Address by Health Minister, Dr AP Motsoaledi for the 1^st Southern African Telemedicine Conference: Cape Town, 16-17 September 2010

• Deputy Minister: Department of Science and Technology,
• Representative of the WHO,
• Acting President of the MRC, 
• Head of the MTN Foundation,
• Representatives from the various academic institutions,
• Representatives from various Countries,
• Representatives of the various Government Departments,
• Programme Director,
• Ladies and Gentlemen:

I thank you for the opportunity to address you all on the occasion of the 1^st Southern African Telemedicine conference. I would like to take this opportunity to commend the organisers of this conference for their vision and foresight in getting us all together here at our Medical Research Council.

Telemedicine is becoming more and more relevant in the context of developing health systems as it promises to bridge the distance between better resourced health services in the urban areas and less resourced health services in the remote rural communities.  However it is not without costs and challenges, and I am sure that this conference will assist us in unpacking these and devising ways to deal with them so that the promise of telemedicine can be realised – whether to improve patient care or to improve health worker skills and knowledge. 

South Africa has undergone an extended period of piloting telemedicine projects. Twenty-eight telemedicine sites were established between March 1999 and September 2000 and over the years the number had increased to 86 sites. This increase resulted largely from the increased interest of various role players who wanted to make a contribution through research and develop cost-effective, appropriate and innovative ICT tools for telemedicine. These telemedicine sites offered services that included tele-radiology, tele-ultrasonography, tele-pathology, tele-ophthalmology and tele-education.

However, the promise of telemedicine has not yet been realised in South Africa. A a desk-top review by the Department of Health indicates that only 32 of the 86 telemedicine sites were functional at the beginning of 2010.  Various factors have been cited as contributing to this poor performance and lack of sustainability.  Amongst these factors is a lack of coordination and leadership, a lack of critical posts at the provincial offices, inadequate budgets and inefficient use of available funds but above all the weak IT infrastructure and inadequate and unreliable connectivity, in many of the areas which we feel would benefit most. We have also faced problems with the coordination and management of work done by various role players.

We have had engagements on telemedicine with other African countries including Democratic Republic of Congo and Namibia. There was a fact-finding mission to look at the feasibility of establishing a telemedicine system between health facilities in Namibia and South Africa. The initiative was started in 2009 with the University of Cape Town to build capacity in the Cardiology section of the Windhoek Central Hospital in Namibia. This initiative was also designed to enable transmission of angiograms and complex radiological images between South Africa and Namibia.  

We were also involved in the scoping and environmental scanning for the application of Telemedicine in the Democratic Republic of Congo. This initiative did not go beyond the scoping and environmental scanning.

I am also made aware of an African universities network initiative which is involved in providing and promoting distance tele-education.  I am informed that the University of KwaZulu-Natal is actively involved in this initiative.

The causes of problems, weaknesses, challenges and gaps in implementing telemedicine in South Africa and following-through on the various initiatives to support other countries must be analysed in this conference in order to help us and other countries to learn and to chart our way forward.  

As we map out the way forward, I would like to encourage real partnerships and working together under the banner of one national telemedicine strategy.  In South Africa, this means that the national telemedicine strategy should ensure a telemedicine programme is developed to contribute directly towards the country’s four outputs of:

( i) Increasing life expectancy
(ii) Decreasing maternal and child mortality
(iii) Combating HIV & AIDS and decreasing the burden of disease from tuberculosis
(iv) Strengthening health system effectiveness

The strategy should be clear on what telemedicine will do and can realistically achieve. For example, a nurse in a remote rural clinic close to the border of Mozambique can be supported by doctors in an urban hospital in Nelspruit in initiating patients on Anti-retro viral treatment. It is important that the views of and challenges faced by telemedicine users, especially the clinicians, are taken into account when aligning the national telemedicine strategy to the four outputs. This will enable us to implement a telemedicine programme that is informed by practical realities. We also must address the code of ethics, regulatory requirements and telemedicine practice across borders that may pose a barrier to the use of telemedicine applications.

I would like to invite all role players including the Medical Research Council, Centre for Scientific Research, MTN Foundation, University of Stellenbosch, University of KwaZulu-Natal and other role players to work together with the Department of Health in revising and implementing the country telemedicine strategy.

I do hope that the conference will to a great extent devise solutions not only on how to effectively apply telemedicine but also on how to bridge the gap that continues to exist in healthcare delivery - the gap experienced between urban developed areas and rural undeveloped areas. Telemedicine can also be used as an effective communication tool across the region and of course a developmental tool in relation to building skills and capacity. I am sure that the gap-bridging that is the theme of the conference will be dealt with on all fronts by this Conference.

Enjoy the conference and your stay in our country!

Thank You.