The intent of this research is to better understand the processes of technology transfer and adoption for e-medicine in developing countries. The importance and impact of these medical-support-at-a-distance technologies are well documented; what is not well understood is how these are adapted to fit national policies, available infrastructure, regional practices, and local culture. This project will longitudinally track e-medicine initiatives in Sub-Saharan Africa, specifically in Ethiopia and Rwanda. The resulting technology transfer models should inform e-medicine efforts in general.
Telemedicine initiatives have revolutionized medical care for people who live in remote communities traditionally underserved by health services. By allowing medical staff to interact with patients via videoconferencing, collect samples, run tests, and exchange data remotely, they are able to provide a more timely, high-quality level of service than otherwise possible. There is now a growing collection of case studies, documenting the successes and failures of adapting these technologies to particular communities. However, there is limited understanding about the factors that affect these implementations. Through field work, this research will examine a variety of factors (e.g., national policies, available infrastructure, regional medical practices, local culture) that impact specific telemedicine efforts in Sub-Saharan Africa, specifically in Ethiopia and Rwanda. These are regions with grave medical needs where interest in and funding for telemedicine efforts is increasing rapidly.
This is a five-year longitudinal study to be supported by a CAREER award. This award is co-funded by NSF's Office of International Science and Engineering.
The project specifically focused on e-medicine-- the use of telecommunication and information technology to provide health care to people who are separated by geography and distance from the provider. Many US and European donors have extablished e-medicine pilot projects in Sub-Saharan Africa. Most of these projects have never gone beyond the pilot stage-- hence, not sustainable. We therefore came up with the following e-medicine sustainability strategies to inform policy and practice. Social Environment The revamping of contemporary healthcare practices and system from its present glut of bureaucracy, corruption, and social stigmas to a coordinated flow of materials and information has been a major problem in SSA. However, the potential effectiveness of e-medicine can no longer be taken for granted. This is, as the result of the study indicates, a healthy technology transfer domain and e-medicine projects supported by robust national healthcare systems are likely to produce more favorable outcomes compared to telemedicine projects that lack support of a robust healthcare system. The social environment strongly influenced the level of institutional and technological environments on sustainable e-medicine outcomes. Knowledge Management Researchers differ in their understanding of how knowledge should be managed whether, as an object or as a process. If knowledge is seen as an object in knowledge management, the focus should be on the construction and management of the knowledge stock. If perceived as a process, the focus should be on the processes of distribution, sharing and creation of knowledge. The study concurs that knowledge management should be viewed as a process and organizational knowledge as shared by individuals which is better explained and understood through the necessary conversion of tacit into explicit knowledge and consideration of its individual and social dimensions. The results of this study revealed that knowledge management practices strongly influenced sustainable e-medicine outcomes in Ethiopia, Rwanda, Nigeria, and Uganda. The results support the general trend in SSA where knowledge of the health professionals in the diaspora from many African countries is being tapped without necessarily calling them back to Africa but giving the same knowledge to African counterparts in urban and rural areas for replication; hence, sustainability of the initiatives in telemedicine. For instance, knowledge management on satellite?enhanced e?health and e-medicine for sub-Saharan Africa has been initiated by European organizations; African stakeholders and the World Health Organization pool their efforts towards a program for building a sustainable, satellite?enhanced e-health and telemedicine network for the whole of sub-Saharan Africa, embracing as a key element, African ownership. The essence of collective knowledge management is related to sustainable e-medicine outcomes. This is because the sharing of knowledge with other professionals has greater benefits than when it is not shared. Collective knowledge, is thus more secure and has more strategic significance than individual knowledge, and by comparison it is less volatile and less easily affected by staff turnover. The Institutional Environment and Donor Involvement. In this study, we hypothesized that countries in SSA with strong institutional and technological environments were more likely to implement policies that will lead to sustainable e-medicine outcomes and that the degree of donor involvement would determine the level of influence of technology transfer and knowledge management practices on sustainable e-medicine outcomes. The study however indicated a limited degree of influence of the constructs to the e-medicine outcome. Although donor participation in e-medicine projects in SSA has yielded tremendous results, their involvement can influence the outcome of a technology transfer venture, in both positive and negative ways. Due to lack of successful technology transfers, healthcare in SSA heavily relies on donor agencies. Despite the fact that many donor agencies, like Médecins sans Frontières (MSF, "Doctors without Borders"), or WHO have supplied resources and effort to support health initiatives, they cannot be omnipresent whenever the crisis or conflict arises. In summary, this project's contribution lies, in part, in urging the e-medicine research and practice community that the problem of sustainability was overlooked in previous studies. This study contributes constructively to describing an alternative approach to sustaining the sparse e-medicine transfer initiatives in SSA by establishing a framework that addresses the sustainability criterion. The study suggested abandoning singular, one-site(typically one organization) e-medicine projects in favor of a network of sites and establishment of databases across country sites by governments in local and referral hospitals to generate local, self-sufficient learning processes together with working mechanisms for the distribution of appropriately formatted experiences of knowledge acquired across sites in the form of vertical and horizontal flows of Information. For example the East African community in Africa should work on joint projects for health systems that will support knowledge sharing and reduce the patient-doctor ratio in resource-poor settings.
