Medical and economic benefits of telehealth in low- and middle-income countries: results of a study in four district hospitals in Mali.

BACKGROUND: The aim of this study was to evaluate the impact of telehealth on 1) the diagnosis, and management in obstetrics and cardiology, 2) health care costs from patients' perspectives, 3) attendance at health centres located in remote areas of Mali. METHODS: The impact of telehealth on health care utilization, quality, and costs was assessed using a five-point Likert-scale based questionnaire consisting of three dimensions. It was completed by health care professionals in four district hospitals. The role of telehealth on attendance at health centres was also assessed based on data collected from the consultations logs before and during the project, between project sites and control sites. Referrals specific to the activities of the research study were also evaluated using a questionnaire to measure the real share of telehealth tools in increasing attendance at project sites. Finally, the cost savings achieved was estimated using the transport and lodging costs incurred if patients were to travel to the capital city for the same tests or care. RESULTS: The telehealth activities contributed to improving medical diagnoses in cardiology and obstetrics (92.6%) and the patients' management system on site (96.2%). The attendance records at health centres increased from 8 to 35% at all project sites during the study period. Patients from project sites saved an average of 12380 XOF (CFA Francs) or 25 USD (American dollar) and a maximum of 35000 XOF or 70 USD compared to patients from neighbouring sites, who must go to the capital city to receive the same care. CONCLUSION: We conclude that in Mali, enhanced training in ultrasound / electrocardiography and the introduction of telehealth have improved the health system in remote areas and resulted in high levels of appropriate diagnosis and patient management in the areas of obstetrics and cardiology. Telehealth can also significantly reduce the cost to the patient.

Deploying portable ultrasonography with remote assistance for isolated physicians in Africa: lessons from a pilot study in Mali.

OBJECTIVE: Demonstrate the feasibility of deploying portable ultrasonography with remote assistance to improve the diagnostic capabilities of isolated physicians in Africa. METHODS: The approach is based on the training of general practitioners for the use of ultrasonography, and the remote support by radiologists using dedicated tools for image transfer over low-bandwidth internet connections. RESULTS: Our early results in a pilot project in Mali show that this approach is feasible, and that isolated physicians can productively use ultrasonography to improve diagnosis and management decisions such as the need for a medical evacuation towards a reference hospital. CONCLUSION: These encouraging early results must be confirmed by larger-scale studies, in order to better understand the organizational requirements and demonstrate outcomes and return on investments for such telemedicine services. This scale-up project will start in 2010 in collaboration with the International Development Research Center of Canada.