Adedeji OJ, Babatunde YO, Ibrahim AD, Adebisi YA, Lucero-Prisno III DE. Towards Universal Health Coverage in Africa: Relevance of Telemedicine and Mobile Clinics (Review Article). SEE- JPH 2021, posted: 18 May 2021. DOI: 10.11576/seejph-4448 1 | P a g e REVIEW ARTICLE Towards Universal Health Coverage in Africa: Relevance of Tele- medicine and Mobile Clinics Oluwakorede Joshua Adedeji1, Yusuf Olalekan Babatunde1, Abdulmumin Damilola Ib- rahim1, Yusuff Adebayo Adebisi2,3, Don Eliseo Lucero-Prisno III3 1 Faculty of Pharmaceutical Sciences, University of Ilorin, Ilorin, Nigeria 2 Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria 3 Global Health Focus Africa Corresponding Author: Oluwakorede Adedeji; Address: Faculty of Pharmaceutical Sciences, University of Ilorin, Ilorin, Nigeria; Email: oluwakorede2017@gmail.com mailto:oluwakorede2017@gmail.com Adedeji OJ, Babatunde YO, Ibrahim AD, Adebisi YA, Lucero-Prisno III DE. Towards Universal Health Coverage in Africa: Relevance of Telemedicine and Mobile Clinics (Review Article). SEE- JPH 2021, posted: 18 May 2021. DOI: 10.11576/seejph-4448 2 | P a g e Abstract Access to essential healthcare services is limited in Africa, resulting in preventable mortalities. Telemedicine, which can be defined as the use of information and communication technologies in the delivery of healthcare services, is applied in various fields of medicine and at multiple times. Some telemedicine projects have been implemented in different African countries. Some successes were recorded, as well as failures. Despite challenges, such as high cost, that inhibit telemedicine coverage, telemedicine still presents excellent opportunities in increasing access to basic healthcare and expert services. Mobile clinics provide the opportunity to expand access to health services across a region. They can be implemented as an extension of fixed1hospitals that are often situated away from remote villages, serve in the heart of communities, and aid in preventive screenings and epidemiological monitoring. Africa has limited resources but lever- aging these existing resources most cost-effectively is key to achieving universal health cover- age in the region. Keywords: Universal Health Coverage, Telemedicine, Information and Communication Tech- nology, Mobile clinic, Africa Source of funding: None Conflicting Interest: The authors declare no conflict of interest. Authors' Contributions: Oluwakorede Joshua Adedeji conceptualized the study. Oluwako- rede Joshua Adedeji, Yusuf Olalekan Babatunde and Abdulmumin Damilola Ibrahim acquired, analysed and interpreted the data for the work. Yusuff Adebayo Adebisi and Don Eliseo Lucero-Prisno III revised it critically for important intellectual content. All authors agree to be accountable for all aspects of the work in ensuring that all questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Adedeji OJ, Babatunde YO, Ibrahim AD, Adebisi YA, Lucero-Prisno III DE. Towards Universal Health Coverage in Africa: Relevance of Telemedicine and Mobile Clinics (Review Article). SEE- JPH 2021, posted: 18 May 2021. DOI: 10.11576/seejph-4448 3 | P a g e Introduction Accessibility to basic promotive, preven- tive, curative, rehabilitative, and palliative health services of adequate quality without incurring financial hardship encompasses the concept of Universal Health Coverage (1). Universal Health Coverage (UHC) en- ables all population members to easily ob- tain primary health services without being pushed to poverty or debt. Health is a fun- damental right of all, and access to it should not be difficult or impossible for anyone. Globally, about 100 million people are pushed into extreme poverty because they have to pay for healthcare (2). This is par- ticularly worse in Africa as 11 million Afri- cans are pushed to poverty each year due to out-of-pocket expenditure (3). UHC is not just about health financing. It encompasses all other components, such as health tech- nologies, health service delivery, health workforce, health facilities and communi- cation networks, information systems, qual- ity assurance mechanisms, governance, and legislation (2). Several African nations are moving slowly towards Universal health coverage (4), but particular challenges threaten the actualization of the "Health for All" reality. Such challenges include the lack of political commitment, lack of coher- ent health financing policies, weak health systems, and weak information systems to monitor UHC progress (1). Africa harbours over 90% of global malaria cases (5), al- most two-thirds of the global total of new HIV cases (6), and over 25% of tuberculo- sis deaths (7). Many deaths can be pre- vented and reduced with effective health coverage in the region. Attaining the third sustainable development goal (good health and wellbeing for all) requires country-spe- cific actions towards achieving universal health coverage (1). Each country's ability to translate plans and policies into concrete actions will determine the reduction in mor- tality rates and overall wellness of the pop- ulation, thus affecting the level of growth. This paper aims to elucidate the roles and relevance of the dual implementation of tel- emedicine and mobile clinics as a tool for ensuring adequate health coverage in Af- rica. Telemedicine, or telehealth, can be re- ferred to as "the delivery of health care ser- vices, where distance is a critical factor, by all health care professionals using infor- mation and communication technologies for the exchange of valid information for the diagnosis, treatment, and prevention of diseases and injuries, research and evalua- tion, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities" (8). The use of telemed- icine can be classified as either clinical (di- agnostic and therapeutic), educational or administrative (9). Mobile clinics are an es- sential part of the health system that can help deliver basic health services to remote areas (10) predominantly rural communities that lack access to health centres. They are instrumental in accessing vulnerable popu- lations (10). Mobile clinics contain neces- sary equipment for temporary treatment of patients in critical situations and can help increase access to essential health services (11). Implementation of Telemedicine and mobile clinics provide significant ad- vantages and challenges that inhibit full im- plementation and utilisation, especially in the African region. However, the dual per- formance may provide substantial benefits and increased access to health services of sufficient quality. This paper assesses the impact of existing telehealth platforms and mobile clinics and the effect of a dual im- plementation. Method We conducted a narrative review of pub- lished articles on telemedicine and mobile clinics in Africa. Search for relevant medi- cal literature in biomedical databases (Google Scholar and PubMed) was con- Adedeji OJ, Babatunde YO, Ibrahim AD, Adebisi YA, Lucero-Prisno III DE. Towards Universal Health Coverage in Africa: Relevance of Telemedicine and Mobile Clinics (Review Article). SEE- JPH 2021, posted: 18 May 2021. DOI: 10.11576/seejph-4448 4 | P a g e ducted using the following key terms: "Tel- emedicine", "Mobile clinics", "Africa", "Telehealth", "electronic health", "e- health" and "e-health". Papers were se- lected based on the country (only African countries were selected), quality, and rele- vance to the scope of the study by review- ing their abstract and title. We also used supplementary references listed under the papers. Implemented Telemedicine projects in Africa were selected and analysed for successes and/or reasons for failures. Results In the use of telecommunication technolo- gies to advance citizens' health and wellbe- ing in the state, Africa is still in its infancy compared to developed countries; neverthe- less, various Telemedicine projects have been implemented in different African countries, as seen in Table 1. These tele- medicine projects were implemented for various purposes across different countries, and some successes were recorded for some projects while some other projects might have failed. Table 1: Various Telemedicine Projects and approaches and Impact towards achieving Universal Health Coverage in Africa Authors Telemedicine Pro- ject Country Roles and impact on Healthcare towards UHC Lessons Antoine Geissbuhler et al [22] Keneyan Blown Mali (2001) Tele-education for physi- cians and students and Tele- consultation to follow up with patients operated in Geneva and returned to Mali. Improved education of physicians for better healthcare delivery and post-discharge care is en- hanced. Problems identified include poor internet connectivity and poor infrastructure re- quired to support Tel- emedicine coverage T. Mpunga et al. [28] Static-image Telepathology pro- gram at Butaro Can- cer Centre of Excel- lence Rwanda (2013) The use of static-imaging telepathology enhanced the diagnosis and interpretation of specimen samples and, overall, improved care and diagnosis for cancer pa- tients in the country. Limited bandwidth and internet instabil- ity limited the choice for dynamic real-time readings. Also, the varying time zones serve as a limitation to synchronous com- munication. N.D Montgmorey et al. [29] Clinicopathologic conferences between clinicians and pathologists in Kamuzu Central Hos- pital (KCH) and pathologists in the University of North Carolina, Chapel Hill (UNC) Malawi (2011) Improved diagnosis of Lymphoproliferative disor- der in resource-limited set- tings on a modest invest- ment and a collaborative ac- ademic environment for Malawian pathologists. Telemedicine can play an influential role in advancing care to millions while leveraging on exist- ing resources and in- vestment. Maurice Mars [19] Drug Resource En- hancement against AIDS and Malnutri- tion (DREAM) pro- ject Tanzania, Ma- lawi, Mozam- bique Telecardiology training, the establishment of telecardi- ology centres, and remote reporting of ECGs from It- aly. Telemedicine can cut across different coun- tries and thus facili- tate intercultural and international collabo- ration. Cheick-Oumar Ba- gayoko et al [31] EQUI-ResHUS Mali (2011) Task shifting of medical imaging in obstetrics and The use of telemedi- cine for training and networking of health Adedeji OJ, Babatunde YO, Ibrahim AD, Adebisi YA, Lucero-Prisno III DE. Towards Universal Health Coverage in Africa: Relevance of Telemedicine and Mobile Clinics (Review Article). SEE- JPH 2021, posted: 18 May 2021. DOI: 10.11576/seejph-4448 5 | P a g e Cardiology in remote loca- tions and provision of CME (Continuing Medical Edu- cation) professionals can help reduce the isola- tion of these profes- sionals working in re- mote areas. Cheick-Oumar Ba- gayoko et al [32] Réseau Afrique Fran- cophone de Télémé- decine (RAFT) pro- ject Madagascar, Rwanda, Mali, Morocco, Mau- ritania, etc. Distance learning, telecon- sultations, and digital col- laboration within Africa and between Africa and Europe. The development of large-scale telemedi- cine projects involves the inclusion of par- ticipating countries in the development of the project. Discussion Overview of telemedicine coverage and ap- plication to various fields of medicine The use of Information and Communication Technologies (ICT) in healthcare has gained ground. Its application spans radiol- ogy, especially teleradiology, i.e., using ICT to transmit radiographic images from one location to another, usually for diagno- sis and interpretation (12, 13). Teleradiol- ogy often involves a store-and-forward or asynchronous form of telemedicine. The patient data is generated, stored, and trans- mitted to a receiver which responds at a later time (13). In psychiatry, telepsychiatry is used to diagnose, educate, treat, consult, transfer medical data, research, and other healthcare activities between a patient and the healthcare provider (14). Telepsychiatry usually involves real-time or synchronous communication between the patient and a healthcare provider in which both individu- als at either end of the communication link are simultaneously present and actively en- gaged ); dermatology (teledermatology in- cludes both store-and-forward communica- tion and real-time synchronous communi- cation between patient and clinician (15).); pathology (telepathology (13)- the applica- tion of telecommunication technologies in microscopic imaging and pathology (16)), etc. The use of telemedicine in real-time video consultations with off-site specialists cuts across various fields such as Oncology, rheumatology, etc.(17); thus, almost every area in medicine has a potential telemedi- cine application. Telemedicine also plays vital roles in managing chronic illnesses, emergency and trauma care, medication prescribing, counselling, stroke interven- tion, and post-discharge coordination (17). Pharmacy practice is not left out in the ap- plication of telemedicine. The use of tele- medicine can provide great advantages in remote dispensing and supervision in com- munity pharmacies. Use of Mobile Clinics Mobile health clinics are designed from vans, trucks, or buses and, depending on use, are fitted with equipment and facilities essential in carrying out the design purpose. Mobile clinics are used for various pur- poses in emergency cases, primary healthcare delivery, preventive screenings, etc. carried out by quite a small number of healthcare professionals. In humanitarian emergencies, mobile clinics are often com- mon in delivering health services (24). In the United States of America, mobile health clinics serve an essential role in providing healthcare to vulnerable populations (25). The use of mobile health clinics for primary healthcare delivery is not quite established in Africa. Globally, more than half of the world's population lives in urban areas. However, in Africa, about 57% in rural ar- eas (26). Among these countries, about 41% in lower-middle-income-countries and 32% in low-income countries live in urban areas. Due to the presence of most hospitals Adedeji OJ, Babatunde YO, Ibrahim AD, Adebisi YA, Lucero-Prisno III DE. Towards Universal Health Coverage in Africa: Relevance of Telemedicine and Mobile Clinics (Review Article). SEE- JPH 2021, posted: 18 May 2021. DOI: 10.11576/seejph-4448 6 | P a g e in the cities, the use of mobile clinics pre- sents an effective framework for health de- livery to those in need in these rural ar- eas.The ratios of the number of hospital beds to the population in most African countries is quite low and below standard values with most African countries having less than 15 beds per 10,000 population (27) and most of these beds often remain in- accessible to the majority of the population. The adoption of mobile clinics may present great benefits in eradicating preventable en- demic diseases such as malaria and reduc- ing the high mortality rate that results from such diseases in the region. Mobile clinics have also been used for massive immuniza- tion programmes and ante-natal care. Mo- bile clinics might even reduce the high mor- tality rate associated with the region due to certain factors such as the absence of a health professional at the time of child de- livery, probably as a result of distance from hospitals. The accessibility of mobile clin- ics to rural and vulnerable communities greatly benefits attaining UHC in Africa. Stakeholders involved in the implementa- tion of a possible framework Modern telemedicine systems and mobile clinics involve a wide range of stakehold- ers, each having their responsibility. The key stakeholders that have important roles for successfully implementing telemedicine and mobile clinics include system designers and developers, (33) healthcare profession- als like physicians, nurses, pharmacists, and community healthcare professionals (34). Also, internet service providers, infor- mation technology support staff, policy- makers, and end-users (35) have essential roles to play to get the required satisfaction from telemedicine projects. A proper eval- uation of telemedicine and mobile clinics is essential to convince various stakeholders of its importance and as a means to come to a rational implementation in various health sectors across African countries. There is a need to establish roles of additional stake- holders that could be an important addition to the novel telemedicine and mobile clinics systems to achieve equal access to health by everyone everywhere in Africa. The central role of nurses can be seen in telemedicine systems adopted in-home care settings, where patients have to be introduced to the use of new technology and empowered to perform self-management. Moreover, nurses are often responsible for daily pa- tient control through remote monitoring systems (36). Also, pharmacists are increas- ingly acquiring a front-line role in many public health initiatives (37), (38) with the possibility of being supported by telecon- sultation when needed. Implementation of telemedicine and mobile clinics as a means to achieve universal health coverage in Af- rica requires a multidisciplinary approach. Firstly, the core of any telemedicine inter- vention would be technology. Technical is- sues like quality, robustness need to be taken into account and integral to any tele- medicine implementation. Given the com- plexity and novelty of telemedicine appli- cations, appropriate training to relevant stakeholders regarding the use is necessary for a successful implementation. Secondly, acceptance by the users (patients and healthcare providers) is required. The users must be satisfied with the system operation and effectiveness. Therefore, as suggested by Berg (39), users should be involved in the early stages of the development process. Thirdly, implementing telemedicine and mobile clinics will influence the financial situations of various parties in the health sector (40). The telemedicine financing will be different from the normal non-telemedi- cine (traditional) approach, affecting the distribution of cost and revenue amongst stakeholders. Therefore, there is a need to design a sustainable business model so that all participants benefit from telemedicine. Finally, there have been discussions on tel- emedicine systems' legal and ethical impli- Adedeji OJ, Babatunde YO, Ibrahim AD, Adebisi YA, Lucero-Prisno III DE. Towards Universal Health Coverage in Africa: Relevance of Telemedicine and Mobile Clinics (Review Article). SEE- JPH 2021, posted: 18 May 2021. DOI: 10.11576/seejph-4448 7 | P a g e cations on different levels (i.e. interna- tional, national, regional) by regulatory bodies (41). Commonly needed policies are related to the protection of the patient's pri- vacy and the patient's safety. Moreover, there is a need for standards to ensure the conformance of telemedicine implementa- tions at (42) the technical level and (43) the organizational level; to guarantee the qual- ity of the telemedicine development (44) Effects of Single and Dual Implementa- tion of Telemedicine and Mobile Clinics in Africa Ensuring successful implementation of tel- emedicine requires satisfying the following factors: governance, policy or strategy, sci- entific development and evaluation (13). An international collaboration between par- ticipating countries in a Telemedicine pro- ject to stipulate guidelines and conduct that regulate the utilisation of the project is nec- essary for governance to ensure smooth im- plementation. Since many telemedicine projects cut across state borders, the prom- ulgation of guidelines can help harmonize country practices. Most countries in the Af- rican region do not have a defined policy or strategy for achieving telemedicine (13), hence the low coverage in the region. As seen from other telemedicine projects in various institutions and countries, the ef- fects of telemedicine in Africa are diverse. In some projects, telemedicine enhances ac- cess to specialty services from experts. Some other projects improve diagnostic services and reduce the time often spent in obtaining diagnostic results. Furthermore, telemedicine has been of great advantage in enhancing interprofessional collaboration, networking and reducing isolation of pro- fessionals working in remote areas (31). Despite the immense advantages telemedi- cine presents to numerous fields particu- larly in reducing the burden of distance and travel, some projects are often short-lived. Improving the chances of success of a Tel- emedicine project involves careful planning based on local resources and community setting, observing the results produced, ex- panding on evidence-based effectiveness, and ensuring adaptability to the local re- gion. There is no "one-size-fits-all" strategy in achieving Universal Health coverage (45), every country needs to adopt a policy or strategy that achieves the best results. Despite the need for the variability of ap- proach to ensure adaptability to the region, the influence of telemedicine cuts across various processes. It can be modified to adapt to the needs of a region, state, or country. Telemedicine, as a means to strengthen and support the healthcare sys- tem in Africa, and not as a separate entity or competitor to the existing means of healthcare, can help improve healthcare coverage and maximise the use of existing resources either among clinicians and healthcare providers or between patients and healthcare providers. The use of mobile clinics successfully reaches vulnerable pop- ulations (10), especially in remote commu- nities, offering urgent and emergency care reduces barriers to healthcare such as trans- portation, time and complexity and provid- ing preventive services and screenings (25). Mobile clinics can be implemented and uti- lised in catering to a particular region or lo- cation. An effective model involves divid- ing a state into regions and assigning a mo- bile clinic to each region. Even in urban slums, Mobile clinics may even provide health services to urban residents who may not afford the expenses of a hospital. A dual implementation of Telemedicine and Mo- bile clinics in Africa combines the ad- vantages and strengths of each approach while minimising their challenges. For ex- ample, Mobile clinics present the disad- vantage of isolation of health professionals, telemedicine can help bridge that gap and provide a medium for collaboration and connection with other health professionals. Telemedicine presents a disadvantage of Adedeji OJ, Babatunde YO, Ibrahim AD, Adebisi YA, Lucero-Prisno III DE. Towards Universal Health Coverage in Africa: Relevance of Telemedicine and Mobile Clinics (Review Article). SEE- JPH 2021, posted: 18 May 2021. DOI: 10.11576/seejph-4448 8 | P a g e limited infrastructure such as mobile sen- sors and appropriate camera technology for data collection from patients. Mobile clin- ics can serve as a point of collection of pa- tient information such as blood pressure, body temperature, and other vitals that may be needed to provide a clinical diagnosis. The concept of a dual implementation of Telemedicine and Mobile clinics is not new in Africa, similar projects like "The Virtual Doctor Project" in Zambia (46) aim to take medical expertise to remote locations, hence, reshaping and improving primary healthcare for all (46). A powerful combi- nation of Telemedicine and Mobile clinics can endeavour to provide services to com- munities where neither the infrastructure nor health facilities exist (46). Limitations The study focused more on the implemen- tation and responsibilities of relevant stake- holders in telemedicine systems and less on mobile clinics. They were very few inter- ventions of mobile clinics in African coun- tries. Recommendations The emergence of telemedicine and mobile clinics should be seen as an opportunity to renew knowledge for medical policy-mak- ing and actions in response to the need to improve health care services for rural and remote communities. Additional stakehold- ers to the already considered patient and physician also need to be factored in the im- plementation of telemedicine and mobile clinic projects: nurses, pharmacists, knowledge engineers, hardware vendors, communication service providers. It is rec- ommended to have a quantitative study on the general public's perspective so that more factors relating to the perception of the public are uncovered and any issues are addressed in the planning and development of telemedicine projects. Stakeholders need to be made aware of standardized project management practices after evaluation. This will contribute to overall improve- ments in planning, managing, organizing, sustaining, and monitoring of telemedicine and mobile clinics. Business models need to be adapted in the national context for suc- cessfully implementing telemedicine sys- tems. This is to avoid any financial situa- tions amongst certain stakeholders in terms of the distribution of cost and revenue. More research and studies are needed to be conducted on how the incorporation of mo- bile clinics can be a great step to achieve universal health coverage in Africa. Conclusion Innovative approaches such as telemedicine and mobile clinics can speed up the attain- ment of Universal Health Coverage in Af- rica (47). A combination of telemedicine tools and mobile clinics in Africa will allow the most remote and vulnerable populations to receive quality care while strengthening health systems across the continent. Imple- menting these approaches, on the other hand, is not without challenges. Successful implementation of these initiatives will re- quire that the African Health and ICT stake- holders embrace the transformative capac- ity they offer (47). Some of the challenges and barriers facing the implementation in- clude an inadequate legal framework, ca- pacity for addressing ethical issues, unreli- able infrastructure, long-term feasibility, and funding (10),(47). If these challenges are addressed and stringent measures put in place, these initiatives will go a long way in achieving UHC. References 1. World Health Organization (WHO), African Union (AU). Uni- versal Health Coverage in Africa: From Concept to Action. 1st Afri- can Ministers of Health Meeting Convened by WHO and AU (2014). Adedeji OJ, Babatunde YO, Ibrahim AD, Adebisi YA, Lucero-Prisno III DE. Towards Universal Health Coverage in Africa: Relevance of Telemedicine and Mobile Clinics (Review Article). SEE- JPH 2021, posted: 18 May 2021. DOI: 10.11576/seejph-4448 9 | P a g e https://www.who.int/health_financ- ing/policy-framework/auc-who- 2014-doc1-en.pdf 2. World Health Organization (WHO). Universal Health Cover- age. https://www.who.int/en/news- room/fact-sheets/detail/universal- health-coverage-(UHC) Last ac- cessed: 27th July, 2020. 3. UNAIDS. Africa-Achieving health coverage without compromising on quality. https://www.un- aids.org/en/resources/presscen- tre/featuresto- ries/2019/march/20190308_uhc. Last accessed: 4th August, 2020 4. B. Appiah. Universal Health Cov- erage still rare in Africa. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. vol. 184,2 (2012): E125-6. doi:10.1503/cmaj.109-4052 5. World Health Organization (WHO). Malaria. https://www.afro.who.int/health- topics/malaria Last Accessed: 27th July, 2020. 6. World Health Organization (WHO). HIV/AIDS. https://www.afro.who.int/health- topics/hivaids#Factsheet Last Ac- cessed: 27th July, 2020. 7. World Health Organization (WHO). Tuberculosis. https://www.afro.who.int/health- topics/tuberculosis-tb Last Ac- cessed: 27th July, 2020. 8. World Health Organization (WHO). Global Health Observa- tory Data. https://www.who.int/gho/goe/tele- health/en/ Last Accessed: 27th July, 2020. 9. C. Combi, G. Pozzani, G. Pozzi. Telemedicine for Developing Countries. A Survey and Some De- sign Issues. Applied clinical infor- matics. vol. 7,4 1025-1050. 2 Nov. 2016, doi:10.4338/ACI-2016-06-R- 0089 10. C. F. Hill, B.W. Powers, S.H. Jain, J. Bennet, A.Vavasis, N.E. Oriol. Mobile health clinics in the era of reform.The American journal of managed care. 2014 20(3), 261– 264. 11. S. Abbasi, H. Mohajer, R. Samouei. Investigation of mobile clinics and their challenges. Inter- national Journal of Health System and Disaster Management. 2016 4(1), 1. 12. J N. Gitlin, Teleradiology. Radio- logic clinics of North America. vol. 24,1 (1986): 55-68. 13. S. Ryu. Telemedicine: Opportuni- ties and Developments in Member States: Report on the Second Global Survey on eHealth 2009 (Global Observatory for eHealth Series, Volume 2). Healthcare In- formatics Research. vol. 18,2 (2012): 153–155. doi:10.4258/hir.2012.18.2.153 14. F. W. Brown. Rural telepsychia- try. Psychiatric services. 49.7 (1998): 963-964. 15. J.D. Whited. Teledermatology re- search review. International journal of dermatology. 45.3 (2006): 220- 229. 16. Weinstein RS, Descour MR, Liang C, Bhattacharyya AK, Graham AR, Davis JR, Scott KM, Richter L, Krupinski EA, Szymus J, Kayser K. Telepathology overview: from concept to implementation. Human pathology. 2001 Dec 1;32(12):1283-99.. https://www.who.int/health_financing/policy-framework/auc-who-2014-doc1-en.pdf https://www.who.int/health_financing/policy-framework/auc-who-2014-doc1-en.pdf https://www.who.int/health_financing/policy-framework/auc-who-2014-doc1-en.pdf https://www.who.int/en/news-room/fact-sheets/detail/universal-health-coverage-(UHC) https://www.who.int/en/news-room/fact-sheets/detail/universal-health-coverage-(UHC) https://www.who.int/en/news-room/fact-sheets/detail/universal-health-coverage-(UHC) https://www.unaids.org/en/resources/presscentre/featurestories/2019/march/20190308_uhc https://www.unaids.org/en/resources/presscentre/featurestories/2019/march/20190308_uhc https://www.unaids.org/en/resources/presscentre/featurestories/2019/march/20190308_uhc https://www.unaids.org/en/resources/presscentre/featurestories/2019/march/20190308_uhc https://www.afro.who.int/health-topics/malaria https://www.afro.who.int/health-topics/malaria https://www.afro.who.int/health-topics/hivaids#Factsheet https://www.afro.who.int/health-topics/hivaids#Factsheet https://www.afro.who.int/health-topics/tuberculosis-tb https://www.afro.who.int/health-topics/tuberculosis-tb https://www.who.int/gho/goe/telehealth/en/ https://www.who.int/gho/goe/telehealth/en/ Adedeji OJ, Babatunde YO, Ibrahim AD, Adebisi YA, Lucero-Prisno III DE. Towards Universal Health Coverage in Africa: Relevance of Telemedicine and Mobile Clinics (Review Article). SEE- JPH 2021, posted: 18 May 2021. DOI: 10.11576/seejph-4448 10 | P a g e 17. R.V. Tuckson, M. Edmunds, M. L. Hodgkins. Telehealth. New Eng- land Journal of Medicine. 377.16 (2017): 1585-1592. 18. M.B. Adeyinka. Fundamentals of modern telemedicine in Africa. Methods of information in medi- cine. vol. 36,2 (1997): 95-8. 19. M. Mars. Telemedicine and ad- vances in urban and rural healthcare delivery in Africa. Pro- gress in cardiovascular dis- eases. 56.3 (2013): 326-335. 20. Parham GP, Mwanahamuntu MH, Pfaendler KS, Sahasrabuddhe VV, Myung D, Mkumba G, Kapambwe S, Mwanza B, Chibwesha C, Hicks ML, Stringer JS. eC3—a modern telecommunications matrix for cer- vical cancer prevention in Zambia. Journal of lower genital tract dis- ease. 2010 Jul;14(3). 21. Geissbuhler A, Ly O, Lovis C, L’Haire JF. Telemedicine in West- ern Africa: lessons learned from a pilot project in Mali, perspectives and recommendations. InAMIA Annual Symposium Proceedings 2003 (Vol. 2003, p. 249). Ameri- can Medical Informatics Associa- tion. 22. Montgomery ND, Tomoka T, Kry- siak R, Powers E, Mulenga M, Kampani C, Chimzimu F, Owino MK, Dhungel BM, Gopal S, Fedo- riw Y. Practical successes in telepathology experiences in Af- rica. Clinics in laboratory medi- cine. 2018 Mar 1;38(1):141-50. 23. Gimbel DC, Sohani AR, Busarla SV, Kirimi JM, Sayed S, Okiro P, Nazarian RM. A static-image telepathology system for dermato- pathology consultation in East Af- rica: the Massachusetts General Hospital Experience. Journal of the american academy of dermatology. 2012 Nov 1;67(5):997-1007. 24. McGowan CR, Baxter L, Deola C, Gayford M, Marston C, Cummings R, Checchi F. Mobile clinics in hu- manitarian emergencies: a system- atic review. Conflict and Health. 2020 Dec 1;14(1):4. 25. Malone NC, Williams MM, Fawzi MC, Bennet J, Hill C, Katz JN, Oriol NE. Mobile health clinics in the United States. International Journal for Equity in Health. 2020 Dec;19(1):1-9. 26. United Nations. World Urbaniza- tion Prospects: The 2018 Revision, Key Facts. Technical re- port (2018).: https://popula- tion.un.org/wup/Publica- tions/Files/WUP2018-Report.pdf 27. World Health Organization (WHO). Global Health Observa- tory Country Views. https://apps.who.int/gho/data/node. country Last Accessed: 27th July, 2020. 28. Mpunga T, Hedt-Gauthier BL, Tapela N, Nshimiyimana I, Muvugabigwi G, Pritchett N, Greenberg L, Benewe O, Shulman DS, Pepoon JR, Shulman LN. Im- plementation and validation of telepathology triage at cancer refer- ral center in rural Rwanda. Journal of Global Oncology. 2016 Apr;2(2):76-82. 29. Montgomery ND, Liomba NG, Kampani C, Krysiak R, Stanley CC, Tomoka T, Kamiza S, Dhun- gel BM, Gopal S, Fedoriw Y. Ac- curate real-time diagnosis of lym- phoproliferative disorders in Ma- lawi through clinicopathologic tele- conferences: a model for pathology services in sub-Saharan Africa. American journal of clinical pa- thology. 2016 Oct 1;146(4):423-30. 30. Mbemba GI, Bagayoko CO, Gag- non MP, Hamelin-Brabant L, Si- monyan DA. The influence of a https://population.un.org/wup/Publications/Files/WUP2018-Report.pdf https://population.un.org/wup/Publications/Files/WUP2018-Report.pdf https://population.un.org/wup/Publications/Files/WUP2018-Report.pdf https://apps.who.int/gho/data/node.country https://apps.who.int/gho/data/node.country Adedeji OJ, Babatunde YO, Ibrahim AD, Adebisi YA, Lucero-Prisno III DE. Towards Universal Health Coverage in Africa: Relevance of Telemedicine and Mobile Clinics (Review Article). SEE- JPH 2021, posted: 18 May 2021. DOI: 10.11576/seejph-4448 11 | P a g e telehealth project on healthcare professional recruitment and reten- tion in remote areas in Mali: A lon- gitudinal study. SAGE Open Medi- cine. 2016 May 6;4:2050312116648047. 31. Bagayoko CO, Gagnon MP, Traoré D, Anne A, Traoré AK, Geiss- buhler A. E-Health, another mecha- nism to recruit and retain healthcare professionals in remote areas: lessons learned from EQUI- ResHuS project in Mali. BMC medical informatics and decision making. 2014 Dec 1;14(1):120. 32. Bagayoko CO, Müller H, Geiss- buhler A. Assessment of Internet- based tele-medicine in Africa (the RAFT project). Computerized Medical Imaging and Graphics. 2006 Sep 1;30(6-7):407-16. 33. Garell C, Svedberg P, Nygren JM. A legal framework to support de- velopment and assessment of digi- tal health services. JMIR medical informatics. 2016;4(2):e17. 34. GRANADE PF. Malpractice issues in the practice of telemedicine. Tel- emedicine Journal. 1995;1(2):87- 9.. 35. Nazviya M, Kodukula S. Evalua- tion of critical success factors for telemedicine implementation. In- ternational Journal of Computer Applications. 2011 Jan;12(10):29- 36. 36. Samples C, Ni Z, Shaw RJ. Nurs- ing and mHealth. International Journal of Nursing Sciences. 2014 Dec 1;1(4):330-3. 37. Meyerson BE, Ryder PT, Richey- Smith C. Achieving pharmacy- based public health: a call for pub- lic health engagement. Public Health Reports. 2013 May;128(3):140-3. 38. Kehrer JP, Eberhart G, Wing M, Horon K. Pharmacy's role in a modern health continuum. Cana- dian Pharmacists Journal/Revue des Pharmaciens du Canada. 2013 Nov;146(6):321-4. 39. Berg M. Patient care information systems and health care work: a so- ciotechnical approach. Interna- tional journal of medical informat- ics. 1999 Aug 1;55(2):87-101. 40. Barlow J, Bayer S, Castleton B, Curry R. Meeting government ob- jectives for telecare in moving from local implementation to main- stream services. Journal of tele- medicine and telecare. 2005 Jul;11(1_suppl):49-51. 41. Bradford WD. Telemedicine and Telehealth: Principles, Policies, Performance and Pitfalls by Adam W. Darkins and Margaret A. Cary. Free Association Books, London, 2000. No. of pages 316. ISBN 1- 853-43518-X. Health Economics. 2001;10(7):681-2. 42. Hjelm NM. Benefits and draw- backs of telemedicine. Journal of telemedicine and telecare. 2005 Mar 1;11(2):60-70. 43. Perednia DA, Allen A. Telemedi- cine technology and clinical appli- cations. Jama. 1995 Feb 8;273(6):483-8. 44. Broens TH. Huis in't Veld RM, Vollenbroek-Hutten MM, Hermens HJ, van Halteren AT, Nieuwenhuis LJ. Determinants of successful tel- emedicine implementations: a liter- ature study. J Telemed Telecare. 2007 Sep;13(6):303-9. 45. World Health Organization (WHO). Universal Health Cover- age: Lessons To Guide Country Actions On Health Financing. https://www.who.int/health_financ- ing/UHCandHealthFinancing-fi- nal.pdf?ua=1 Last accessed: 27th July, 2020. https://www.who.int/health_financing/UHCandHealthFinancing-final.pdf?ua=1 https://www.who.int/health_financing/UHCandHealthFinancing-final.pdf?ua=1 https://www.who.int/health_financing/UHCandHealthFinancing-final.pdf?ua=1 Adedeji OJ, Babatunde YO, Ibrahim AD, Adebisi YA, Lucero-Prisno III DE. Towards Universal Health Coverage in Africa: Relevance of Telemedicine and Mobile Clinics (Review Article). SEE- JPH 2021, posted: 18 May 2021. DOI: 10.11576/seejph-4448 12 | P a g e © 2021 Adedeji et al; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 46. E.N. Mupela, P. Mustarde, H.L. Jones. Telemedicine in primary health: the virtual doctor project Zambia. Philosophy, ethics, and humanities in medicine. 6.1 (2011): 9. 47. Olu OO, Muneene D, Bataringaya JE, Nahimana MR, Ba H, Turgeon Y, Karamagi HC, Dovlo D. How can digital health contribute to sus- tainable attainment of universal health coverage in Africa? A Per- spective. Frontiers in Public Health. 2019;7:341. ______________________________________________________________________