Sub-Saharan Africa
Frequently Asked Questions
(South Africa, Cameroon, Zambia, Tanzania)
Cameroon: No specific regulations.
Zambia: legal regulations in tertiary hospitals.
South Africa: Some recommendations from indemnity insurers like MPS and the Health Professions Council recently.
The state sector for now does not have any legal recommendations for telemedicine in South Africa.
Tanzania: there are no widely accessible
Ethiopia: the Hospital/College ICT department oversees the Telemedicine service in the hospital/college
Ghana: no specific regulations
Nigeria: no specific regulations
Cameroon, Zambia: no reimbursement
South Africa: Private sector: There are codes for telephone consultations that are reimbursed by Medical insurance companies according to their own rules. There are no codes for other forms of telemedicine consultations
Tanzania: no reimbursement
Ethiopia: can use the ICT department computers for free, but the user will pay the controlling personnel...for their time they spend out of their working hours.
Nigeria: Individual private practiioners may charge fees per consultation. There are no rules or recommendations regarding institutional preferences for time split between physical and virtual visits.
Cameroon, Zambia, South Africa: Phone calls, e mails, Skype, or WhatsApp, other teleconferences, Zoom
Tanzania: WhatsApp, text messages
Ghana: WhatsApp.
Nigeria: Phone calls, text messages (sms or WhatsApp), and video conferences, video chat for selected tech savvy patients.
Zambia, Cameroon: Lack of training how to conduct telemedicine, lack of motivation of doctors
South Africa: Consent and identification of patients. I used this mostly in patients who I know for long periods and only for basic follow up, discussion of medication, basic DBS adjustments with patient controller at home
Lack of access of patients and students to adequate internet (bandwith, data cost, hardware). Privacy concerns
Tanzania: Patient confidentiality, availability of internet in remote areas and phones with WhatsApp. There is also lack of training and availability of materials for video conferencing.
Ethiopia: ALL, except patient rejection, we don't have a problem with patients as long as they are consented in advance
Ghana: Quality of internet access, privacy/confidentiality, time constraints.
Nigeria: Technology limitations. Many hospital including government-owned hospitals do not have electronic medical records and private hospitals with secure electronic medical records have not enabled a virtual-visit function. Direct to patient from physician through phone video calls, WhatsApp video calls are limited by the cost of data required for the visit (average of 15 – 20mins for a follow-up)
Lack of EMR-enabled prescriptions (while some pharmacies will sell medications without a prescription, others won’t. Also few pharmacies offer delivery option)
Lack of institutional infrastructure to support telemedicine
Lack of telemedicine protocol and internet-connectivity to sustain this from the hospital end.
From the patient perspective, technological availability limited (smart phones, tablets), where available sometimes patient not tech savvy, cost of data prohibitive for many, and sometimes bandwidth in some areas cannot support a video call or WhatsApp call
Cameroon, Tanzania, Zambia: Lectures using Zoom, Skype, whatsapp, text message.
South Africa: Many neurologists here currently use telephone or video/phone (Zoom, Skype), emails to do follow up consults until they can reschedule appointments..Since the restrictions guidelines on ethics and medicolegal issues have become available
Ethiopia: At our department we are currently using ZOOM based teaching, for weekly seminars and case discussion
Ghana: More WhatsApp after the in-office visits have been reduced.
Nigeria: Some government-owned hospitals – all clinics (including the neurology and movement disorders clinics) have dedicated phone numbers posted on the hospital website so registered patients can contact their physicians
State – Lagos state has just this week launched a remote visit service for residents via voice or video call 24/7 using a toll-free line in English and 3 major local languages (for primary care consultations)
State – private hospitals also enabling paid access through various platforms (Zoom, WhatsApp, Telephone and other video conferencing apps)