The impact of digital communication and data exchange on primary health service delivery in a small island developing state setting

Abstract

Tuvalu is one of the smallest and most remote countries in the world. Due partly to its geography, the limited availability of human resources for health, infrastructure weaknesses, and the economic situation, Tuvalu faces many health systems challenges to delivering primary health care and achieving universal health coverage. Advancements in information communication technology are anticipated to change the face of health care delivery, including in developing settings. In 2020 Tuvalu commenced installation of Very Small Aperture Terminals (VSAT) at health facilities on remote outer islands to allow the digital exchange of data and information between facilities and healthcare workers. We documented the impact that the installation of VSAT has had on supporting health workers in remote locations, clinical decision-making, and delivering primary health more broadly. We found that installation of VSAT in Tuvalu has enabled regular peer-to-peer communication across facilities; supported remote clinical decision-making and reduced the number of domestic and overseas medical referrals required; and supported formal and informal staff supervision, education, and development. We also found that VSAT’s stability is dependent on access to services (such as a reliable electricity supply) for which responsibility sits outside of the health sector. We stress that digital health is not a panacea for all health service delivery challenges and should be seen as a tool (not the solution) to support health service improvement. Our research provides evidence of the impact digital connectivity offers primary health care and universal health coverage efforts in developing settings. It provides insights into factors that enable and inhibit sustainable adoption of new health technologies in low- and middle-income countries.

Responding to COVID-19 on the outer islands of Tuvalu

“…( 1 ) With a land mass of 26 km 2 consisting of Funafuti and eight outer islands (OIs), Tuvalu is one of the smallest and most remote countries in the world. ( 2 ) Approximately 40% of Tuvalu’s population of 11 000 live on the OIs. ( 2 ) In March 2020, with the primary objective of a COVID-19-free country, the Government of Tuvalu declared a state of emergency and initiated strict border measures.…”

“…( 2 ) Approximately 40% of Tuvalu’s population of 11 000 live on the OIs. ( 2 ) In March 2020, with the primary objective of a COVID-19-free country, the Government of Tuvalu declared a state of emergency and initiated strict border measures. ( 3 ) As a precautionary measure to protect against the transmission of the virus to the OIs, the Government mandated the relocation of people from Funafuti back to their home islands and prohibited people returning to Funafuti.…”

“…Apart from Vaitupu and Niulakita, all have just one health clinic served by a small team of health personnel, in most cases comprising a nurse, nurse’s aide and sanitation officer. ( 2 ) Vaitupu, which hosts the only government-run high school in the country, has two clinics, one of which serves the transient high school population, which reaches 500 pupils during school terms. Currently, there is no purpose-built clinic on the island of Niulakita and the local nurse uses her own house as a makeshift clinic to serve a population of around 40.…”

“…The only hospital in Tuvalu, PMH is a 50-bed facility that provides primary- and secondary-level care and limited diagnostic services. ( 2 , 3 ) A significant amount of the health expenditure is spent on the Tuvalu Medical Treatment Scheme, whereby Tuvaluans are sent overseas to access specialty health care. ( 2 )…”

“…( 2 , 3 ) A significant amount of the health expenditure is spent on the Tuvalu Medical Treatment Scheme, whereby Tuvaluans are sent overseas to access specialty health care. ( 2 )…”