Small Island Developing States (SIDS) – low-lying coastal countries that tend to share similar sustainable development challenges – present some of the biggest and most difficult challenges to overcome when it comes to access. SIDS experience the perfect storm, developmentally speaking, in terms of barriers to access, such as small but growing populations, limited resources, remoteness, susceptibility to natural disasters, high costs for energy, communication, and transport, and increasingly fragile environments threatened by climate change.
Vanuatu, a linguistically and culturally diverse nation of 65 inhabited islands located in the South Pacific Ocean, is a prime example of the challenges SIDS face. Vanuatu ranks 125th out of 187 countries on the Human Development Index, and faces high maternal and infant mortality rates. Inter-island travel is prohibitively expensive, and can be impossible at times given weather conditions and infrequent transport schedules.
Understandably, healthcare provision in Vanuatu offers a set of challenges most individuals never have to think about. Treating patients spread across the various islands that make up Vanuatu, is difficult. On top of that, geographic isolation leads to a lack of timely health-data reporting to the government – that is, if it is captured at all. This is exactly the problem that the Vanuatu Inter-Island Telemedicine and Learning (VITAL) Network Project recognized and is successfully addressing. Given Vanuatu’s specific challenges, VITAL embraced telemedicine as a natural choice to help meet the healthcare needs of its community. Launched in October 2016, VITAL’s goal was to connect primary healthcare workers on Maewo, a remote island in Vanuatu with no existing cellular network, to doctors at a hospital on a neighboring island, via the Internet. VITAL leveraged a multistakeholder approach to bring community members together and successfully advocate for Internet access to communicate from Maewo with doctors at a hospital on a neighboring island. Specifically, they facilitated a partnership between the communities and the Government of Vanuatu to enable this goal. High-speed Internet connectivity facilitates video conferencing between doctors and primary healthcare workers, which enables speedy diagnosis and care for islanders.
VITAL’s success has been astounding. In less than six months, two villages have engaged with doctors more than 1,250 times and have helped 32 patients. This includes six life-threatening cases involving mothers and children, and 10 patients who would have been permanently disabled without intervention. When viewed in the context of the project, which covered half the island’s total population of 3,569 people, these numbers are significant given how long the project has operated. Relations between the government, healthcare providers, and patients has also improved.
Operational challenges resulted in experimentation with different technologies and platforms in order to achieve the goal of improving healthcare outcomes for Maewo’s villagers. One of those challenges was switching from the original microwave point-to-point connections to High Throughput Satellite (HTS) connections. Once the community began their survey for tower sites, they realized that government funded towers could be hosted there. Thus, Kacific Satellite Broadband was used as an interim solution. A second challenge was in finding an application specific to the needs of the community for telemedicine. Although they chose an appropriate tele-health client, project members also rely on services such as Skype and Facebook. Socio-economic factors and a lack of trust in the national healthcare system also were a challenge, as they influenced patients’ receptiveness to health resources and medical recommendations.
Despite the challenges, VITAL harnessed the efforts made by the local communities of Maewo Island to provide Internet connectivity to their villages. The Vanuatu Office of the Government’s Chief Information Officer (OGCIO) and the office of the Telecommunications and Radiocommunications Regulator (TRR) offered free technical assistance and support. Kacific Broadband Satellites provides satellite Internet connectivity for the communities in order to facilitate telemedicine and eHealth. The community successfully fundraised and paid for all installation fees as well as carried the equipment to sites using the only means of transport available: by foot-path, over a mountain, carrying the equipment on their backs. Furthermore, despite no digital literacy, primary healthcare workers were trained in three days to use solar-powered tablets to initiate a videoconference via the Internet with a doctor at the referral hospital. With little supervision and prompting, communications rose more than 1,000%, and such interaction has improved health outcomes through more than 1,250 interactions to solve routine and life-threatening cases alike.
SIDS experience the double-edged reality of being some of the most difficult to access yet most vulnerable states. Information and communication technologies (ICTs) can be an affordable and sustainable way to support development in health and other services, as the VITAL project proves. Behind the technical success of the project was strong community organization and collaboration among multiple stakeholders that ensured its success. Through effective ICT training, VITAL was able to provide expedient and effective healthcare to remote communities, while maintaining patient trust and privacy. And, rural healthcare workers had access to specialists who provided remote diagnoses, continuing education, and constructive feedback. Thankfully, since many SIDS experience similar challenges, we hope more stakeholders from other SIDS can draw on the successful case study of VITAL and implement similar solutions.