjoyed
by urban communities. This lack of access has been created by a number of factors,
including lack of health workers prepared to work in these areas, distance from
the location of health services and a lack of adequate resources. The problem
is further compounded for those health workers who choose to work in rural and
remote communities by the lack of access to education, training and ongoing
support for their roles, including adequate peer support. The end result of
this often is higher turnover of staff.
The convergence of information and communication technologies has created the
technical environment where there are rapid developments in interactive technologies.
These technologies combine the high-speed communications made possible by digital
technology with very sophisticated computer based programs and applications.
The interactive applications developing have high levels of functionality, at
increasingly more affordable prices. However, the access to reliable and adequate
telecommunications services, particularly the telephone network, in most rural
areas of the globe is limited and must be upgraded. The first step is to provide
telecommunications services that will enable voice, fax and data communications
adequate for Internet access. The next step is upgrading of telecommunications
services to digital standards; and, thirdly, in the longer term to broadband
services as they become available and affordable. It is recognised that for
many rural communities it will not be economic to provide services beyond basic
telephony. The impact of these developments remains uncertain, and the costs
may still be too great for many developing countries. Nevertheless, the potential
for these technological developments to enable the delivery of cost effective
telehealth services must be acknowledged in any planning and implementation
process for introducing telehealth to rural areas.
It is important to implement a level of technology that is appropriate to the
short term and long term goals of a region. In choosing the level of technology
for a particular rural community, in terms of usefulness and return on investment
there is a hierarchy of specifications and needs for telecommunications methods
for planners and systems designers to consider. These are:
1. Voice - single point, half duplex
2. Voice - single-point, full duplex
3. Voice - multi-point
4. Analog data exchange - fax, email
5. Digital data exchange - including digitised images e.g. X-rays
6. Real-time video conferencing - high bandwidth, multi-point
The opportunity exists now for information and telecommunication technologies
to have a significant impact on the health of rural communities. It is the particular
application of these technologies to health - telehealth - that offers the potential
to lower the barriers of distance, cost, poor distribution of services and lack
of support for health workers that at present restrict the access of rural communities
to the level of health services enjoyed by most urban communities. However,
whilst telehealth has been promoted as a technology that has the potential
to deliver, or improve the delivery of, health services to rural areas there
has been no significant quantitative evidence to date to support this assertion.
In particular, there is no evidence to support any significant cost-benefit
from introducing telehealth into rural areas. This lack of evidence suggests
that any funders planning to introduce telehealth services to rural areas should
carefully assess the impact of telehealth on funding for both existing services
and any future services.
Specific issues that need to be addressed include:
* the lack of awareness and training in the use and application of the relevant
technologies for telehealth by many rural health workers;
* further research and evaluation projects need to be undertaken to determine
the potential of the emerging technologies for telehealth;
* the legal and regulatory issues that may act as barriers to the effective
implementation of telehealth need to be resolved;
* the present telecommunications infrastructure and services for most rural
areas are unreliable and inadequate for systematic and effective application
to telehealth;
* the development of information and communication technology policies and initiatives
for health are often staggered and fragmented and could benefit from strategic
alliances across health sectors with other government, education and private
sectors on a local and global scale.
Surveys of rural health workers suggest that as a group they are early adopters
of technology. This attitude will be significant factor that will influence
the introduction of telehealth services into rural communities.