By Betsy Amsalu

As access to healthcare becomes more challenging due to the rising costs and in many cases, the lack of health care professionals, telemedicine has become an integral aspect of health care delivery in health systems globally. It is now possible for patients to connect with a physician, get a diagnosis, and order prescriptions all from the comfort of their home. The importance of telemedicine cannot be overstated, especially in the era of Covid-19. However, the conveniences of telemedicine do not apply or operate in most developing countries like Ethiopia. Despite overall gains in healthcare access and quality, the majority of Ethiopians are still unable to obtain medical care due to the high out-of-pocket costs for health services, inadequate access to transportation, and mistrust of modern medicine and healthcare providers caused by the inability to understand and analyze health information required to make informed health decisions. The incorporation of telemedicine is arguably the most viable solution to the dire health care problems in Ethiopia. There are several proven telemedicine models in different countries that can be replicated with minimal investment, which can yield improved health outcomes.
Ethiopia’s health system is unable to meet the demand for care, causing prolonged wait times to see primary care providers and specialists. Instead of waiting, patients choose to see private providers, despite the immense financial strain. Limited access to care, in addition to the lack of resources to manage the prevalence of disease, the Ethiopian life expectancy is a mere 66.95 years. Although the maternal mortality rate has shrunk significantly since 2000, the maternal mortality rate sits at 412 per 100,000 live births and child mortality rate at 67 per 1,000 in 2020 according to USAID. Additionally, a 2018 study by the World Bank found that there is only one physician per 10,000 people in Ethiopia. Few nations, most of which in Africa, have a lower physician-to-population density compared to Ethiopia. These poor health statistics can be reversed by implementing telemedicine as a vital component of the health system. Ethiopia has one of Africa’s most sophisticated telecommunications industry as well as one of the fastest-growing economy. Information and Communication Technology (ICT) has seen remarkable growth in the last few decades. Although, development of telemedicine on a grand scale requires serious financial and human resources, Ethiopia’s growth in the ICT sector is a promising development for telemedicine’s prospect.
There are proven models that have successfully managed to bridge the healthcare gap and can be replicated in Ethiopia. For example, MedicallHome, a telemedicine program in Mexico provides telephone access to licensed doctors 24/7, coupled with sizable discounts at a national network of more than 10,000 healthcare providers. The program mainly serves low- and middle-income households and costs $2 to $5 per month. The implementation of this model has led to the dramatic reduction in inefficient utilization of health services. The program successfully reduced the number of users that utilize emergency room services, which resulted in significant savings for patients and the overall health system. In addition to the potential for cost reduction, this model relieves some pressure in an overstrained healthcare system. With over 80 million mobile subscriptions in Ethiopia, the country has the capacity to adopt this model and expand health care access to millions of citizens. The primary goal of telemedicine in Ethiopia should be the expansion of healthcare access with the objective of improving the poor health statistics.
Although telemedicine is an important component of a healthcare system, there are immense application challenges and barriers. There are several factors that will affect the proper implementation and utilization of telemedicine in Ethiopia. These factors include, but not limited to, the government’s willingness to provide sufficient funding to coordinate and administer high quality telehealth services, active collaboration between academia and health care providers to train new healthcare professional entering the workforce on the proper use of telemedicine, and securing foreign investments and expertise to support costs. According to the Word Bank, Ethiopia spent a mere 3.3% of GDP on health care in 2018 compared to the 5.47% health care expenditure in 2010. Restructuring the existing healthcare delivery workflow to include telemedicine will require a robust collective effort from all stakeholders, including the unwavering financial backing of the federal government and the Ministry of Health.
Ethiopia has achieved significant health improvements in the last few decades, such as lowering infant and maternal mortality, but more work is required-particularly in rural areas. Telemedicine alone will not solve the crumbling health care system in Ethiopia. However, with the proper guidance from the government and much needed investment from the private sector, telemedicine can play a significant role in improving the health of the nation. The implementation of telemedicine on a grand scale will undoubtedly meet many challenges along the way. However, it can be achieved with a collective collaborative effort of various sectors. The Federal Ministry of Health along with organizations like the Bill & Melinda Gates Foundation, should develop a strategy to implement telemedicine in Ethiopia’s health infrastructure.

The writer can be reached via ba53584n@pace.edu

Globally, antibiotic use in hospitals has surged since the start of the COVID-19 pandemic, and over-the-counter sales, legal in many countries, have soared. This is further fueling the global crisis of antimicrobial resistance, as bacteria evolve and become immune to these drugs.

By LOICE ACHIENG OMBAJO

Fear of COVID-19 is driving increased over-the-counter (OTC) sales and in-hospital prescriptions of antibiotics – and fueling a silent pandemic in its wake.
Globally, antibiotic use in hospitals has surged since the start of the COVID-19 pandemic. Even though studies show that only 8% of patients admitted to hospital with COVID-19 also have an infection requiring antibiotics, more than 70% receive them. In addition, many people worried about possible or actual COVID-19 symptoms, and alarmed by global reports about the pandemic, have turned to buying antibiotics without seeing a health-care worker.
This is further fueling the global crisis of antibiotic resistance, as bacteria evolve and become immune to these drugs. We must move quickly – with international policy, national laws, and local action – to control what the World Health Organization has identified as one of the ten leading health threats to humanity.
Antibiotics treat infections caused by bacteria, and have no impact on a virus such as SARS-CoV-2, which causes COVID-19. Overusing them merely accelerates the emergence of antibiotic resistance, which will undercut our ability to treat common diseases. Simple infections such as pneumonia or urinary tract infections, which currently can be quickly cleared by common antibiotics, may prove impossible to treat and become deadly.
This is particularly true in many African, South American, and Asian countries, where access to health-care workers is limited and there are no restrictions on antibiotic sales. In India, antibiotic sales have risen astronomically in recent years, largely driven by unregulated OTC purchases, including of unapproved drugs. Likewise, in Kenya, all antibiotics can be purchased without a prescription.
Bacteria that develop resistance to multiple antibiotics are responsible for causing difficult-to-treat infections, which are up to three times more likely to kill people than infections caused by non-resistant bacteria. And data from several countries – including China and Egypt – indicate that up to 50% of bacteria-causing infections in critical-care units are resistant to several antibiotics. In the United States, it is estimated that close to three million people get an antibiotic-resistant infection each year, leading to more than 35,000 deaths annually.
Drug-resistant bacteria are also more likely to spread from person to person, and have been known to cause large disease outbreaks in hospitals. Many COVID-19 treatment wards around the world are currently grappling with this problem.
As an infectious-disease specialist working on the COVID-19 management front line and also leading the treatment of drug-resistant infections in Kenya, I have often struggled to treat patients with severe bacterial infections that had developed resistance to all available antibiotics. Many of the recently developed drugs that could potentially treat resistant bacteria are often extremely expensive and not available in many countries. A ten-day course of one such antibiotic in Kenya, for example, costs almost $10,000, putting it beyond the reach of most patients.
In fact, many patients entering the hospital for COVID-19 treatment say that they have already taken one or more antibiotics at home in an attempt to address some of their symptoms. Often, using these drugs had made them feel that they were being treated, so they delayed going to the hospital.
Some may argue that allowing unrestricted use of antibiotics can enable access to treatment for those unlikely to be able to see a doctor, and may be cheaper for the poor. But the resulting antibiotic resistance is expensive to treat and potentially costs lives.
What must we do to forestall this next pandemic? For starters, the WHO and other global agencies must speak out much more strongly and explicitly against the use of antibiotics in cases of COVID-19, unless these drugs are specifically indicated for another bacterial infection.
In addition, national governments must tighten restrictions on OTC antibiotic purchases. Evidence suggests that introducing and enforcing laws to limit such sales can be effective if these efforts are sustained over time. Requiring pharmacies to display a notice stating that it is illegal to sell antibiotics to customers without a doctor’s prescription also has been associated with reduced antibiotic sales.
Hospitals should adopt so-called antibiotic stewardship strategies to reduce unnecessary prescriptions. These measures can lead to reduced antibiotic use and cost, and decrease the risk of antibiotic-resistant infections in hospitals. Effective strategies could include developing guidelines for managing common infections, restricting antibiotic use in viral infections, strengthening laboratory capacity – especially in low- and middle-income countries – to help clinicians identify the correct bacteria to treat, and providing continuing education for all clinicians.
Finally, individuals – despite their understandable fears of COVID-19 – should not risk harming themselves by using antibiotics unnecessarily.
The message is clear: if we do not act now to curb antibiotic use, we will invite a new pandemic. And, unlike COVID-19, no vaccine will save us.

Loice Achieng Ombajo is an infectious-disease specialist at the University of Nairobi and a 2021 New Voices Fellow at the Aspen Institute.