A Teledermatology Pilot Programme for the Management of Skin Diseases in Primary Health Care Centres: Experiences from a Resource-Limited Country (Mali, West Africa).

In sub-Saharan Africa, in particular in rural areas, patients have limited access to doctors with specialist skills in skin diseases. To address this issue, a teledermatology pilot programme focused on primary health centres was set up in Mali. This study was aimed at investigating the feasibility of this programme and its impact on the management of skin diseases. The programme was based on the store-and-forward model. Health care providers from 10 primary centres were trained to manage common skin diseases, to capture images of skin lesions, and to use an e-platform to post all cases beyond their expertise for dermatologists in order to obtain diagnosis and treatment recommendations. After training, the cases of 180 patients were posted by trained health workers on the platform. Ninety-six per cent of these patients were properly managed via the responses given by dermatologists. The mean time to receive the expert's response was 32 h (range: 13 min to 20 days). Analysis of all diseases diagnosed via the platform revealed a wide range of skin disorders. Our initiative hugely improved the management of all skin diseases in the targeted health centres. In developing countries, Internet accessibility and connection quality represent the main challenges when conducting teledermatology programmes.

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.