From Africa Recovery, Vol.13#4 (December 1999), page 26 (part of special feature on information technology)

According to Maria Musoke, radio can play a big role in improving basic health and reducing the number of maternal deaths

Telemedicine in rural Uganda

By George Koomson*

"Africa does not need sophisticated equipment." Ms. Maria Musoke speaks as an information specialist who studied the communications component of a pilot health project last July in eastern Uganda's Iganga district. The project has helped reduce maternal mortality rates by as much as 40 per cent over the past three years. There, intermediate technologies (very high frequency [VHF] radios and walkie-talkies) "worked wonders." She favours a multi-dimensional approach "to respond to different abilities and needs." High-end equipment is fine at district and national level, "but it is impractical to supply Internet facilities to traditional birth attendants who can't read or write."

The project -- Rural Extended Services and Care for Ultimate Emergency Relief (RESCUER) -- teams up the UN Population Fund, Uganda's Ministry of Health and Population Secretariat and Iganga district authorities. RESCUER is part of the ministry's efforts to reduce Uganda's high maternal mortality rate -- about 506 per 100,000 -- by improving local care and referral systems. Some 80 per cent of Uganda's 17 million people live in rural areas, fertility rates are high and over 60 per cent of childbirth is handled by traditional midwives, relatives and friends.

The project has three components: communications, transport and provision of quality health services. The communications system uses VHF radios installed in base stations and health units, in the referral hospital ambulance and the District Medical Officer's vehicle, while the birth attendants have walkie-talkies. The midwives and birth attendants got additional training and now there is better quality care. But transport has been the biggest problem as the ambulance sometimes breaks down.

Training has been according to needs, Ms. Musoke says. The birth attendants were taught basics "such as what to do when a woman in labour comes to them panting; or what to do about a retained placenta. The midwives got a refresher course since some have been out of school for 10 years or more. All health workers were trained to use the communication equipment."

On the significant changes the RESCUER project has introduced, Ms. Musoke points first to the fact that health personnel have been able to call and get practical advice even when no vehicle is available. "They had faster responses to situations and felt less isolated." The project has also helped overcome absenteeism, "which used to be a big problem." Now, people are afraid they can be called at any time and calls are heard on the other receivers, including in the chief medical executive's office. "Senior officers are likely to radio to the responsible officer if a call receives no response for about 30 minutes," she adds.

The increased number of births handled by trained personnel, referrals to health units and the reduction in maternal mortality "shows that the RESCUER project has caused a change in the health-seeking behaviour and reproductive outcomes in Iganga district."

The health authorities started the project by raising awareness and providing some training. People also began to see other uses in the project, Ms. Musoke notes. Before RESCUER began, if a refrigerator broke down, "you might have to travel many miles for repairs. But now, with just a radio call, a technician can be sent down to do the job."

Communications "made a significant contribution to the success of the project," Ms. Musoke observes. When transport broke down, the presence of a midwife and the communications system played a big role in saving lives: the birth attendants consulted health units, which in turn consulted colleagues and their seniors. The walkie-talkie technology was "a great source of empowerment" for the birth attendants, she adds. It improved their image, built confidence in their clients and helped them attend to more women.

The initial cost of the project was under $124,000, covering the cost of the radio and monitoring equipment and training for technicians and users. After this phase, running costs decreased. According to Ms. Musoke, the system uses solar energy for electricity. "After the initial expenses, there are the usual maintenance costs, but these are small and easy to bear, which means that even when donors pull out, the project will still be sustainable."

Because of its positive results, the RESCUER project is already being replicated in three other districts and there are plans to extend it in phases to 30 more.

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