Harnessing Rural Healthcare Infrastructure Across Africa
Telemedicine and remote monitoring program proposal aimed for cancer patients in low- and middle-income countries.
Presentation by Kingsley Essel Arthur, Pharmfield Pharmaceutical Limited
Article by Dan Stanton, Managing Editor, Informa Connect
While cancer is a major public health issue worldwide, it is excessively problematic in low- and middle-income countries (LMICs). According to pharmacist Kingsley Essel Arthur from Pharmfield Pharmaceutical Limited, such countries account for over 70% of all cancer deaths worldwide, due to factors including the distance to clinics, transportation challenges, and an overall lack of resources.Speaking at the Clinical Trials Europe (CTE) event in November 2023, Essel Arthur said that in Africa there are roughly 1,200 oncologists – representing one per million people – and only 500 radiotherapy machines across the whole continent. Furthermore, within the relatively developed country of Ghana, there are regions where it takes on average four-and-a-half hours for a patient to get to a care center.
Thus, Essel Arthur’s proposal to CTE’s “Clinical Innovation Challenge” focused on a telemedicine and remote monitoring program for cancer patients in LMICs aimed at providing patients with access to high-quality cancer care from the comfort of their own homes.
The program looks to use telemedicine and remote monitoring technologies to connect patients with experienced healthcare professionals that are trained in cancer care. The intention is for patients to receive care through video conferencing, phone calls, secure text messaging, and remote monitoring devices, with remote monitoring devices used to collect data on patients’ vital signs, symptoms, and medication adherence. Such data will be used to monitor patients’ progress and identify potential problems early on.
To implement such an effort, Essel Arthur stressed the need to identify and partner with local healthcare organizations in LMICs – particularly hospitals and clinics – to ensure the program is integrated with the local healthcare system and that patients have access to the care they need.
Referencing his native Ghana, he cited data from the primary healthcare regulator Pharmacy Council of Ghana, which show there are more than 4,000 pharmacies and almost 20,000 over-the-counter medicine sellers (OTCMS).
“People trust their primary care source as compared to traveling long distance,” Essel Arthur said. Therefore, “what we want to do as a company is develop this telemedicine program to provide accessible and convenient cancer care and vision through OTCMS and pharmacies.”
These rural healthcare units are key to the success of the program, and thus training the relevant healthcare professionals on how to use telemedicine and remote monitoring technologies will be a key factor in success. Essel Arthur was therefore asked how such gargantuan upskilling would be implemented across such a fractured network.
“Our goal is to work with the regulatory body, the Pharmacy Council … [which] has given us the assurance that they will work hard getting us access to all the relevant rural areas that have these OTCMs. The most important part about this is that the medical board, in terms of the two major hospitals in Ghana, are also in alliance with the idea.”
Data and clinical trial results taken from the major hospitals with data collected directly from the rural areas will produce more authentic results and allow for full monitoring of the patient outside the clinic setting, he continued. “In the African environment, a person can go to the pharmacy and take things on their own without supervision. And that’s something we must work on, based on education.”
As such, it will be essential to equip pharmacies and OTCMSs with knowledge of the platforms through training, along with how to use electronic health records to get them to monitor the patient throughout the whole cancer journey.
In unison, patients will also need to receive access to the relevant telemedicine and remote monitoring technologies needed to participate in the program. This could be done through a variety of means, said Essel Arthur, by providing patients with smartphones and tablets, or by partnering with telecommunications companies to provide patients with access to mobile internet.
A patient education program will also need to be developed and implemented to teach patients both how to use the telemedicine and remote monitoring technologies and teach them about the importance of adhering to their treatment.
According to Essel Arthur, the plan will be evaluated through numerous methods, including patient and healthcare professional surveys aimed at gauging satisfaction and identifying areas of improvement, along with data analysis to monitor the program’s impact on patient outcomes, healthcare costs, and healthcare quality.
He also highlighted the sustainability goals associated with this program. Specifically:
Seeking funding from various sources, including grants, donations, government partnerships, and private sector collaborations.
Exploring options for cost recovery through nominal patient fees, insurance partnerships, and local healthcare provider contributions.
Investing in the training of local healthcare professionals to ensure the self-sufficiency and longevity of the program.
Advocating for the integration of telemedicine and remote monitoring into national healthcare policies and regulations.
Engaging local communities in program decision-making and awareness campaigns to secure ongoing support.
Allocating resources for technology maintenance and upgrades to ensure program sustainability.
However, one of the judges – Jessica Shull, director of Digital Therapeutics at Vicore Pharma – advised Essel Arthur to not overlook the importance of trial results in creating a sustainable solution in the long term.
“For cancer studies, it needs to be very carefully thought out how you’re going to measure the effect of treatments to reach your endpoints because that’s what regulators are going to want to see. That’s what determines the success of your study,” she said. “Those tests and measures need to be done in a way that is possibly not with these OTCMSs but in an actual center or [it will be necessary to] work out a way that is acceptable to the regulatory bodies.”
Shull complimented the program’s focus on harnessing OTCMSs – a “brilliant resource” – but stated that unlike Ghana not all LMICs will have similar rural healthcare options available to utilize in a similar way.
Another delegate questioned why this program particularly focused on cancer when such a system of remote telecommunications could apply to a full range of disease management.
“We chose cancer earlier on as a team because of the first-hand knowledge behind it. We realized it was a non-communicable disease in Africa; people can talk about hypertension, diabetes, etc., and there’s more education on that side. But when it comes to cancer, there’s no education. Even the vaccination of HPV has not been widely distributed, and there are still people who have stigma or have less knowledge about the issues of HPV.”
Therefore, the mortality rates in Africa are disproportionately high, Essel Arthur added, particularly in rural areas, encouraged by myths around cancer and the reliance on herbal preparations.
“Our goal is to enforce education and make sure we are reducing this mortality rate in the next five to 10 years in Africa. That’s why we are focusing on cancer even though it is complex.”
