Argument: Taking healthcare beyond basic needs

Not only does VDP improve access to primary health care but the networks developed between different health advisers mean changing health demands can be met. Across Africa there is now a shift in the type of diseases prevalent. Increasing rates of non-communicable disease are being recorded - for which advisers can provide ongoing support. Additionally, there remains a need to improve understanding and treatment of mental health issues within rural areas in particular. Concern with mental health requires greater recognition across Africa. Finally, data can be collected on health issues affecting rural areas for targeted intervention.

Candidate 1: "Will virtual doctors be used?

Even if VDPs do improve access to health services we cannot assume the health services will be used. The use of traditional healers, and practices, remains popular across rural Zambia [1] . If the population is unwilling to use modern medicine then providing better access to that medicine will be of little benefit. If formally trained doctors and medicines are not accepted, or trusted, by communities then the resources being spent on VDPs would be much better spent on education to encourage people to make better use of the facilities they already have than introducing new technology based solutions that will simply be more likely to be rejected.

[1] See further readings: Bansal, 2012."
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: "How sustainable?

A key issue that needs to be raised is funding. Currently the VDP is funded by a range of corporate partners - including Microsoft and Google. However, for the project to be sustainable in the long-run investment is required from a wider range of bodies, and further partnerships need to be formed with the public sector. The government needs to be included as a funder and supporter. The neglect, and exclusion, of the government within discussion on health projects - such as VDP - only acts to remove their responsibility and obligation to tackle the social dilemma. Healthcare is the responsibility of government, not the NGOs and private firms that are providing VDP."
Candidate 4: "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 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: "Resolving the health service crisis?

To what extent does the VDP resolve the lack of health service professionals in Zambia? Two caveats emerge.

Firstly, the project shows how intervention from international organisations can work against trade union demands and employment issues. The project is introducing a model of outsourcing. The medical staff do not need to be based in hospitals so reducing government costs and decentralising employees. Recent strikes by nurses [1] shows dissatisfaction with work conditions and overwork. It raises concern over the motives of the VDP. Is the VDP encouraging social protection and an ethical work environment for all medical professionals? Or is the VDP an escape mechanism to keep wages low and neglect demands made by working nurses? A majority of the expert ‘virtual doctors’ employed are volunteers. Ultimately then the government might consider the VDP a good excuse not to invest in training Zambian doctors.

Secondly, does the VDP resolve the issue of brain drain? Improved incentives and increased salaries are required for trained medical professionals, to motivate them to stay. The VDP may help educated doctors but it does not provide them with reasons to remain in Zambia, rather it gives them contacts with outside healthcare systems where their skills will be much better rewarded.

[1] See further readings: Kunda, 2013."
Candidate 7: "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."
Candidate 8: "A dangerous reliance on technology?

ICT is providing innovative solutions to resolve many social problems across Africa. However, is there now a dangerous reliance on technology? Not everyone has access to mobiles and signal remains precarious. When answers, diagnosis, and treatment, are reliant on using technology in the field it needs to be ensured that the service fitted in mobile clinics will remain reliable for field health workers. Additionally, it needs to be ensured that the network of global professionals frequently check messages for updates and respond as quickly as possible. The quality of health service cannot be improved if the response time remains low due to insufficient technology or connectivity. The scheme requires partnerships to telephone and information technology companies.

The reliance on technology is also danger when we consider what information the technology used is actually providing. The VDP will mainly involve text-based emails and messages to provide patient information. Expanding to use images and videos - such as through Skype - will ensure the virtual doctor is more involved in the process, reducing error."
Candidate 9: "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."

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?
