Intended for healthcare professionals

The Impact Of Informatics

Informatics in clinical practice in developing countries: still early days

BMJ 1999; 319 doi: (Published 13 November 1999) Cite this as: BMJ 1999;319:1297
  1. Subbiah Arunachalam, distinguished fellow (
  1. M S Swaminathan Research Foundation, Chennai 600 113, India

    Tamil Nadu will soon become the first state in India to provide telemedicine in the public sector when the local hospital in Thiruvallur is connected to the Chennai Medical College (about 40 km away) through an integrated services digital network (ISDN) line and linked terminals. Tamil Nadu cannot yet connect every district and taluk hospital to the nearest medical college because the ISDN facility is not available in many places outside Chennai. This reflects misplaced priorities in a country which has developed technologies for launching missiles and satellites and for producing nuclear bombs; provides cellular telephones, colour televisions, and luxury cars for the rich; and sends thousands of computer professionals to the United States every year. The story is the same everywhere in the developing world.

    Summary points

    Developing countries can benefit the most from informatics and telemedicine, but they have the least access to these technologies

    Despite growing interest in informatics and telemedicine, developing countries have not made much progress

    Inadequate access to technology, inadequate investment in health care, and misplaced priorities have hindered developments

    In the absence of deliberate government policy, new technologies will benefit only the rich

    Priority must be given to establishing the infrastructure for health care as technology alone can be counterproductive

    Inadequate access to technology

    Inadequate access to technology, especially computers and telecommunications, is a key factor in the inability of developing countries to take advantage of progress in delivering health care. Most developing countries do not have the necessary infrastructure—the computer terminals, networks, communication channels, and bandwidth. This is not surprising when we consider that the income of the richest 20% of the world's population, which enjoys 83% of the world's income, is 80 times greater than that of the poorest 20%.1 In developing countries as a whole, 3.9% of the population have a telephone line, 0.7% have …

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