Understanding Contextual Issues in the Adoption of ICT in Health: The Case Of Telemedicine In Ghana
| E. Afari-Kumah Accra Institute of Technology/ Open University of Malaysia This e-mail address is being protected from spambots. You need JavaScript enabled to view it | Dr. Hilla Addo Accra Institute of Technology/ Open University of Malaysia This e-mail address is being protected from spambots. You need JavaScript enabled to view it |
Purpose
Currently, Ghana is experiencing high attrition of doctors (Sodzi-Tettey, 2007:146). The limited number of doctors available too, mostly refuses to accept postings to rural and remote areas. Telemedicine could help solve these medical woes (Huston and Huston 2000; Mbarika 2004). Telemedicine can play a very important role in the amalgamation and redistribution of medical services to cities and local communities in Ghana. Telemedicine is the science and art of the maintenance of health and prevention, alleviation or cure of disease in patients using information and communication technologies (van Beijnum, Pawar, Dulawan, and Hermens, 2009).
The general objective of the study will be to identify contextual issues that would enable Telemedicine to reach scale and sustainability in Ghana. To achieve the general objective, the research will be aimed at addressing the following specific objectives; to identify contextual issues that could influence adoption and use of telemedicine technologies in Ghana? to determine the effects of each of the contextual issues on adoption and use of telemedicine technologies in Ghana?, to find out the extent to which the contextual issues identified are contributing to the sustainability of telemedicine technologies and to make recommendations for the adoption and sustainability of telemedicine in Ghana.
Design/methodology/approach
For this study, constructivism or an Inductive approach will be adopted. Two reasons inform my judgment in using the inductive approach; first there is lack of established theoretical frameworks that deal with telemedicine. Therefore, I shall start this study by exploring the topic in general, and considering issues that seems important to the study and subsequently identifying some relevant frameworks as the study progresses. The other reason is that since there have been constant innovation in Telemedicine today, with its multiplicity in different countries, little regarding a standardized Telemedicine is known, which rules out a deductive approach which is based on testing an acceptable theory in a new situation. Considering the purpose and proposed research questions for this study, qualitative case study research and grounded theory methods will be adopted.
Since this study is a contextualist and interpretivist one, it’s appropriate to analyze the case using an interpretivist epistemology. Actor Network theory (ANT) would be adopted. While many approaches to research in technological areas treat the social and the technical in entirely different ways, actor-network theory (ANT) proposes instead a socio-technical account in which neither social nor technical positions are privileged. ANT deals with the social-technical divide by denying that purely technical or purely social relations are possible, and considers the world to be full of hybrid entities (Latour 1993) containing both human and non-human elements.
The primary tenet of ANT is the concept of the heterogeneous network. ANT claims that any actor, whether person, object (including computer software, hardware, and technical standards), or organization, is equally important to a social network. As such, societal order is an effect caused by an actor network running smoothly. This order begins to break down when certain actors are removed.
The methodological cornerstone of the ANT approach is to follow actors to see how they attempt to impose worlds upon one another, and to describe the dynamics and internal structures of actor worlds. It tries to trace and explain the processes whereby stable networks of aligned interests are created and maintained. ANT literally instructs us “to map out the set of elements (the network) that influence, shape, or determine an action. But each of these elements is in turn part of another actor-network and so forth” (Monteiro, 2000).
In this study, the data collection will be based on qualitative approach such as interviews, documents collected and participatory observations and informal discussions, physical artifacts etc. In qualitative approach, the data from interviews consists of direct quotations or direct explanations from people about their opinions, experiences, knowledge and feelings. The data from observations contains detailed descriptions of people’s activities, behaviors, actions and organization processes. Document analysis in qualitative inquiry yields excerpts, quotations; official publications and reports, archival records, personal diaries etc (Robson, 2002). The principal method of data collection is via face-to-face, semi-structured interviews with key informants selected from participating health facilities. Other sources of data include text or image data, administrative documents and annual reports. The research data will be analyzed with QSR's NVivo 8 and Atlas.ti 6.1 software. The methodology, theory and how the study would be executed shall be discussed extensively in this paper.
Findings/Results/Observations
Ghana currently has a national coverage for telecommunication via landlines and cellphone. Internet connectivity is accessible nationally via ADSL, GPRS and VSAT. All the ISPs have internet enable features on their network. The Ministry of Communication is rolling out a programme for optical fibre connectivity for all regional hospital and selected district hospitals. A national wide area network (WAN) is also being deployed by the Ministry of Communication for use by the MDAs. There are however challenges with bandwidth and cost. Some eHEALTH/ telemedicine initiatives in Ghana are Sene Portable digital Assistant (PDA) project, The Pan Africa eNetwork at the Komfo Anokye Teaching Hospital for telemedicine and elearning, Millennium Villages Project (MVP) and the Regenerative Health Programme which use mobile phones for disseminating public health messages. For this study, the Sene project (PDA), MIMCom, Satellife project, Pan African Project (Video Conferencing) and the MVP* (mobile health) would be studied.
Research implications
This study will be significant to practitioners in ICT and health, patients, healthcare organizations, researchers, policy makers, and donor partners since it would create awareness among practitioners on some of the needs of patients, donors, and policymakers.
In addition, the study will contribute to existing literature in ICT deployment. It would offer important contribution to the body of knowledge for this very under researched part of the world (Mbarika & Okoli, 2002) that could benefit academic and scientific community, industry, and government sectors in sub-Saharan Africa, and by extension, other developing countries.
Practical and Policy implications
The findings are of direct benefits to Health care practitioners. In the current technological age, use of the Internet and other related technologies in the healthcare industry to improve the access, efficiency, effectiveness and quality of clinical and business processes utilized by healthcare organizations, practitioners, patients and consumers to improve the health status of patients is on the ascendancy.
Furthermore, the findings of the study will be significant to policy makers who will become aware of issues surrounding implementation and sustainability of Telemedicine. The study will prompt policy makers to develop Policies to ensure successful management of Telemedicine infrastructures in organizations. It will also prompt policy makers to enact laws geared towards the need for budgetary allocations to support Telemedicine Infrastructure and development.
The study will in addition, promote policy initiatives to ensure uninterrupted Telemedicine services in all facilities and communities where Telemedicine are deployed; and also, to become more committed to the sustenance of Telemedicine Facilities and services.
Three Learning Points for Ghana and Africa
African studies investigating telemedicine tend to be rather limited relative to the empirical and theoretical papers emanating from Western and developed world. However studies on telemedicine from West African and Ghanaian contexts are almost non-existent and this study therefore attempts to start filling this research gap. This research will contribute knowledge to theory, the issues of telemedicine and lastly telemedicine in Africa, Sub-Saharan Africa and Ghana.
Keywords: Telemedicine, Information, Communications, Technology, Ghana, Actor Network Theory, Sustainability, Medicine, Information and Communication Technology
References
- Sodzi-Tettey, S (2007): GMA@50: Ghana’s health. Ghana Medical Journal. September 2007 Volume 41, Number 3
- Mbarika, Victor Wacham A. (2004): Is telemedicine the panacea for Sub-Saharan Africa's medical nightmare? Commun. ACM 47(7): 21-24
- Huston, T. & Huston, J. (2000). Is telemedicine a practical reality?. Association for Computing Machinery. Communications of the ACM, 43(6), 91-95.
- B.J.F. van Beijnum, P. Pawar, C.B. Dulawan, H.J. Hermens (2009): mobile virtual communities for telemedicine: research challenges and opportunities. International Journal of Computer Science and Applications, Techno mathematics Research Foundation Vol. 6, No. 2, pp 19 – 37, 2009 .
