Are conditions in Tanzania conducive for EMR and Telehealth implementation?
Access to services
Success in Tanzania’s eHealth and Telemedicine implementation will, to a large extent, depend on a good and well functioning telecommunication infrastructure. 52 million people live in Tanzania. As of early 2018, there were 23 million regular internet users in Tanzania. This is over 40% of the population. When you consider that the population is relatively young, 22 million represents a substantial majority of the adult population. The growth is remarkable when you consider that five years earlier the number of regular users was estimated at just over half a million.
The telecom backbone: Tanzania's NICTBB
Tanzania has implemented an ICT strategy which has significantly narrowed the urban-rural digital divide. The National fibreoptic cable network is officially known as the National ICT Broadband Backbone (NICTBB). Phase I and II were completed and operational as of 2012. Phase I was delivered in June 2010 and Phase II followed in June 2012. The two phases together delivered 7,560 km of optic fibre. The consequence was reduced bandwidth transport charges by a whopping 99.2%. The initial part of Phase III was completed in 2016
At its inauguration, the government stated that it considered NICTBB as an important strategic vehicle intended to provide the entire population of the country with reliable, efficient, and cost-effective accessibility and connectivity to ICT-infrastructures, facilities, and services. This was for the purpose of enhanced socio-economic development as well as creating a knowledge-based society. Higher quality healthcare provision certainly falls in the enhanced socio-economic development category.
Tanzania’s strategy was also to position itself as a regional ICT hub. As such, phase one backbone construction included extension to the eight border points. With that, the NICTBB has facilitated cross-border connectivity for mostly landlocked neighbouring countries namely Rwanda, Burundi, Malawi, Kenya, Uganda and Zambia to the EASSy & SEACOM undersea cables.
Broadband connectivity potential in Tanzania
In Tanzania, the core infrastructure is in place with all 169 districts in the country connected to the broadband network. The challenge now is to cover the so-called ‘last mile’. Realistically, that would remain a long-term ambition. The vast majority of individual broadband services clients use mobile. TTCL is the main fixed-line broadband service provider and manages the backbone. The service is mainly used by banks (for ATMs), government agencies, public institutions, and international organisations. Healthcare providers, both public and independent, have already or are well set to take advantage of this. As of 2016, only 74 (out of 150) district hospitals had acquired broadband connectivity. It is a start, but the pace clearly needs accelerating.
Whilst it is the case that all telecom service providers (including TTCL) utilise the backbone capacity supplied on equal terms, opening to and aggressively incentivising telecom providers to establish last-mile services will be required if the benefits of the huge and commendable investment in the core broadband infrastructure (NICTBB) are to be fully realised.
Success in Tanzania's eHealth and Telemedicine Implementation: Rural Service Users
Success of any grand social project, and this is one such project, is measured on how and to what extent it reaches the majority of the intended beneficiaries.
70% of Tanzanians live in rural areas. Rural broadband connectivity is an integral part of Phase IV of the strategy. The government is working in partnership with Viettel Tanzania (Halotel), a Vietnamese state-owned investment firm to implement this. A total of 18,000 km of fibreoptic cable at a cost of almost 1 billion US dollars have been laid already, covering most of the country.
However, Tanzania’s eHealth and Telemedicine implementation success should not be taken as a given. Lessons from countries with similar conditions and challenges need to be heeded. In neighbouring Uganda, also a part of the East African community, a study of the numerous such schemes there revealed that meticulous prior planning is absolutely essential. This may seem like an obvious thing but it is not always done with the diligence it deserves. A telemedicine services pilot project was concluded in Tanzania at the end of 2017 and this showed great promise in a country with a severe shortage of specialists. That meticulous and detailed planning which should include ensuring friction-less access to patient’s medical records is the missing piece of the puzzle
Mobile Phone Penetration in Tanzania
Success in Tanzania’s eHealth and Telemedicine implementation, like elsewhere, does indeed depend on the telecommunication infrastructure. However, in the short to medium term at least, mobile telephony appears to be the platform that will drive this implementation forward.
By 2014, mobile penetration had already outstripped fixed line subscription to the tune of 10 to 1. The ratio is a lot higher now as subscription to mobile telecom services continues to grow apace. There is keen competition among the numerous service providers and this has helped lower costs to users in Tanzania. As of February 2018, there were over 40 million mobile telephony subscribers in the country. This would suggest that the vast majority of adults in this country of 52 million have (or have access to) a mobile phone. The availability of affordable smartphones is also steadily increasing and many people are replacing feature phones with smartphones, especially in urban areas. The fact that 82% of subscribers go online via phones is a strong indicator of a surge in the uptake of smartphones.
Over recent years, Tanzania has performed well in the Telecommunication Regulatory Environment (TRE) assessment. In 2012, it had the third best (most favourable) score among peers, coming only behind Rwanda and Namibia.
All these developments augur well for Tanzania’s eHealth and Telemedicine implementation with AfyaRepo being an integral part of that solution.