Introduction
Zimbabwe, like many other African countries, faces significant challenges in delivering healthcare services, particularly in rural and hard-to-reach areas. These challenges include a shortage of skilled healthcare professionals, limited access to medical facilities, and a strained healthcare infrastructure. According to the current health sector strategy there is less than one facility for every 10,000 people in Harare and Bulawayo, and a national average of 1.1 facilities per 10,000 people, well below its target of two health facilities per 10 000 (Ministry of Health and Child Care, u.d1). The ratio of doctors and nurses to population ratio is very low, which leads to many referrals to the higher-level facilities and the attendant challenges and delays in care. Zimbabwe has been gradually adopting telemedicine and remote care technologies as part of its strategy to overcome these challenges and enhance service delivery.
Application of Telemedicine Initiatives in Zimbabwe
The Government of Zimbabwe is implementing telemedicine to support virtual consultations, monitor patient health remotely, and extend the coverage of specialist health services. The government first piloted telemedicine in 2015, in collaboration with the International Telecommunications Union (ITU), to offer support to healthcare workers in remote facilities. In the pilot project, 12 remote/rural hospitals were connected to a referral hub, Parirenyatwa General Hospital in Harare, for health worker to health worker consultations, and patient monitoring. By 2023, the project had linked 173 facilities across three provinces in Zimbabwe.
In 2018, the government partnered with GlobalMed, to provide equipment and other technical support for provider-to-provider video conferencing at 16 clinics in Manicaland Province. GlobalMed provides mobile exam stations, tablets, cameras and various linked medical examination devices. The package is fully portable and grid-independent, and can be deployed in the remotest, hardest to reach of villages.
Other telemedicine initiatives in Zimbabwe include private sector initiatives such as Maisha Medik mobile app, which supports video consultations with a doctor, and BatsiHealth, a telemedicine platform which supports live video consultations and monitoring of patients. BatsiHealth also runs smart kiosks, in collaboration with ZimSmart Villages, where patients can consult a doctor through video link. A report on the initiative indicates that over the second half of 2024, 1,800 consultations were conducted through the ZimSmart Villages kiosks (Gavi, 20242). Zimbabwe has also implemented an electronic patient monitoring system since 2013 for HIV and TB patients on treatment (UNDP, 20143).
Policy and Regulatory Framework
To realise its full potential, telemedicine requires a supportive policy and regulatory environment. In Zimbabwe, the Ministry of Health and Child Welfare developed the National Digital Health Strategy (2021-2025) (Ministry of Health, undated) to ensure that the country has supportive policy and regulation to support digital health initiatives. The strategy lays out the government’s priorities in establishing appropriate health ICT infrastructure and scaling up use of high impact technologies, to accelerate delivery of digital health solutions to complement regular services. A solar power project (Solar for Health Initiative) has also been rolled out to address unstable power supplies (International Energy Agency, 20234). In addition, the government has made investments in staff and recruited provincial ICT officers to provide ICT support at the facilities. To boost internet access and reduce costs, in 2024, the Government of Zimbabwe licensed Starlink, a satellite-based internet service, now available across the country (Context, 20245).
Impact
During the COVID-19 pandemic, telemedicine played a critical role in reducing face-to-face consultations, helping to manage the spread of the virus while ensuring continuity in healthcare delivery. For instance, patients with respiratory conditions received timely consultations and advice, even when they were unable to visit hospitals (Chitungo et al, 20216). In another study in 2023 by Chigaro et. al7., 20% of healthcare workers in a sample drawn from health facilities in Harare indicated that they had used video-conferencing consultation.
Another 2020 study by Moyo et. al., titled “Use of Telemedicine in Obstetrics and Gynaecology in Zimbabwe During a Lockdown Period,” found that in 94% of the cases, patients who had been managed remotely during the COVID-19 lockdowns were satisfied with the service they received.
Lessons Learnt
Zimbabwe’s progress in integrating the use of telemedicine to extend the reach of health services appears to be hinged on three elements: Partnerships with innovators and telecommunication providers; a clear policy/government strategy that prioritises telemedicine; and direct government investments in resources required for the system.
- Partnerships: Forging partnerships appears to have helped the government access expertise and resources to set up telemedicine. The pilot project in 2015-2019 in Manicaland was made possible through partnership with the ITU, who brought in funds and technical expertise in setting up telecommunication infrastructure. The government also partnered with an innovations company, GlobalMed, to pilot live video-supported telemedicine, in partnership with various stakeholders such as local telecommunication companies, international health organizations, and private sector players.
- Supportive government strategy: The Government of Zimbabwe includes tele- and digital health in key guiding documents. The National Digital Health Strategy provides guidance for investments, while the Data Protection Act No 5 of 2021 protects personal data collection and use, as would apply in telemedicine.
- Direct government investments to support telemedicine: The Zimbabwe government has invested in hiring ICT officers for hospitals, to support virtual care, among other services. The government has also supported telecommunication infrastructure to facilities and alternative energy sources (solar power) for those not linked to the electricity grid. The recent licensing of Starlink in the country also indicates government’s efforts to have reliable and affordable internet, as poor internet and high data costs have been barriers to telehealth in Zimbabwe.
Conclusion
Adoption of telemedicine offers opportunities to expand access to services across all levels of care on the African continent. Zimbabwe has shown that through partnerships, government leadership and the right investments, African countries can harness this potential and give their people services that are personalised, convenient and portable.