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Health from Above: Space-Based Healthcare Services in Africa

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Space Fostering African Societies

Part of the book series: Southern Space Studies ((SOSPST))

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Abstract

Despite recent improvements, health indicators such as child and maternal mortality and life expectancy in Sub-Saharan Africa remain amongst the worst in the world. The meagre healthcare budgets, poor transportation links, unpredictable energy supplies and unreliable internet services that characterise large swathes of the continent exacerbate the problem. Further, the significant mismatch between disease burden and qualified healthcare personnel continues to stifle efforts to reverse these trends. Space-based healthcare systems may be the key to substantial change in healthcare while stimulating economic growth within and beyond the healthcare sector. Indeed the Pan-African e-Network on Tele-education and Tele-medicine (‘PAeN’), an African-wide platform with satellite-based connectivity, was established to help address these problems. Despite its sub-optimal outcomes to date, its potentially transformative role remains clear. In this chapter, a case is made for the urgent revival and refinancing of PAeN specifically and wider implementation of space-based healthcare services generally. An explanation of space-based healthcare services is followed by detailed discussion of African health indicators which make its use particularly vital to the continent. The arrested development of PAeN is then discussed and examples of successful space-based healthcare services are highlighted. Barriers to effective and extensive use of space-based healthcare services are outlined and recommendations on how to overcome them made.

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Notes

  1. 1.

    Para 1(b)(i), The Space Millennium: Vienna Declaration on Space and Human Development, Third United Nations Conference on the Exploration and Peaceful Uses of Outer Space ('UNISPACE III’) (Vienna, Austria, 1999) http://www.unoosa.org/pdf/reports/unispace/viennadeclE.pdf (accessed 2 May 2019).

  2. 2.

    African Union, First Progress Report of the Chairperson of the Commission on the Pan African e-Network on Tele-education and Tele-Medicine, PRC/2 (ii) (7-2018) (Addis Ababa: Meeting of the Permanent Representatives’ Committee, 2018).

  3. 3.

    World Health Organization, Global Health Observatory (GHO) Data (2016).

  4. 4.

    Ibid.

  5. 5.

    Ibid.

  6. 6.

    Countries in other regions of the globe have also sought or are in the processes of attempting to utilise space-based telemedicine, Canada is one example, see “McMaster researchers head north to explore space-based telemedicine”21 July 2009 http://fhs.mcmaster.ca/main/////news/news_2009/space_based_telemedicine.html.

  7. 7.

    Claudia Pagliari et al., “What is eHealth (4): A Scoping Exercise to Map the Field” (2005) 7:1 Journal of Medical Internet Research e9.

  8. 8.

    Kylie Cox Orme, “Guardians of the Galaxy: How Space Tourism Regulation Will Shape Telehealth” (2017) Air and Space Law 163, online: http://www.kluwerlawonline.com/document.php?id=AILA2017013.

  9. 9.

    The American Telemedicine Association, Telemedicine, Telehealth, and Health Information Technology (2006) see also; David Pratt, “Telehealth and Telemedicine in 2015” (2015) 25 Albany Law Journal of Science & Technology 495; Bonnie Kaplan & Sergio Litewka, “Ethical Challenges of Telemedicine and Telehealth” (2008) 17:4 Cambridge Quarterly of Healthcare Ethics 401.

  10. 10.

    Ibid.

  11. 11.

    Gunther Eysenbach, “What is e-health?” (2001) 3:2 Journal of Medical Internet Research E20.

  12. 12.

    N Ateriya et al., “Telemedicine and Virtual Consultation: The Indian Perspective” (2018) 31:4 National Medical Journal of India 215.

  13. 13.

    The Oxford English Dictionary defines ‘tele’, when used as a prefix, as ‘action, observation, or communication at, over, or across a distance, or denoting devices used for this’.

  14. 14.

    For the sake of brevity, ‘space-based healthcare services’ will be used in this chapter as an umbrella term to refer to all medically related services, education and information provided remotely via satellite in orbit.

  15. 15.

    Richard Wootton, John Menzies & Paula Ferguson, “Follow-up Data for Patients Managed by Store and Forward Telemedicine in Developing Countries” (2009) 15:2 Journal of Telemedicine and Telecare 83.

  16. 16.

    Ramesh S Krishnamurthy & Jason Hatton, “Space Science and Technologies to Advance Health-Related Sustainable Development Goals” (2018) 96:3 Bulletin of the World Health Organization 3.

  17. 17.

    PricewaterhouseCoopers, Cost Benefit Analysis of Satellite-Enhanced Telemedicine and eHealth Services in Sub-Saharan Africa (2008).

  18. 18.

    Ibid.

  19. 19.

    E Afarikumah & SY Kwankam, “Deploying actor-network theory to analyse telemedicine implementation in Ghana” (2013) 1:2 Science Journal of Public Health 77 at 77.

  20. 20.

    United Nations Committee on the Peaceful Uses of Outer Space, Report of the Working Group on Space and Global Health, Annex III, Report of the Scientific and Technical Subcommittee on its fifty-sixth session A/AC.105/1202 (Vienna, Austria, 2019); United Nations Committee on the Peaceful Uses of Outer Space, Fourth Meeting of the Expert Group on Space and Global Health held from 31 January to 1 February 2018: Progress Report, Scientific and Technical Subcommittee Fifty-fifth session A/AC.105/C.1/2018/CRP.17 (Vienna, Austria, 2018); United Nations Committee on the Peaceful Uses of Outer Space, Final report of the Action Team on Public Health: The Use of Space Technology to Improve Public Health - Note by the Secretariat, A/AC.105/C.1/L.305 (Vienna, Austria, 2011).

  21. 21.

    United Nations Committee on the Peaceful Uses of Outer Space, supra note 20.

  22. 22.

    United Nations, Space Benefits for Africa: contribution of the United Nations System, Committee on the Peaceful Uses of Outer Space, A/AC.105/941,20 August 2009 http://www.unoosa.org/pdf/reports/ac105/AC105_941E.pdf.

  23. 23.

    Eugen Davies, “Continental Africa Telemedicine Alliance inaugurated”, Business& Financial Times Online, 25 February 2019 https://thebftonline.com/2019/business/health/continental-africa-telemedicine-alliance-inaugurated/ (accessed 9 May 2019).

  24. 24.

    This is also the case in Europe and North America, see Richard Wootton et al., eds, Telehealth in the Developing World (Ottawa: Royal Society of Medicine Press and International Development Research Centre, 2009).

  25. 25.

    Mordor Intelligence, Telemedicine Market - Growth, Trends, and Forecast (2019 - 2024), 2018. https://www.mordorintelligence.com/industry-reports/global-telemedicine-market-industry.

  26. 26.

    Space in Africa, African Space Industry Annual Report: Executive Summary (Lagos, 2019). https://africanews.space/report/.

  27. 27.

    World Health Organization, The Health of the People: What Works - The African Regional Health Report 2014 (Brazzaville, Republic of Congo: WHO Regional Office for Africa, 2014).

  28. 28.

    World Bank, Poverty and Shared Prosperity Report 2018; World Health Organization, supra note 27; World Bank, “Year in Review 2018 in 14 Charts”.

  29. 29.

    United Nations, Department of Economic and Social Affairs, World Population Prospects 2017 – Data Booklet, Data Booklet ST/ESA/SER.A/401 (Population Division, 2017).

  30. 30.

    World Health Organization, Global Health Estimates 2016: Estimated Deaths by Cause, Age and Sex. (World Bank Income Group, 2018).

  31. 31.

    Ibid.

  32. 32.

    The World Bank: Data, Physicians per 1000 People, 2016. World Health Organization's Global Health Workforce Statistics, OECD, supplemented by country data. https://data.worldbank.org/indicator/SH.MED.PHYS.ZS.

  33. 33.

    United Nations Economic Commission for Africa, The Demographic Profile of African Countries, March 2016; Centre for Strategic and International Studies, Urbanisation in Sub-Saharan Africa, 2018.

  34. 34.

    Alvin Powell, “Where Surgery is Lacking”, The Harvard Gazette, 8 November 2010 https://news.harvard.edu/gazette/story/2010/11/where-surgery-is-lacking/.

  35. 35.

    John G Meara et al., “Global Surgery 2030: Evidence and Solutions for Achieving Health, Welfare, and Economic Development” (2015) 386:9993 The Lancet 569.

  36. 36.

    Ibid.

  37. 37.

    Manop Kanato, “Drug Use and Health Among Prison Inmates” (2008) 21:3 Current Opinion in Psychiatry 252.

  38. 38.

    Whilst most of the literature in this area are based on findings in North America or Europe, evidence suggests that similar or worse situations exist in African countries see, Richard Smith, “Prisoners: an end to second class health care?” (1999) 318:7189 British Medical Journal 954; Department of Health, Joint Prison Service and National Health Service Executive Working Group. The Future Organisation of Prison Health Care (London, 1999); Victor Kwawukume, “Prisons Council to Construct Modern Hospital”, The Daily Graphic (3 June 2016), online: https://www.graphic.com.gh/news/general-news/prisons-council-to-construct-modern-hospital.html; A A Sarpong et al., “An Assessment of Female Prisoners’ Perception of the Accessibility of Quality Healthcare: A Survey in the Kumasi Central Prisons, Ghana” (2015) 5:3 Annals of Medical and Health Sciences Research 179.

  39. 39.

    Buddhika Senanayake et al., “Telemedicine in the Correctional Setting: A Scoping Review” (2018) 24:10 Journal of Telemedicine and Telecare 669; World Health Organization, Telemedicine: Opportunities and Developments in Member States: Report on the Second Global Survey on eHealth (Geneva, Switzerland, 2009).

  40. 40.

    African Union, supra note 2.;Ministry of External Affairs, Government of India, http://www.mea.gov.in/Portal/ForeignRelation/Pan-Project-March-2012.pdf.

  41. 41.

    African Union, supra note 2.

  42. 42.

    Eurisy, ‘Satellite-based healthcare solutions: bringing services closer to patients’, 24 April 2019 https://www.eurisy.org/article-satellitebased-healthcare-solutions_40 (accessed 28 May 2019).

  43. 43.

    African Union, supra note 2.

  44. 44.

    Ibid at 7.

  45. 45.

    PricewaterhouseCoopers, supra note 17

  46. 46.

    Ibid at 5.

  47. 47.

    Ibid at 4.

  48. 48.

    Victoria M Gammino et al., “Using Geographic Information Systems to Track Polio Vaccination Team Performance: Pilot Project Report” (2014) 210 The Journal of Infectious Diseases S98

  49. 49.

    Ibid at S100 For the prevalence of hand-drawn maps see also, Ed Yong, “Most Maps of the New Ebola Outbreak Are Wrong”, The Atlantic (21 May 2018), online: https://www.theatlantic.com/health/archive/2018/05/most-maps-of-the-new-ebola-outbreak-are-wrong/560777/.

  50. 50.

    Gammino et al., supra note 49 at S100.

  51. 51.

    Marlene M Maheu et al., The Mental Health Professional and the New Technologies: A Handbook for Practice Today (Mahwah, New Jersey: Lawrence Erlbaum Associates, 2011) at xviii and 451.

  52. 52.

    Michael W King, “Telemedicine: Game Changer or Costly Gimmick” (2018) Denver Law Review 289.

  53. 53.

    A Le Roux, “Telemedicine: A South African Legal Perspective” (2008) Journal of South African Law.

  54. 54.

    Health Professions Council of South Africa, General Ethical Guidelines for Good Practice in Telemedicine, Pretoria, South Africa, August 2014 https://www.hpcsa.co.za/Uploads/editor/UserFiles/downloads/conduct_ethics/Booklet%2010.pdf.

  55. 55.

    Space in Africa, “Ivory Coast to Become the 9th African Country with Satellite in Space”, 26 July 2018 https://africanews.space/ivory-coast-to-become-the-9th-african-country-with-satellite-in-space/.

  56. 56.

    Space in Africa, supra note 26.

  57. 57.

    John Nkengasong, Benjamin Djoudalbaye, & Olawale Maiyegun, “A New Public Health Order for Africa’s Health Security” (2017) 5 The Lancet e1064.

  58. 58.

    African Union, Agenda 2063: Framework Document, pg.v, September 2015.

  59. 59.

    Ethiopian Space Science and Technology Institute http://etssti.org/establishment/; Ghana Space Science and Technology Institute https://gssti.gaecgh.org; National Space Research and Development Agency https://nasrda.gov.ng/en/tenders-eoi/.

  60. 60.

    African Union, supra note 2.

  61. 61.

    Damien Dietrich et al., “Applications of Space Technologies to Global Health: Scoping Review” (2018) 20:6 Journal of Medical Internet Research e230.

  62. 62.

    Maurice Mars, “Telemedicine and Advances in Urban and Rural Healthcare Delivery in Africa” (2013) 56:3 Progress in Cardiovascular Diseases 326.

  63. 63.

    Liezel Cilliers & Stephen Flowerday, “User Acceptance of Telemedicine by Health Care Workers A Case of the Eastern Cape Province, South Africa” (2014) 65:1 The Electronic Journal of Information Systems in Developing Countries 1 at 1.

  64. 64.

    Cilliers & Flowerday, supra note 64; S Nwabueze et al., The Effects of Culture of Adoption of Telemedicine in Medically Underserved Communities (Hawaii: International Conference on System Sciences., 2009); Mars, supra note 63.

  65. 65.

    Afarikumah & Kwankam, supra note 19 at 83.

  66. 66.

    Scott A Borgetti, Philip J Clapham & Jeremy D Young, “Telehealth: Exploring the Ethical Issues” (2017) DePaul Journal of Health Care Law.

  67. 67.

    Ateriya et al., supra note 12.

  68. 68.

    Borgetti, Clapham & Young, supra note 67 cf. Nola M Ries, Briony Johnston & Shaun McCarthy, “Technology-Enabled Legal Service Delivery for Older Adults: What Can Law Learn from Telehealth: Findings from an International Review of Literature” (2016) Elder Law Review

  69. 69.

    Madeleine Rosuck, “Telemedicine Is the New Narcotics Candy Store: Teladoc Opens the Floodgates for the Unrestricted Sale of Dangerous Drugs Case Notes” (2018) SMU Science and Technology Law Review 89.

  70. 70.

    Caroline Klimek, “Using Outer Space in the Fight Against Ebola”, Faculty of Medicine, University of Toronto, 20 August 2015 https://medicine.utoronto.ca/news/using-outer-space-fight-against-ebola (accessed 3 May 2019).

  71. 71.

    African Union, African Health Strategy: 2016-2030, pp. 7 and 12 https://au.int/sites/default/files/documents/30357-doc-final_ahs_strategy_formatted.pdf

  72. 72.

    African Union, African Space Strategy: Towards Social, Political and Economic Integration, HRST/STC-EST/Exp./16 (II) (Cairo, Egypt: Second Ordinary Session for the Specialized Technical Committee Meeting on Education, Science and Technology, 2017).

  73. 73.

    African Union, African Space Strategy: Towards Social, Political and Economic Integration, HRST/STC-EST/Exp./16 (II) (Cairo, Egypt: Second Ordinary Session for the Specialized Technical Committee Meeting on Education, Science and Technology, 2017).

  74. 74.

    Eurisy, ‘Satellite-based healthcare solutions: bringing services closer to patients’, 24 April 2019 https://www.eurisy.org/article-satellitebased-healthcare-solutions_40 (accessed 28 May 2019).

  75. 75.

    Richard FitzGerald, “Telemedicine doctors abroad don’t have to register with the GMC” (2012) 344 British Medical Journal e873.

  76. 76.

    Julia Selman Ayetey, “Ghana must use space for national development”, The Daily Graphic, 20 February 2019 https://www.graphic.com.gh/features/features/ghananews-ghana-must-use-outer-space-for-national-development-2.html (accessed 4 May 2019).

  77. 77.

    Though Algeria and Kenya have spacesports they have been inactive for more than 10 years, see Thomas G Roberts, Spaceports of the World, CSIS Aerospace Security Project (Centre for Strategic & International Studies, 2019).

  78. 78.

    Afarikumah & Kwankam, supra note 19; Paul J Hu et al., “Examining the Technology Acceptance Model using Physician Acceptance of Telemedicine Technology” (1999) 16:2 Journal of Management Information Systems 91.

  79. 79.

    Innovation Science Technology Africa http://www.ist-africa.org; Ghana Tech Summit http://ghanatechsummit.com.

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Authors and Affiliations

  1. Faculty of Law, University of Cape Coast and Doctoral Candidate, Institute of Air and Space Law, McGill University, Montreal, Canada

    Julia Selman Ayetey

  2. Department of Internal Medicine and Therapeutics, School of Medical Science and Cape Coast Teaching Hospital, Cape Coast, Ghana

    Harold Ayetey

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Correspondence to Harold Ayetey .

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  1. SpaceLab, University of Cape Town, Rondebosch, South Africa

    Annette Froehlich

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Selman Ayetey, J., Ayetey, H. (2020). Health from Above: Space-Based Healthcare Services in Africa. In: Froehlich, A. (eds) Space Fostering African Societies. Southern Space Studies. Springer, Cham. https://doi.org/10.1007/978-3-030-32930-3_10

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