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Thesis.Pdf (2.662Mb) DEDICATION It is with great honour, respect and sympathy that I dedicate this piece of study to my late uncle; late 1st Lieutenant Alobwede Marcus Njikang, from whom what I am today greatly depended on. I thank him for telling and teaching me that great things and persons are born from tiny sparks of inspiration. May his soul rest in perfect peace. i ACKNOWLEDGEMENT The writing of this report has been one of the most noteworthy academic challenges I have ever had to face. Without the support, tolerance and leadership of the following people, this study would not have reached its end. It is to them that I owe my intimate appreciation. Firstly, I will like to thank the almighty God for His spiritual courage, care and energy, He alone provided to me all through my education. Special thanks go to Gunnar Elingsen, who undertook to act as my supervisor despite his many other academic and professional commitments. His wisdom, knowledge and commitment to the highest standards inspired and motivated me. My friends, colleagues and classmates, who inspired my final effort despite the enormous work pressure we were all facing together. Immense thanks goes to all those who participated in this research project with interest and enthusiasm. I will like to give a special thank you to my parents, who have always sustained my educational efforts, encouraged and believed in me, in all my activities and who so loving and generously cared for me and my kid brothers and sisters. Lastly, I will like to thank my beloved one; Pauline N, for the care, courage and perseverant during all this difficult moment of my life. ii ABSTRACT Telemedicine implementation in Africa is increasingly becoming am important topic of discussion; in and out of Africa, investigated, and implemented, yet the term lacks conceptual clarity and definition to health workers within the African continent itself. The primary purpose was to examine perceived susceptibility, some common barriers, and self-efficacy associated with the implementation put in place. Furthermore, the components, process, and outcomes of telemedicine as it is delivered in the African health structure have not been clearly expressed. This report provides an exemplary analysis concept, through available literature; even though very insufficient. During the study, a qualitative finding method was employed. Whereby the interpretative research method has been the key method to interpret all phenomena, it provides a useful tool with which to analyze existing literature on the development, scope and the extent to which telemedicine is used within Africa and other low income countries. From the finding, it was basically identified that the high cost of telemedicine infrastructure tools is so far the greatest challenge African have in the effort put in place to sustain the implementation of telemedicine. This is compared to the economic situation of the nation. Other related factors are technical and organisational challenges, infrastructural difficulties, cost distribution and cost recovery policies put in place, the direct benefit of telemedicine, African health policies and educational challenges. Despite the successes as well as failures within the African nations, telemedicine programs are still working to achieve the results needed to propel this new approach of health care forward, telemedicine today is outstandingly from many other studies very promising due to the great value that can be brought by its implementation. iii Table of content Dedication……………………………………………………………………………………...i Acknowledgement…………………………………………………………………………….ii Abstract……………………………………………………………………………………….iii Table of content……………………………………………………………………………….iv List of abbreviations………………………………………………………………………….vii List of pictures………………………………………………………………………………...ix List of tables…………………………………………………………………………………...x 1 INTRODUCTION: ………………………………………………………………………...1 1.1-Research objective………………………………………………………………………...3 1.2-Research question…………………………………………………………………………4 1.3-Study context and methodology…………………………………………………………...5 1.4-Motivation for thesis………………………………………………………………………6 1.5-Expected contribution……………………………………………………………………..6 1.6-Thesis‟s structure and outline……………………………………………………………..6 2 THEORY: ………………………………………………………………………………….8 2.1-Defination and concept of telemedicine…………………………………………………...9 2.2-Quality of health system in Africa……………………………………………………….11 2.3-Telemedicine in developing countries…………………………………………………...13 2.4-The use of IT to improve health care services in Africa…………………………………14 2.4.1-The concept within information infrastructure………………………………………...20 2.5-Information infrastructure………………………………………………………………..18 2.6-Actor network theory…………………………………………………………………….22 2.7-Community participation………………………………………………………………...25 3 METHOD: ………………………………………………………………………………...27 3.1-Research purpose………………………………………………………………………...28 iv 3.2-Research design………………………………………………………………………….28 a- Quantitative research method……………………………………………………………...29 b- Interpretive research method………………………………………………………………30 c- Qualitative research method……………………………………………………………….30 3.3-Interpretive field work and the principles………………………………………………..34 3.3.1-Data collection…………………………………………………………………………36 3.3.2-Sample size…………………………………………………………………………….37 3.3.3-Participant observation…………………………………………………………………38 3.3.4-Interviews………………………………………………………………………………38 3.3.5-Literature study………………………………………………………………………...39 3.4-Reflection on the method………………………………………………………………...40 3.4.1-Getting access………………………………………………………………………….40 3.4.2-Working as an outsider………………………………………………………………...41 3.4.3-Ethical considerations………………………………………………………………….41 3.4.4-Limitation of study……………………………………………………………………..42 4 CASE STUDY: …………………………………………………….................................44 4.1-A brief description of the republic of Cameroon………………………………………...45 4.2-History of the Cameroon health sector…………………………………………………..47 4.3-Organisation of the Cameroon health sector……………………………………………..49 4.4-The Yagoua regional hospital……………………………………………………………50 4.5-GP in Cameroon………………………………………………………………………….55 4.6-The telemedicine centre in Cameroon…………………………………………………...59 5 DISCUSSION: ……………………………………………………………………………67 5.1-Telemedicine as a tool to provide health in Africa………………………………………68 5.2-Sustaining telemedicine in Africa………………………………………………………..69 5.3-Challenges faced by telemedicine in Africa……………………………………………..71 5.3.1-Financial challenges……………………………………………………………………71 v 5.3.2-Technical and organisational challenges……………………………………………….73 5.3.3-Infrastructural difficulties……………………………………………………………...73 5.3.4-Cost distribution and benefits………………………………………………………….75 5.35-Policy and politics related setback……………………………………………………...76 5.3.6-Telemedicine in the hands of the private sector………………………………………..78 5.3.7-Human resource-related challenges……………………………………………………79 5.3.8-Educational problem…………………………………………………………………...82 6 CONCLUSION: …………………………………………………………………………..84 7 BIBLIOGRAPHY: ……………………………………………………………………….88 8 APPENDICES: …………………………………………………………………………...95 vi LIST OF ABBREVIATIONS AIDS: Acquired immune deficiency syndrome ANT: Actor network theory CME: Continued medical education CRTV: Cameroon radio and television CP: Community participation DS: Dialogue structure ENT: Ear Nose and Throat EPR: Electronic patient record GTC: Genesis telecare centre GDP: Gross domestic product GTZ: German agency for development co-operation. HD: High definition HIV: Human immunodeficiency virus ICT: Information communication technologie IFC: International finance cooperation II: Information infrastructure IMF: International monetary fund IS: Information system MDG: Millennium development goal NGO: Non-governmental organization NST: Norwegian centre for telemedicine PHC: Primary health care Sq km: Square kilometre TB: Tubercle bacillus TV: Television vii UN: United nation UNICEF: United Nations International Children's Emergency Fund UNESCO: United Nations Educational, Scientific, and Cultural Organization Via: Through WHO: World health organisation viii LIST OF PICTURES Picture1: Combining infrastructures for Telemedicine in Cameroon. Picture 2: community participation model Picture 3: Diagramatic representation of qualitative findings and others Picture 4: Position of Cameroon on the world map Picture 5: Map of Cameroon showing important towns Picture 6: Diagrammatic representation of the Cameroon health sector Picture 7: Showing the Cameroon health structure. Picture 8: Map of the Far North region Picture 9: Entrance to the Yagoua regional hospital Picture 10: Yagoua hospital entrance Picture 11: Yagoua regional hospital corridor Picture 12: Yagoua hospital ward Picture 13: Inauguration of telemedicine at the Yagoua regional hospital PIC 14: Traditional healer in Yagoua Picture 15: Network use at the genesis telecare centre. Picture 16: telemedicine conferance Picture 17: Telemedicine office in Yaoundé. Picture 18 ( I) and Picture 18 (II); (The three pictures on the screen are the images that appeared, A; written in red is the image of Prof Line and her students at the hospital. B; written in red is the image of Dr Fonkong and his colleagues at the Yagoua regional hospital. And C; written in red is the image of the technical team at the genesis telecare centre.) ix Picture 19: Challenges faced by telemedicine in Africa Picture 20: Private sector in relation to health LIST OF TABLE Table 1:Data collection. Table 2: General statistic for Cameroon Table 3: Health statistics for Cameroon x CHAPTER -1 INTRODUCTION {In this section of
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