The fibre benefit to hospitals

By Dan Muhuni

When Bitange Ndemo, the Permanent Secretary in the Ministry of Information and Communication announced that the government would pay 50 percent of bandwidth cost for the Business Process Outsourcing (BPO) sector, it caused excitement in the industry.
Everybody in the BPO business wanted to benefit from the government scheme, which is calculated to reduce the cost of bandwidth and allow Kenya to compete with countries like India’s BPO sector. The announcement also made many entrepreneurs to invest in the sector with the hope of enjoying the reprieve.
While the step can be said to have spurred activity and raised the profile of Kenya’s BPO, the health sector remains neglected, yet telemedicine could save lives and ensure that many people access expert doctors locally, regionally and even abroad.
This year, more than 50 hospitals in East Africa will be struggling to raise the money for internet connectivity so that they can benefit from a project that seeks to interconnect hospitals in the region. The project by Africa Medical Research Foundation (AMREF) and Computer Aid International (CAI) requires hospitals to cater for the cost of connectivity while computers, cameras, scanners and training would be provided by the two organisations.
Currently there are 15 hospitals across the region practicing telemedicine under the project but the high cost of bandwidth means that they are restricted to emails as opposed to real time telemedicine and video streaming.
The move has however improved quality, effectiveness, access and the cost of providing health care for the hospitals that are mainly based in remote areas. For effective telemedicine, a hospital would require bandwidth of 512kbps uplink and 512kbps downlink which costs about Sh140,000 (US$ 2000) per month. Because of poor infrastructure, the remote hospitals can not use wireless or microwave links; they will have to purchase VSAT equipment at the cost of Sh406,000 (US$ 5800).
Therefore, a hospital will have to incur an initial cost of about Sh1 million which includes bandwidth for two months, the equipment, internal networking and staff training.This high cost of connectivity has deterred many hospitals from embarking on telemedicine yet the referral hospitals are there and willing to assist other doctors from remote hospitals. Paul Maziku, an assistant ICT officer at Bugando hospital in Mwanza says connectivity is a challenge, citing instances when remote hospitals are disconnected because of failure to pay the monthly bills. The cost of bandwidth remains a stiff challenge to the hospitals; they have opted to lower bandwidth tiers, which are shared, making the quality and speed of the internet slow.
For instance 128 kbps uplink and a downlink speed of 384 kbps costs Sh64,350 (US$ 990) and is shared among eight users, meaning that the speed is low for a hospital that needs instant connectivity and response. With a 128/384kbps shared link, a hospital can send emails, scan and send attachments. The hospital can also network the computers among the offices within the compound and share information such as finance and administrative data and also access patients’ records online. For instance; if a radiologist in one wing wants to know whether a patient had been treated for any other ailment, she or he will access the data instantly by the click of a button instead of searching for the file or retrieving it from the archives.
In deed, apart from telemedicine, hospitals can improve their efficiency because records will be online and they can confirm details with suppliers before sending a vehicle to receive the supplies. The computer would also store details of the expiry dates of all medicines. With subsidised bandwidth, more hospitals will be in a position to deliver telemedicine to many more people who may not have the resources to travel to referral hospitals. Connectivity in rural hospitals would greatly help governments monitor the health care system. But connectivity is not the only issue. There is that of software and availability of computers.
Because they are few, hospital administration wants to utilise the computers for both telemedicine as well as a repository of all hospital information. This makes the computer slow and at times it is not used for the actual work. An increase in the number of computers would improve the level of efficiency. Then there is the question of software. Computer Aid usually donates machines according to software specifications by the users.
In this case, AMREF selects the software that should be installed into the computers before they are shipped to the rural hospitals. “The software specifications are similar in all stations, the packages, the needs for these stations are also similar in many ways, some of the software is installed in operating system but for some we have to install in all the machines we receive. We install Gimp application which helps the users in the station trim their pictures to the right dimensions and DPI (Dots per inch) without compromising the quality,” says Frank Odhiambo, who has been working with the remote hospitals all over East Africa.