PROPOSAL FOR THE DELIVERY OF MEDICAL

CONSULTATION SERVICES USING THE

TELECOMMUNICATION SYSTEM

Date: DECEMBER 2018

Submitted by: KEHBUSAL (NIG)

Submitted to: MTN FOUNDATION - HEALTH

INTRODUCTION
This proposal has been prepared on behalf of the KEHBUSAL (NIG.) an organization that
represents Cal Dr. interests and concerns.
 PURPOSE
The purpose of this proposal is to highlight the need for the creation of a medical consultation
service (cal doctor)using the telecommunication system (MTN) in Nigeria. In this proposal, we
will define the current healthcare service been rendered and the challenges they face in Nigeria,
and will discuss why medical services should be used via telecommunication system i.e. medical
consultation to fill up the healthcare grap in the country.
 SUMMARY
Healthy communities are the backbone of strong, sustainable societies. But there are still
millions of people without access to basic healthcare. Access to quality medicines has been
identified as one of the greatest challenges facing Africa. According to WHO, many of the most
neglected people in terms of healthcare live in the poorest countries often in Sub-Saharan
Africa and in the rural areas.

In Nigeria over 70% of the population live in the semi urban and rural areas, where affordability
and access to quality healthcare is a major challenge.

In the public health-care space, we face poor infrastructure, old or inoperative equipment and
generally poor attitude, even skills and competency levels are often questioned. If you have
taken a seriously ill patient to our public health facilities – be they primary, secondary or
tertiary institutions, you will have known that many more people are healed by faith in Nigeria
than by medical care [1]. The state of healthcare in Nigeria has been worsened by several
factors. As a result of this,the creation of a medical consultation service (cal doctor)using the
telecommunication system (MTN) is urgently needed to save the crumbling health sector by
resolving most of the healthcare related issues

1. As it will reduce the workload of hospitals

2. Provide health service for both the rural and urban areas
3. Reduce cost related service e.g. transportation to health centre when not needed
4. Accessible to both the financial needy and stable patient
5. Provide easy access to health service
6. Breaking communication barrier between patient and doctor by providing preferred
choice of language for patients
7. To follow up health services been rendered to ensure maximum satisfaction.
8. Educate patients
9. To reduces patronage of quacks like the Mallam trying to sell you “ burantasi” at the
filling station, to the unlicensed “doctor” hanging a stethoscope and trying to diagnose
“staphylococcal” infections, to the illiterate medicine dealer who is mixing you a
concoction of black and red capsules and yellow tabs from his illegal and ramshackle
kiosk for the treatment of malaria and thyphoid, pretending to be a “chemist”.
 RECOMMENDATIONS
1. That CAL DOCTOR be identified as a recognized specialty to aid the healthcare system.

2. That the practitioners employed should be licensed.

3. That employees goes through customer care training.

4. That the employee are constantly updated on customer care service improvement.

5. That all calls be recorded for safe keeping and is subject to review for improvement.

6. That all calls are treated as important and confidential

THE HEALTH SECTOR IN NIGERIA
The Nigerian health care has suffered several down-falls.[ 2 – 8] Despite Nigerian's strategic
position in Africa, the country is greatly underserved in the health care sphere. Health facilities
(health centers, personnel, and medical equipments) are inadequate in the country, especially
in rural areas.[2, 6 ] While various reforms have been put forward by the Nigerian government
to address the wide ranging issues in the health care system, they are yet to be implemented at
the state and local government area levels.[ 3 , 6] According to the 2009 communiquι of the
Nigerian national health conference, health care system remains weak as evidenced by lack of
coordination, fragmentation of services, dearth of resources, including drug and supplies,
inadequate and decaying infrastructure, inequity in resource distribution, and access to care
and very deplorable quality of care. The communiquι further outlined the lack of clarity of roles
and responsibilities among the different levels of government to have compounded the
situation.[ 3 ]

Unarguably, problems in the health care system of any country abound to a certain extent.[ 9 –
12] Although health has the potential to attract considerable political attention, the amount of
attention it actually receives varies from place to place.Provision of timely information aimed at
combating possible health menace among many other things is an important function in the
health sector. Hence, inadequate tracking techniques can lead to huge health insecurity, and
hence endanger national security, etc.

Indicators of health care in Nigeria

In spite of the huge development in the health care in relation to the last decades,[ 12 ,14 – 16 ]
much is still needed to be done in the health care system.

Although the total expenditure in health amounts to 4.6% GDP,[ 12 ] financial managerial
competency, besides inadequate funding, remains a major problem. Current statistics show
that health institutions rendering health care in Nigeria are 33,303 general hospitals, 20,278
primary health centers and posts, and 59 teaching hospital and federal medical centers.[ 13 ]
This represents a huge improvement in regards to the last decades; nonetheless, health care
institution continues to suffer shortage.
Major flaws in the Nigerian health care system
In spite of the various reforms to increase the provision of health to the Nigerian people, health
access is only 43.3%.[ 5 ] The inadequacy of the health care delivery system in Nigeria could be
attributed to the peculiar demographics of the Nigerian populace. In Nigeria over 70% of the
population live in the semi urban and rural areas, with about ~30% living in the urban
areas.[ 13 ,17 ] About 60% of the health care is provided by private vendors and only 40% by
the government.[ 13 ,19 –24 ] Over 70% of drugs dispensed are substandard. Hence, the
ineffectiveness of the NIHS had recently been attributed to the fact that the scheme represents
only 40% of the entire population, and 52-60% are employed in the informal sector.

Over half of the population live below the poverty line, on less than $1 a day and so cannot
afford the high cost of health care.[ 17 ] Also, a recent study by Akande had reported a poor
referral system between the various tiers of health care which probably tells on the poor
managerial functions of the health care delivery system.[ 18 ]

At the primary health care level, some have sort solutions to the aforementioned flaws. For
example, several community health financing schemes [Community Based Health Insurance
(CBHI)] from individuals’ (taxi drivers, market women, etc.) effort to provide the health needs
for their communities are documented.[ 5 ,18 ] Some urban subpopulations have also initiated
the scheme. The number of CBHI probably exceeds 585 according to a recent report by Obinna
Onwujekwe and colleagues (2010).[ 5 ] In that study, the authors reported high preferences for
health care benefits both at the urban and rural areas. Problems encountered in the CBHI are
its very small and inadequate funding capabilities. That notwithstanding, some CBHI have
increased their scope to be registered as health maintenance organizations.[ 5 ] Also, quality of
health care provided is not accessed, although this remains a problem for the NHIS too.

Outside the inadequate medical practitioners to meet up the medical need of the general
populace, and difficulties accessing quality healthcare, there are loads of frustrating procedures
faced by people trying to access healthcare unless, the private option which is expensive and
not easily affordable by the majority, that's why there are always high prevalence of one
disease or the other most especially in the Sub-Saharan Africa. For example, in Nigeria using the
government healthcare facility as a case study. When trying to access a government hospital,
the problems encountered are sometimes more than the health challenges (problem) faced. Is
it the time and energy wasted to get or open your file?, or the time wasted before you are
attended to due to insufficient staff, to the illed manners of the practitioners or the inability to
show care(empathy) and a long list so on, but with the introduction of Cal Dr. these health
challenges would become history putting quality health care at your finger tips.
Cal Dr.
This is an advanced medical platform which involves the introduction of telecommunication
services into the health-care sector, to tackle major healthcare challenges faced in the country.

When a call is passed through, our customers are answered by an answering machine which
connects them to our doctors. After quality consultation are rendered, our doctor are
automatically connected to a care agent, which the necessary informations are shared. Cal Dr.
in turn sends this information to our customers through a text message or e-mail. In cases of
appointment booking, our doctors would explain the required informations in booking an
appointment,which after our customer are connected to a care agent whom would follow
through with the booking, details about the appointments are sent through a text message or
e-mail.

Cal Dr. not only functions as a form of Health service booking and medical advisory but also
create a strong referral system, track, monitor,educate about health and aid control of disease
outbreak. This platform comes in two bundles to meet the wide demand for health service, the
free for all service and the subscription based platform.

Free for all service

This services are benefited by non subscribed customers, they would be accessed for free when
a call is passed through, they include.

 Options for language selection.

 Quality consultation in form of medical advisory.
 Prescriptions of drugs mostly OTC drugs.
 Provide in-depth explanations to any diseases conditions.
 Book appointment with a trusted diagnostic centre closest to subscribers location.
 Notify customers when their test results are ready.
 Send follow-up messaged.
 Menstrual Cycle planner, specially for the ladies.
 Send notifications/informations about suspected disease outbreak, signs and symptom,
prevention e.t.c

Subscription based service

The services rendering to our subscribers, would be accessed through both the social media
platform and when a call is passed through, they include.

 Options for language selection.

  Lower call rate when calling kal Dr. customer service.
 Quality consultation in form of medical advisory.
 Wide range prescription of drugs but limited by FDA class of controled and monitored.
 Provide in-depth explanations to any diseases conditions.
 Book appointment with a trusted diagnostic centre closest to subscribers location.
 Provide quotations and secure discounts on booked test for our subscribers.
 Notify subscribers when their test results are ready.
 Create a strong referral system for cases best attended to in a hospital.
 Book and follow up for referrals made to the hospital.
 Options to opt-in for medical sessions like psychotherapy session, antenatal topic
discussions etc
 Medical sessions are not limited to calls only and can also be accessed via the online
platform for better service delivery.
 The psychotherapy session can be best accessed via video chats and the antenatal via
live streaming videos.
 Menstrual Cycle planner, specially for the ladies.
 Send follow-up messages.
 Live chat via social media.
 Send notifications/informations about suspected disease outbreak, signs and symptom,
prevention e.t.c
 Daily Health Tips sent directly to your phone, so you never mis out.

The services by Cal Dr. are prone to improvement, as more services would be added Or
reformed to improve service delivery, which would be achieved by research and customers
feedback

Benefits
1. Affordability is key as it is affordable to both the financial needy and stable populace.
2. Accessible irrespective of the geographical location.
3. Health service has never be easier to access, as medical care would be time effective.
4. Its primary objective, is to reduce the work load off hospitals, not to take works best
handled by the hospital.
5. Improve the quality of healthcare across the country.
6. Eliminate language barrier.
7. Most health challenges people find difficult disclosing to doctors due to social factors
like self integrity, would be easily disclosed comfortably since personal informations are
not disclosed.
A reseaech was carried out by Glob Health Action on barriers accessing health care in
Nigeria.Data came from a nationally representative sample of 18,028 women (aged 15–49) who
had a total of 28,647 live births within the 5 years preceding the 2008 Nigeria Demographic and
Health Survey. The risk of death in children below age five was estimated using Cox
proportional hazard models and results are presented as hazards ratios (HR) with 95%
confidence intervals (CI). Data were collected using face-to-face interviews, the questions asked
included getting permission to access health care, 2) not wanting to go alone, 3) concern that a
female health worker may not be available, 4) getting money needed for treatment, 5) concern
that a male health worker or any health worker may not be available, 6) concern that drugs
may not be available, 7) distance to healthcare facility and 8) transport cost [25].

The study result indicate higher under-five mortality risks for children whose mothers had
cultural barriers and children whose mothers had resource-related barriers to health care (HR:
1.44, CI: 1.32–1.57, p <0.001), and those whose mothers had physical barriers (HR: 1.13, CI:
1.04–1.24, p <0.001), relative to children whose mothers reported no barriers [ 25 ]. Barriers to
health care remains an important predictor of child survival. The benefits of Cal Dr. would aid
breakdown this barriers in accessing health care to a minimum.

Task schedule layout

1. An estimated time frame of 6 months which might be extended as it is contingent on
other factors.
2. Setup a customer care centre and an active care line.
3. Setup social media platform, which should take a duration of 5 months.
4. Program and testing of the platforms.
5. The continues recruitment of practicing practitioners in relations to increase in demand,
with about 80% to 85% of them being contract employees.
6. Patient to doctor ratio of approximately 1:1,105 per annum for contract employees.
7. Training of practitioners on customers care service.
8. Communicate the new workflow to the employees.
9. Communicate the aims, goals, rules of engagements and policy to the employees.
10. Recording of calls with the aim to improve customer service, and for researcher/
reference purposes.
Funding
Funding and administrative structures for Cal Dr. service delivery are different in each
geographical location. Funding mechanisms, available manpower, cultural practices such as the
practice of purdah system (i.e. wife seclusion) and level of literacy have created the need for
variability[ 26 – 28 ].

In Northern Nigeria, the Ministry of Health budget to Community Health Care are little in
respect to their population, and compliance rate are low due to literacy level, financial state
and cultural practices e.g. practice of purdah system (i.e. wife seclusion)

In Western Nigeria, the Ministry of Health funds Community health Care and compliance is high
but problems faced by the general populace trying to access it, is disturbing from the general
attitude of medical staff to insufficient medical practitioners.

The most effective model for funding Cal Dr. service delivery is inconclusive, as start up cost,
Labour supply cost, maintenance cost and on going monthly charges are yet unattained as tools
for financial research are limited

Revenue Model
Fees are charged at a rate of #1,000 naira to each subscriber for a year (365 days), revenue are
also going to be generated from calls rate per minute. For free for all customers a 10% revenues
will be generated from referrals made to diagnostic centre, and also calls rate.

Estimated Growth first year

80,000 customers with an approximation of 20% being subscription based customers, slow
growth is expected as sensitization programs are required to promote trust

20% of 80,000customer makes 16,000 subscription based customers

Each subscribed customers pays a annual fee of #1,000

Relevant competition
Previous solution have been attempted to improve the poorly ranked 140th position of Nigeria
in the global healthcare access report [29 ], taking advantage of the growing technological age
without considering the socio-economic status that Nigeria overtakes India on the world
extreme poverty list with 86.9 million people which is about 33.1% of the population [ 30 ], and
the illiteracy level which is high in northern part of the country, not forgetting that majority of
the citizens with poor access to quality healthcare falls within this class.

This led to the creation of ADA, a medical mobile application which is limited to internet users
without considering the non internet users, illiterates and people who can't express their
feelings/state in writing, other creations like Kangpe which is accessed by mobile application
and website and others have been created with little effect on the health sector.

I became aware of this problem during my early years as a student nurse during my clinicals,
with my knowledge in both medical ( both government and private sector ) and management
sector, I have come to realise more ways are needed to aid the medical sector.
 CONCLUSION
Current literatures in the Health sector and the outcome of the research on barriers accessing
health care in Nigeria clearly demonstrate the benefits of Cal Dr. in enhancing the health
service experience in the country. It is unrealistic to expect that the over-loaded health care
system will be able to meet the ever-increasing demands from the country. Cal Dr. those not
aim to take the work load of the hospital but to reduce the work load off the hospital as its
benefits outweighs the cost, it services are the most effective and efficient system for service
delivery as it is the first of its kind ( Health-care and Telecommunication sector together ).

Thank you for your time and consideration, I look forward to discussing further this proposal
with you.
Defined Terms
Practitioners :A person who practices a profession or art, especially law or medicine

Dearth: A period or condition when food is rare and hence expensive; famine.

Deplorable: To be felt sorrow for; worthy of compassion.

Prevalence: (epidemiology) The total number of cases of a disease in a given statistical

population at a given time, divided by the number of individuals in that population.

OTC drugs: Over The Counter drugs

Contingent: (with upon) Dependent on something that is undetermined or unknown.

 REFERENCES
1. Mazi Sam Ohuabunwa. Nigeria’s healthcare: Both the poor and the rich cry. 2018 Available
from: https://www.vanguardngr.com/2018/09/nigerias-healthcare-both-the-poor-and-the-rich-
cry/ [cited 10 September 2018].

2. Health Reform Foundation of Nigeria (HERFON) [Last accessed on 2010 Nov 23]. Available
from: http://www.herfon.org/

3. Maternal Mortality in Nigeria. [Last accessed on 2010 Dec 16]. Available from:
http://reproductiverights.org/en/feature/maternal-mortality-in-nigeria .

4. Nigeria National Health Conference 2009 Communique. Abuja, Nigeria. [Last accessed on
2010 Nov 5]. Available from: http://www.ngnhc.org .

5. Nnamuchi O. The right to health in Nigeria. ‘Right to health in the Middle East’ project, Law
School, University of Aberdeen. Draft Report December 2007. [Last accessed on 2010 June 21].
Available from: http://www.abdn.ac.uk/law/hhr.html .

6. Onwujekwe O, Onoka C, Uguru N, Nnenna T, Uzochukwu B, Eze S, et al. Preferences for

benefit packages for community-based health insurance: An exploratory study in Nigeria. [Last
accessed on 2010 June 21];BMC Health Services Research. 2010 10:162. Available from:
http://www.biomedcentral.com/1472-6963/10/162 .[ PMC free article] [ PubMed ]

7. Nigeria Primary Health Care Policies. Available from:

http://www.photius.com/countries/nigeria/society/nigeria_society_primary_health_care_~100
06.html .

8. Asangansi I, Shaguy J. Proceedings of the 10 International Conference on Social Implications

of Computers in Developing Countries. Dubai: 2009. May, [Last accessed on 2011 Jan 2].
Complex dynamics in the socio-technical infrastructure: The case with the Nigerian health
management information system. Available
from:http://www.ifip.dsg.ae/Docs/dc17_Asangansi_finalv3.pdf .

9. Dougherty D, Conway PH. The “3T’s” road map to transform US health care. The “how” of
high-quality care. JAMA. 2008;299:2319–21. [ PubMed ]

10. Davis K, Schoenbaum SC, Audet AM. A 2020 vision of patient-centered primary care. J Gen
Intern Med. 2005;20:953–7. [ PMC free article] [ PubMed ]
11. Green-Pedersen C, Wilkerson J. How agenda-setting attributes shape politics: Basic
dilemmas, problem attention and health politics developments in Denmark and the US. J Eur
Publ Pol. 2006;13:1039–52.

12. Moe JL, Pappas G, Murray A. Transformational leadership, transnational culture and
political competence in globalizing health care services: A case study of Jordan's King Hussein
Cancer Center. [Last accessed on 2010 Oct12];Globalization and Health. 2007 3:11. Available
from: http://www.globalizationandhealth.com/content/3/1/11 . [PMC free article ] [ PubMed]

13. Omoruan AI, Bamidele AP, Phillips OF. Social health insurance and sustainable healthcare
reform in Nigeria. Ethno Med. 2009;3:105–10.

14. Healthcare. [Last accessed June 10]. Available from:

http://www.motherlandnigeria.com/health.html .

15. Awosika L. Health insurance and managed care in Nigeria. Ann Ibadan Postgrad Med.
2005;3:40–6.

16. Akande TM. Referal system in Nigeria: Study of a tertiary health facility. Ann Afr Med.
2004;3:130–3.

17. Steinberger R, Fuart F, van der Goot E, Best C, von Etter P, Yangarber R. Text mining from
the web for medical intelligence. In: Perrotta D, Piskorski J, Soulie-Fogelman F, Steinberger R,
editors. In: Mining Massive Data Sets for Security. Amsterdam, the Netherlands: OIS Press; 2008.

18. Akande TM, Monehin JO. Health management information system in private clinics in iIorin,
Nigeria. Nig Med Pract. 2004;46:102–7.

19. Health Insurance report. Repositioning the National Health Insurance Scheme (NHIS) for
effective take-off: From policy to Action. Quart Health Insur J. 2005;7:1–4.

20. National Bureau of statistics. [Last accessed on 2011 Jan 5]. Available from:
http://www.nigerianstat.gov.ng/

21. Nigeria Demographic and Health Survey. 2008. [Last accessed on 2010 Dec 12]. Available
from: http://pdf.usaid.gov/pdf_docs/PNADQ923.pdf .

22. Nigeria Medical News. [Last accessed on 2010 Nov 6]. Available from:
http://www.nigerjmed.com/

23. Nigerian National Population Commission. [Last accessed on 2010 Dec12]. Available from:
http://dec.usaid.gov/index.cfm?p=search.getSqlResultsandCFID=9534andCFTOKEN=82199862a
ndp_searchtype=detailedandq_InstNmx=Nigeria.%20National%20Population%20Commission .
24. Banjoko SO, Banjoko NJ, Omoleke IA. Knowledge and perception of telemedicine and E-
health by some Nigerian health care practitioners. [Last accessed on 2010 Dec 15]. Available
from: http://wikieducator.org/images/d/df/PID_536.pdf .

25. Glob Health Action. Sunday A. Adedini , Clifford Odimegwu,Olusina Bamiwuye , Opeyemi
Fadeyibi , and Nicole De Wet. Barriers to accessing health care in Nigeria: implications for child
survival [Last accessed on 2018 Dec 9]. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3957799

26. Wall LL. Dead mothers and injured wives: the social context of maternal morbidity and
mortality among the Hausa of Northern Nigeria. Studies in Family Planning.1998;29:341–59.
[ PubMed ]

27. Hugo N. Purdah: separation of the sexes in northern Nigeria. 2012 Available from:
http://www.consultancyafrica.com/index [cited 10 October 2013].

28. UNESCO. Africa literacy facts from UNESCO. 2013 Available from:
http://www.africanlibraryproject.org/our-african-libraries/africa-facts [cited 27 September

29. Editorials, The Sun News. Nigeria poor healthcare access ranking. [Last access 2018 Dec 12].
Available from: http://sunnewsonline.com/nigerias-poor-healthcare-access-ranking/

30. Channels Television. Nigeria overtakes India in world extreme poverty Rankin. [Last access
on 2018 Dec 12]. Available from: https://www.channelstv.com/2018/06/25/nigeria-overtakes-
india-in-worlds-extreme-poverty-ranking/