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Covid-19 could lead to telehealth revolution in Fiji

Posted By on November 13, 2020 @ 12:30

Unprecedented events such as pandemics and natural disasters frequently provoke national introspection, leading to innovative plans and policies that adapt to new circumstances and update capacities.

In Fiji, the Covid-19 pandemic has exposed the unpreparedness, uncertainty and lack of government support for the private primary care and family medicine sector, which has contributed to the disruption of continuing assessment and management of patients, particularly those with chronic ailments. Future-proofing Fijian healthcare will require socially innovative changes to better prepare the system for pandemic and epidemic situations.

Like many [1] countries, Fiji struggled [1] to maintain the delivery of routine health services in the face of the Covid-19 outbreak. Access to services was restricted to prevent the spread of the virus and non-Covid patients stayed away, fearful of acquiring the disease while visiting their usual medical centre.

Private medical practitioners especially were impacted by the need to protect their regular patients while not being equipped to test and treat possible Covid victims. Adding to the pressure was an unwillingness to trust patients to be aware of or honest about their possible exposure to the virus.

The unavailability of personal protective equipment in Fiji was a particular problem among private practitioners. This led to the temporary closure of clinics, including my own. The quality of healthcare services was reduced as the pandemic struck and in the longer term. Even the temporary closure of clinics increased the risk of other diseases worsening due to a lack of treatment during the pandemic.

Covid-19 has highlighted the importance of private primary care health facilities in managing the problem of overcrowding at public health centres and the risk that those services would be overwhelmed. This led the government to decentralise Covid testing [2].

Private practice services [3] have also been recognised as an underused but important means for improving the quality of healthcare in developing states like Fiji.

The pandemic has underscored both the real and the potential importance of making better use of technology, especially telehealth and telemedicine [4]. Telehealth denotes the use of technology to deliver remote healthcare advice, while telemedicine is focused more narrowly on delivering clinical services remotely.

The fact that Covid-19 is the fifth virus epidemic this century [5] shows that an investment in telemedicine infrastructure should be part of Fiji’s new normal for health delivery. The benefits of telemedicine will enhance efficacious, cost-effective and patient-centred care as well as patient satisfaction.

Regional telehealth networks [6] have provided an important mechanism to share information and advice about Covid-19 within the Pacific region and across Fiji despite travel restrictions. Unfortunately, telemedicine capacity lagged far behind the need for it.

To maintain the continuity of care, some private general practitioners attempted a form of telemedicine using telephones, email, social media and online platforms to maintain contact with patients remotely.

For established medical practices, a more formal telemedicine capacity could have allowed management and counselling of patients already on their books, especially those with complex chronic illnesses.

Fiji should embrace telemedicine as a priority both to extend the reach of its limited medical capacity and to future-proof the nation against new challenges. As a developing economy, it will have to address critical challenges in order to introduce the advanced technology required.

The barriers to telemedicine technology [7] in developing states include cultural unreadiness, a lack of confidence in the use of the technology, inadequate resources and low health literacy levels.

In Fiji, key infrastructure works through the internet and widespread use of smartphones. However, the delivery of clinical consultation through this infrastructure is restricted by other needs. Most Fijians lack equipment such as digital blood pressure monitors, thermometers and glucometers.

Issues such as government financial support, equitable distribution of resources, health-provider support and patient autonomy will have to be addressed through transparent top-down leadership, combined with bottom-up implementation strategies.

Leadership will be needed to increase support for information and communication technology infrastructure in a way that engages both the public and private health sectors in an integrated network. Fiji’s government will also have to address medico-legal considerations [7] for patients and providers such as the need to ensure confidentiality and security without which telemedicine consultations could be seriously limited.

Adequate physical infrastructure will then have to be made available either directly to individuals or through community nurses. Basic telemedicine tools and knowledge of their use are essential if medical practitioners are to provide clinical services remotely.

Improved clinical services can actually lead to a disruption to health services [8] if there is not effective coordination between the primary care (both public and private) and secondary care sectors. Ensuring this disruption doesn’t occur will also require national leadership.

A coordinated, bottom-up approach for implementation will involve community education strategies along with professional primary-care-provider training to secure confidence in telemedicine from health providers and prospective patients.

In Fiji, telemedicine will also boost access to health services [9] during non-pandemic times. Healthcare delivery and services such tele-referrals, tele-psychiatry, tele-palliative care and tele-pharmacy could be made available to patients in geographically isolated and disadvantaged areas with low health-provider–patient ratios.

With the development of context-specific telemedicine projects through the provision of flexible, adaptable and reusable [10] hardware, software and communication tools, supervised by an ethico-legal regulatory body, the people of Fiji would have access to comprehensive, high-quality healthcare that would increase overall wellbeing.

This post is part of an ASPI research project on the vulnerability of Indo-Pacific island states [11] in the age of Covid-19 being undertaken with the support of the Embassy of Japan in Australia.



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URL to article: https://www.aspistrategist.org.au/covid-19-could-lead-to-telehealth-revolution-in-fiji/

URLs in this post:

[1] many: https://www.fijitimes.com/lives-of-kids-at-stake/

[2] decentralise Covid testing: https://www.rnz.co.nz/international/pacific-news/426338/call-to-decentralise-covid-testing-in-fiji

[3] Private practice services: https://www.bmj.com/content/323/7311/463.short

[4] telehealth and telemedicine: https://www.aafp.org/news/media-center/kits/telemedicine-and-telehealth.html

[5] fifth virus epidemic this century: https://sundial.csun.edu/156361/news/a-timeline-of-outbreaks-from-2000-to-present/

[6] Regional telehealth networks: https://www.spc.int/updates/blog/2020/02/coronavirus-disease-covid-19-what-is-spc-doing-to-help

[7] barriers to telemedicine technology: https://www.intechopen.com/books/telehealth/barriers-to-development-of-telemedicine-in-developing-countries

[8] disruption to health services: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934523/#:~:text=Minimally%20Disruptive%20Medicine%20(MDM)%20is,treatment%20burden%20on%20patients

[9] boost access to health services: https://www.liebertpub.com/doi/10.1089/TMJ.2020.29040.rb

[10] provision of flexible, adaptable and reusable: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5228142/

[11] ASPI research project on the vulnerability of Indo-Pacific island states: https://www.aspi.org.au/report/indo-pacific-island-states-vulnerabilities-age-covid

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