Argument: The network approach: promoting learning

The use of ICT and creating a network of professional experts enables learning and knowledge transfer between health workers and academics. In addition to the brain-drain, whereby skilled health professionals continue to emigrate from Zambia, Zambia also shows a slow rate of training of new health workers. Therefore the VDP provides a vital learning tool. VDP provides practical skills by healthcare workers to learn from first-hand experience while having access to a field of experts, or advisers, able to answer any questions. The quality of healthcare will be improved as workers in remote locations are given access to information and correct answers for diagnosis. A global pool of skills can be drawn upon, and utilised, when required.

Candidate 1: "A study carried out by Masiye (2007) indicates only around 40% of Zambia’s hospitals can be defined as efficient. There remains a significant problem of resource wastage in Zambia’s hospitals and the hospitals are technically inefficient in producing, and delivering, services. Health goals cannot be achieved in Zambia if hospitals continue to function inefficiently. This raises concern as to how the hospitals cope once referrals are sent? Is the wider health system adequate?

Outsourcing of medical professions into rural areas, and making improvements in the speed and quality of referrals does not resolve the issue of hospital quality. Although VDP’s can act to significantly reduce the number of inappropriate referrals investment, training, and improved management, is still required within Zambia’s hospital system. Additionally, improved access to drugs is needed. Drug shortages have been reported due to corruption scandals - funding provided to supply drugs in the health sector have previously gone missing [1] . Generic drugs are in short-supply, and high demand. Without doctors being able to access vital drugs, whether they are located in hospitals or remote areas, treatment cannot be provided.

[1] See further readings: IRIN, 2011."
Candidate 2: "Can the VDP go beyond basic needs and rights when the scale, and scope, of basic need is so large? Figures show a negative image not only of physical health, also the environment in which people live in. The maternal mortality ratio is calculated at around 590 per 100,000 and infant mortality (under 1) stands at 53 per 1,000 live births. However, only 61% of the population have access to improved drinking water; and 48% are able to access improved sanitation facilities (UNICEF, 2013).

Can we rely on NGO’s providing the VDP to fulfil basic needs when the challenges are so large?"
Candidate 3: "Today the inclusion of private stakeholders in providing access to health is proving to be a sustainable approach. To achieve developmental impact the public sector is no longer the key source or actor. Although increased support by the government - both financial and political - may be required in the future it is not fundamental for the implementation stage. The VDP can continue to grow and be sustainable through the work of private organisations and funders. The state can later step in and expand the system nationwide when it is fully demonstrated. Private partnerships are changing how health-care is provided and its sustainability."
Candidate 4: "Zambia needs to improve its health care system in general, not work on implementing a virtual programme. Physical contact is still necessary for diagnosis and treatment.

Alternative schemes are being used to meet health needs and improve the structure of Zambia’s health system. For example, the Clinton Foundation and DFID [1] have invested in the provision of community health workers. These programmes invest in training community health workers across Zambia’s rural regions. The health workers trained are therefore physically located within the regions. This is much more important than having virtual doctors on call.

[1] See further readings: Clinton Foundation, 2013."
Candidate 5: "Although the use of virtual networks and doctors may provide solutions to share knowledge it creates other difficulties. The use of VDP as an educational tool clearly has downsides. First it is not designed for training; if it were why not use a tool specifically for training? As the VDP is not any educational benefits have to be considered secondary. Unlike with a specifically educational tool there is no way for the experts to test that the knowledge they are passing on is being learnt or that their advice is being followed.

Additionally, if the use of virtual doctors is educating medical officers on the ground does it ensure the newly trained professional will stay in Zambia? The bigger picture of what the officers do, and whether the government implement competitive labour policies, requires consideration."
Candidate 6: "Technology will only be required within the mobile clinics, to enable the VDP networks to be used. It is a key component, but not the only foundation of which the VDP is based on. This means that the clinics can carry equipment to ensure access to the internet remains – such as a satellite connection. Furthermore, significant developments have been made in Zambia’s technological revolution. Internet connectivity has improved in rural areas; and pioneering movements across rural areas - such as the implementation of solar-powered internet - means connectivity is spreading into rural, remote, Zambia."
Candidate 7: "The VDP is providing a number a solution to the lack of human resources within Zambia’s health sector. VDP is enabling the growth of local jobs, for Zambian nationals. Although there are no current figures to estimate the amount of jobs that will be provided within the health sector, the VDP has currently been rolled out into six sites and continues to expand. New clinics will be set-up across Zambia, as well as Tanzania, Malawi and Kenya. A growing body of health workers will be required to maintain the VDP network; reducing the doctor to population disparity in Zambia."
Candidate 8: "Figures showcasing the popular use of traditional practices, and medicine, do not show the reasons behind use. It fails to recognise the degree of choice and the nature of treatment provided. If people don’t have access to modern medicine then they will go to that which is available. The answer then is to increase access to modern medicine to provide the alternative."
Candidate 9: "Mobility remains a key issue across Africa. The WDR (2009) identifies three key sources for effective integration: institutions, infrastructure, and interventions. Infrastructure includes systems that facilitate the geographical movement of goods, services, people, and ideas - such as roads. The reality of a mobile clinic therefore relies heavily on having the infrastructure to support flexibility, mobility, and frequent movement.

Mobile clinics still won’t be able to reach all patients that need their help; public investment is required into infrastructure such as roads and railways first. The project can only work if mobile clinics are able to be mobile. Further, even if they are mobile it doesn’t necessarily ensure people become ill when the medical officer happens to be visiting."

Although the use of virtual networks and doctors may provide solutions to share knowledge it creates other difficulties. The use of VDP as an educational tool clearly has downsides. First it is not designed for training; if it were why not use a tool specifically for training? As the VDP is not any educational benefits have to be considered secondary. Unlike with a specifically educational tool there is no way for the experts to test that the knowledge they are passing on is being learnt or that their advice is being followed.

Additionally, if the use of virtual doctors is educating medical officers on the ground does it ensure the newly trained professional will stay in Zambia? The bigger picture of what the officers do, and whether the government implement competitive labour policies, requires consideration.
