ASSESSMENT OF THE ROLE OF TELEHEALTH DURING HEALTH CRISES: A CASE STUDY OF THE COVID-19 PANDEMIC IN NIGERIA      

CHAPTER ONE

INTRODUCTION

Background of the Study

The rapid transmission and escalating incidence of the pandemic pathogen known as 2019-novel coronavirus (2019-nCoV) are causing great concern. The World Health Organisation (WHO) officially declared the coronavirus, a highly contagious virus, as the first pandemic caused by the coronavirus family on 11 March 2020 (World Health Organisation [WHO], 2020a). The World Health Organisation (WHO) has assessed the risk of the pandemic as "very high" on a worldwide scale. As of May 12, 2020, the African Region has reported a total of 46,829 confirmed cases of the coronavirus disease 2019 (COVID-19) according to the WHO (WHO, 2020b). The government, business, industry, and public sectors are currently facing a dire scenario and are ill-equipped to handle emergencies, particularly in the context of Africa's health services. Given the significant impact of COVID-19 on healthcare services and the global economy, governments are preparing for the most severe outcomes. COVID-19 is a respiratory pandemic that mostly affects individuals who are susceptible to the virus, including older adults, those with chronic obstructive pulmonary disease (COPD), asthma, and immunodeficiency (Centers for Disease Control and Prevention [CDC], 2020).

As the pandemic surged, traditional healthcare delivery systems were overwhelmed, leading to the exploration and adoption of alternative methods of healthcare provision. Telehealth, the use of electronic information and telecommunications technologies to support and promote long-distance clinical healthcare, emerged as a crucial solution during this period (Owoyemi, 2020). Telehealth, although it has been available for some time, has not had a widespread impact due to limited awareness of its potential and resistance to adopting the new system. These challenges are present in both developed and developing countries. The Health Resources and Services Administration defines "telehealth" as the use of electronic and telecommunications technology to facilitate and encourage long-distance clinical healthcare, health-related education for patients and professionals, as well as public health and administration (Health Resources and Services Administration [HRSA], 2020). Telemedicine, often known as telecare, is a component of telehealth. According to the Centres for Medicare & Medicaid Services, telemedicine refers to activities that involve two-way, real-time interactive communication between a patient and a physician or practitioner at a remote location (Centers for Medicare & Medicaid Services [CMS], 2020). COVID-19 is an infectious virus that has led most governments to implement quarantine measures in order to minimise in-person interactions, including within hospitals. Access to healthcare is essential for the population during disasters, crises, or pandemics to prevent a prolonged decline in quality of life. 

Telehealth is a crucial tool for managing patient monitoring, prescriptions, and diagnoses that do not require laboratory tests. It also helps reduce long hospital queues, the risk of exposure to the coronavirus, hospital-acquired infections, hospital admissions, and readmissions. This, in turn, promotes social distancing, which is a major factor in preventing the spread of the virus (CDC, 2020; WHO, 2020c).

Based on the 2018 edition of the Atlas of African health statistics from the WHO African region, the majority of nations in Africa did not achieve the Millennium Development Goals (MDGs) target (WHO, 2018). Africa is classified by the WHO as one of the six regions, with an estimated annual population growth rate of 2.6%. This is significantly greater than the growth rates of the Eastern Mediterranean, South-East Asia, Americas, Western Pacific, and Europe, which are 2.0%, 1.3%, 1.1%, 0.7%, and 0.3% respectively (WHO, 2018). Despite Africa's large population, Nigeria is ranked as the sixth most densely inhabited country in the region. Compared to other WHO regions in 2015, Africa had the lowest healthy life expectancy, despite a decline in crude birth and death rates (WHO, 2018). Telehealth enhance and fortify the healthy life expectancy, health services, and quality of life in the Africa area during the COVID-19 era. Moreover, the emergence of COVID-19 required a swift transition in healthcare delivery approaches to reduce direct interaction and control the transmission of the virus. Telehealth emerged as an essential instrument in this situation, allowing healthcare providers to give medical care from a distance. In response to the pressing need, the Nigerian government initiated the promotion of telehealth solutions, utilising the already established telecommunications infrastructure to facilitate virtual consultations, remote monitoring, and digital health education (Adeloye et al., 2020). Therefore, a survey will be conducted in order to assess the role of telehealth during health crises: a case study of the COVID-19 pandemic in Nigeria.

Statement of the Problem

The concept of telehealth is not new; it has evolved significantly over the past few decades with advances in technology and increasing internet penetration. However, its adoption had been relatively slow in many parts of the world, including Nigeria, due to infrastructural, regulatory, and socio-cultural challenges (Dorsey & Topol, 2020). The healthcare system is characterized by a mix of public and private providers, with significant disparities in access and quality of care between urban and rural areas. The country has a high burden of infectious diseases, a growing prevalence of non-communicable diseases, and a limited healthcare workforce (World Bank, 2019).

Before the COVID-19 pandemic, Nigeria's healthcare system was already under strain, with inadequate infrastructure, insufficient funding, and a lack of comprehensive health insurance coverage. These challenges were exacerbated by the pandemic, which overwhelmed healthcare facilities and disrupted routine health services (Abdullahi et al., 2020). Additionally, the pandemic's rapid spread necessitated stringent public health measures, including lockdowns and social distancing, which further impeded access to traditional healthcare services.Hence, it is in the light of these that the study seeks to assess the role of telehealth during health crises: a case study of the COVID-19 pandemic in Nigeria.

 1.3  Objectives of the Study

The main purpose of this study is to assess the role of telehealth during health crises: a case study of the COVID-19 pandemic in Nigeria. Specifically, the study will;

Evaluate the effectiveness of telehealth in providing medical consultations during the COVID-19 pandemic in Nigeria.

Assess the level of patient satisfaction and trust in telehealth services during the COVID-19 pandemic.

Identify the challenges faced by healthcare providers in implementing telehealth services during the pandemic.

1.4  Research Questions

The following questions have been prepared for the study:

How effective was telehealth in providing medical consultations during the COVID-19 pandemic in Nigeria?

What was the level of patient satisfaction and trust in telehealth services during the COVID-19 pandemic?

What challenges did healthcare providers face in implementing telehealth services during the pandemic?

1.5 Research Hypotheses

H0: Telehealth was not effective in providing medical consultations during the COVID-19 pandemic in Nigeria.

Ha: Telehealth was effective in providing medical consultations during the COVID-19 pandemic in Nigeria.

1.6 Significance of the Study

The insights from this research will guide the development of policies and regulations that support the integration of telehealth into national healthcare systems, especially during emergencies. Through the results of this study, patients will benefit from improved access to healthcare services through telehealth, especially during times when in-person visits are risky or impractical. Furthermore, companies and individuals developing telehealth technologies will use the findings to enhance their products to better meet the needs of healthcare systems during crises.

Nevertheless, subsequent researchers will use it as a literature review. This means that other students who may decide to conduct studies in this area will have the opportunity to use this study as available literature that can be subjected to critical review. Invariably, the result of the study contributes immensely to the body of academic knowledge with regard to the role of telehealth during health crises.

1.7 Scope of the study   

The scope of this study is boarded on the role of telehealth during health crises: a case study of the COVID-19 pandemic in Nigeria. Empirically, this study will evaluate the effectiveness of telehealth in providing medical consultations during the COVID-19 pandemic, identify the challenges faced by healthcare providers in implementing telehealth services during the pandemic and assess the level of patient satisfaction and trust in telehealth services during the COVID-19 pandemic.

Geographically, the study will be delimited to health workers in Lagos State.

1.8 Limitation of the study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. In addition, there was the element of researcher bias. Here, the researcher possessed some biases that may have been reflected in the way the data was collected, the type of people interviewed or sampled, and how the data gathered was interpreted thereafter. The potential for all this to influence the findings and conclusions could not be downplayed. More so, the findings of this study are limited to the sample population in the study area, hence they may not be suitable for use in comparison to other schools, local governments, states, and other countries in the world.

 1.9 Definition of Terms

Health: Refers to a state of physical, mental, and social well-being in which an individual is free from illness and injury.

Telehealth: Involves the use of digital information and communication technologies, such as computers and mobile devices, to access and manage health care services remotely.

Telemedicine: Refers to the delivery of healthcare services and clinical information using telecommunications technology. This includes remote consultations, diagnoses, and treatments via phone, video conferencing, email, or other digital communication tools.

COVID-19: Stands for Coronavirus Disease 2019.