Leveraging smart glasses for telemedicine to improve primary healthcare services and referrals in a remote rural district, Kingandu, DRC, 2019–2020

ABSTRACT

Background

Telemedicine enables new forms of medical consultation and is expanding worldwide. Patients in sub-Saharan Africa could potentially benefit substantially from telemedicine.

Objective

To improve primary healthcare services, especially referrals to the district hospital, for the population in three health centres in the rural district Kingandu in the Democratic Republic of the Congo (DRC) by introducing Smart Glasses, and leveraging them for telemedicine.

Methods

The project involved the design and introduction of an intervention combining community engagement with technological innovation (Smart Glasses, communication equipment, moto-ambulances, and new diagnostic tests), and with staff training. Utilisation of the intervention, use of the health centres, and referrals to the hospital were monitored through the routine health information system and project-specific registers. Key stakeholders were interviewed and the project costs were analysed.

Results

The use cases for the intervention were defined in consultation with the stakeholders. Smart Glasses were used in 10% of consultations in the health centres mostly for advice during curative consultations. The total number of consultations increased significantly in the intervention health centres. The number of referrals to the hospital remained stable, but an increased proportion effectively arrived in the hospital. The Smart Glasses and moto-ambulance greatly facilitated emergency referrals, often requiring a potentially life-saving intervention in the hospital. All stakeholders involved highly valued the intervention.

Conclusion

Telemedicine can contribute to improving primary healthcare services in a remote rural area, as part of a more comprehensive intervention and with intensive participation of all stakeholders. It can increase acceptability and use of the existing services; improve diagnosis, treatment, and referral of patients; and can also facilitate on-the-job training and supportive supervision.

KEYWORDS:

• Health system
• sub-Saharan Africa
• digital health
• referral
• rural health

Responsible Editor Julia Schröders

Responsible Editor Julia Schröders

Acknowledgments

We acknowledge all stakeholders in the rural district of Kingandu, especially the community leaders, the health centre staff, and the patients for their enthusiastic participation in the design of the intervention and their continued engagement to overcome the practical problems in a difficult context.

Disclosure statement

Steven Serneels is co-founder, chairman of the board of directors and shareholder of Iristick which developed the Smart Glasses used in the intervention. He initiated the program Social in Motion within Iristick, to make these Smart Glasses available for under-served populations. The other authors have no competing interest.

Author contributions

All authors were involved in the design of the intervention. JD and FS were in charge of the implementation of the project, respectively in Kingandu and in the NGO office. SS had the initial idea, obtained the funding, brought the consortium together and managed the overall project. LK, WvdP, and WVD designed the monitoring and evaluation of the project. SS and WVD analysed the available project information and extracted the data for the results. WVD drafted all successive versions of the papers, which were reviewed by SS, LB, and WvdP. The final version was approved by all authors.

Ethics and consent

The project was approved by the Ethics Committee of the School of Public Health of the University of Kinshasa. No images or videos from the Smart Glasses consultations were stored; they were automatically deleted after streaming. Written consent was taken from each patient before using the technology.

Paper context: what is already known?

Delivery of primary healthcare in remote rural areas in sub-Saharan Africa faces many challenges, including among others acceptability by the users, low qualification and support of staff, difficult transport and communication.

Telemedicine leveraged by Smart Glasses as part of a comprehensive intervention (stakeholder engagement, introduction of new technology, and staff training) can contribute to overcoming these challenges.

Improved availability of internet access in rural Africa can support primary healthcare services and referrals.

Additional information

Funding

The project was funded by a grant of CAD 250,000 from Grand Challenges Canada.