By Williams Ugbomeh

As the world grapples with the COVID-19 pandemic, the role of telemedicine in transforming healthcare systems has never been clearer. In Nigeria, where access to quality healthcare remains a significant challenge, telemedicine is emerging as a solution to bridge gaps in care, particularly in rural areas. However, while the promise of telemedicine is great, Nigeria faces several barriers that could either hinder its full potential or propel it forward. The question remains: can Nigeria embrace telemedicine as a key component of its healthcare system, or will it fall behind? This article examines the critical trends, technological requirements, policy frameworks, and social impacts that will shape the future of telemedicine and remote healthcare in Nigeria.

Nigeria’s healthcare system is under immense pressure. The country has one of the lowest doctor-to-patient ratios in the world, with an estimated one doctor per 5,000 patients, compared to the World Health Organization’s recommended one per 600. This issue is exacerbated by the massive migration of Nigerian doctors abroad, leaving the population with a severely depleted healthcare workforce. Moreover, 50% of Nigeria’s population lives in rural areas where medical facilities and trained healthcare professionals are sparse. Telemedicine offers a solution that could address this shortage by connecting patients in remote areas with doctors through digital platforms. The ability to consult a doctor via video call or mobile app would significantly reduce the burden on healthcare facilities and provide timely medical care to those who otherwise might go without it. With the right infrastructure and policy frameworks, telemedicine has the potential to transform how healthcare is delivered in Nigeria, especially for underserved populations.

Across Nigeria, several innovative telemedicine platforms and projects are already making strides, although their reach remains limited. Startups and private sector players are leading the charge in delivering telehealth solutions. One example is Mobihealth International, founded by Dr. Funmi Adewara. This platform connects Nigerian patients with doctors in the diaspora for virtual consultations. Through partnerships with over 200 hospitals, Mobihealth has demonstrated how telemedicine can expand access to healthcare while leveraging Nigeria’s large diaspora community to fill gaps in medical expertise. In Lagos, the Ilera Eko program is helping to extend telemedicine services through a government-backed health insurance initiative. Ilera Eko offers mobile-based consultations as part of a larger healthcare reform effort aimed at providing more affordable and accessible care. These early successes highlight the potential for telemedicine to address the most urgent healthcare needs in Nigeria, particularly in chronic disease management, maternal health, and emergency consultations.

Yet, despite these promising examples, there is still much to be done to scale these efforts. Nigeria’s telemedicine market is estimated to reach $770 million by 2024, but without robust infrastructure and regulatory support, this potential remains largely untapped. For telemedicine to flourish, Nigeria needs significant investment in digital infrastructure. Access to the internet, a stable power supply, and affordable mobile devices are all critical components of a successful telemedicine ecosystem. Only half of Nigerians have reliable access to the internet, with rural communities experiencing even more limited connectivity. Broadband penetration is particularly low in these areas, and data costs remain prohibitively high for many Nigerians. The National Broadband Plan (2020-2025) aims to increase internet speeds and reach 90% of the population by 2025, with a focus on affordability. However, this plan’s success will depend on concerted efforts from both the government and the private sector. Telecom companies need to expand their networks, particularly in rural regions, and ensure affordable data packages for users who rely on mobile services for telehealth consultations. The electricity deficit also presents a significant challenge. Frequent power outages in many parts of Nigeria could disrupt telemedicine services, making it difficult to maintain remote consultations, especially if there is no reliable backup power. Solar-powered solutions for clinics and individual healthcare providers could mitigate this issue and allow the telemedicine ecosystem to operate more effectively in off-grid areas.

Another critical aspect of digital infrastructure is mobile device penetration. Although smartphone ownership is on the rise, many Nigerians still use basic phones that cannot support mobile health apps or video consultations. As of 2022, the Nigerian mobile market had approximately 150 million subscribers, but basic phones still account for a large share of this market. This creates a challenge for telemedicine services that rely on app-based platforms. To reach the largest possible audience, solutions that can operate on feature phones (through SMS or USSD codes) should be prioritized, especially for rural and low-income populations.

The health outcomes from telemedicine have the potential to be transformative, especially for underserved populations. Rural communities in Nigeria stand to benefit the most, as telemedicine can provide access to specialist care that might otherwise be unavailable. For example, in remote regions, a community health worker (CHW) could use a mobile device to consult a doctor remotely on a patient’s diagnosis or treatment plan. This not only saves time and money but also ensures that patients receive timely care that could prevent complications or even death. Chronic disease management is another area where telemedicine can make a significant impact. Nigeria has a rising prevalence of chronic diseases such as hypertension and diabetes, yet many patients struggle to access regular care due to distance or financial constraints. Telemedicine platforms that allow for remote monitoring and medication adjustments can help manage these conditions more effectively. For example, patients with diabetes can use glucose monitors connected to mobile apps that allow healthcare providers to track their blood sugar levels remotely. Doctors can then offer tailored advice and adjust treatment plans without the need for in-person consultations. Maternal health is another area where telemedicine can improve outcomes. Nigeria has one of the highest maternal mortality rates in the world, with many women in rural areas having limited access to prenatal and postnatal care. Through mobile platforms, women can receive regular consultations, health education, and emergency advice, reducing the risk of complications during pregnancy and childbirth.

Looking to other countries in the Global South, we can see how telemedicine has already had a positive impact on healthcare. In Kenya, telemedicine has been used successfully in rural areas to provide consultations and referrals. The Kenyan government has integrated telehealth into its national health programs, offering remote consultations for maternal care and chronic disease management. These initiatives have demonstrated the feasibility of telemedicine in improving healthcare access and quality of care in rural communities. Similarly, India’s eSanjeevani platform, which provides remote consultations to millions of people across the country, offers a valuable model for Nigeria. The platform has reached over 20 million users since its launch and is seen as a pioneering success in telemedicine. This success has been driven by strong government support, clear regulations, and partnerships between the private sector and healthcare providers.

If Nigeria can learn from these examples, it can overcome its own challenges in scaling telemedicine. The country must build on existing initiatives, invest in the necessary infrastructure, and create a regulatory framework that enables telemedicine to operate at scale. While Nigeria has made strides in developing digital health policies, there is still no comprehensive telemedicine regulation. The Nigerian Medical Association and the Medical and Dental Council of Nigeria have issued guidelines on telemedicine, but they remain vague and not widely adopted. A clear, national telemedicine framework is necessary to ensure that the delivery of healthcare services via technology adheres to established standards of practice. The government must prioritize the development of regulations that define the scope of telemedicine, ensure patient safety, and set standards for healthcare professionals practicing remotely. Regulations should address key concerns such as data privacy, licensing, and accountability. For instance, Nigeria could draw on India’s telemedicine guidelines, which set strict standards for healthcare providers offering remote consultations, including mandatory training and certification for doctors. Moreover, telemedicine must be included in national health insurance programs. As Nigeria works toward Universal Health Coverage, integrating telemedicine into health insurance packages can help improve affordability for patients. Telemedicine should be recognized as a legitimate service that is reimbursed by both public and private insurance providers.

Despite its promise, telemedicine faces several challenges in Nigeria. One of the biggest obstacles is affordability. Many Nigerians struggle to pay for healthcare, and telemedicine services are often priced beyond the reach of the average person. For telemedicine to be sustainable and accessible, it must be cost-effective. One potential solution is subsidized services for low-income patients, either through government programs or partnerships with NGOs. Digital literacy is another barrier. Many Nigerians, especially older adults and those in rural areas, lack the skills to navigate digital platforms. Training programs aimed at both healthcare providers and patients are essential to ensure that telemedicine is accessible to everyone. Trust in remote healthcare remains a significant challenge. Many Nigerians still prefer face-to-face consultations and are wary of receiving medical care through a screen. Building trust in telemedicine will require public education campaigns, success stories, and clear communication about the benefits and limitations of remote consultations. Community health workers can play a key role in educating patients and building confidence in telemedicine.