Abstract
Telemedicine is considered to be an effective strategy to aid in the recruitment and retention of physicians in underserved areas and, in doing so, improve access to healthcare. Telemedicine’s use, however, depends on individual and contextual factors. Using a mixed methods design, we studied these factors in Senegal based on a micro, meso and macro framework. A quantitative questionnaire administered to 165 physicians working in public hospitals and 151 physicians working in district health centres was used to identify individual (micro) factors. This was augmented with qualitative descriptive data involving individual interviews with 30 physicians working in public hospitals, 36 physicians working in district health centres and 10 telemedicine project managers to identify contextual (meso and macro) factors. Physicians were selected using purposeful random sampling; managers through snowball sampling. Quantitative data were analyzed descriptively using SPSS 23 and qualitative data thematically using NVivo 10. At the micro level, we found that 72.1% of the physicians working in public hospitals and 82.1% of the physicians working in district health centres were likely to use telemedicine in their professional activities. At the meso level, we identified several technical, organizational and ethical factors, while at the macro level the study revealed a number of financial, political, legal, socioeconomic and cultural factors. We conclude that better awareness of the interplay between factors can assist health authorities to develop telemedicine in ways that will attract use by physicians, thus improving physicians’ recruitment and retention in underserved areas.
Highlights
As with many countries, Senegal suffers from an inadequate supply and misdistribution of physicians [1,2]
A total of 165 physicians working in public hospitals and 151 in district health centres were randomly selected to study the micro factors, while 30 physicians working in public hospitals and 36 in district health centres were randomly chosen to study the meso and macro factors
The random sampling used to select physicians in public hospitals and district health centres was the systematic random sampling which consist of randomly select the first participant and systematically the other participants based on a scale
Summary
Senegal suffers from an inadequate supply and misdistribution of physicians [1,2]. Certain specialist physicians are available only in Dakar [2]. To access these physicians, patients from underserved areas sometimes have to travel very long distances. Patients from underserved areas sometimes have to travel very long distances This situation can negatively affect their health and exacerbate health inequities [3]. Prior research on this topic suggests that the misdistribution of physicians in Senegal is influenced by a combination of professional, personal, family and community factors [4]. Personal factors include the individual reasons why physicians choose to not work and not stay in underserved areas. Uneven distribution of physicians in Senegal is further affected by a high rate of emigration, with more than the half of Senegalese trained physicians estimated to be working abroad [5]
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