The Application of Medical Artificial Intelligence Technology in Rural Areas of Developing Countries to solve issue of health equity

Introduction

Artificial intelligence (AI) is an emerging computer technology that is increasingly being employed in the medical domain to enhance the proficiency and efficacy of clinical practises, while also mitigating the occurrence of medical errors (Bohr and Memarzadeh, 2020). The disparity in healthcare services between urban and rural areas poses a significant challenge in developing nations. A primary factor contributing to the limited access and substandard quality of healthcare in rural regions is the scarcity of well-trained healthcare professionals. Several studies have demonstrated that the implementation of computer-assisted or artificial intelligence (AI) medical procedures has the potential to enhance healthcare results in rural regions of developing nations (Guo and Li., 2018).

Hence, it is vital to engage in a comprehensive examination and exploration of the advancement of appropriate artificial intelligence (AI) technology in the field of medicine, specifically tailored to cater to the unique needs and challenges faced by rural areas. This research study is mainly focused to examine the different kinds of issues related to health equity that are faced in rural areas of the developing countries and furthermore focused to examine the application of medical artificial intelligence technology for dealing with such issues.

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Background

For vulnerable communities, achieving health fairness and enhancing the quality of healthcare are significant social goals, especially in developing nations. Several governmental agencies, non-profit organisations, and academic institutions have been paying attention to this problem and have been looking for potential answers (World Health Organization. 2010; Nu´n˜ ez, A. 2017). The term “developing countries” refers to nations, whose annual per-capita gross national income is lower than $11,905, as measured in US dollars. When we talk about “rural regions,” we’re referring to places where there are less than 150 people living in one square kilometre of land (Strasser, Kam and Regalado,2016).

The life expectancies of rural people in developing nations, as well as their general health state, are typically lower than those of urban residents in these countries. One of the most important aspects of a society’s trajectory is its level of poverty. In developing countries, the quality of care provided to the people is not adequate and it is caused by a number of factors, including inadequate public health spending, inadequate health insurance coverage, a lack of qualified health professionals, unavailability of the facilities, inadequate training, transportationand a number of other factors.

It is more severe in developing countries than it is in affluent countries when it comes to not having properly trained staff in the nursing field particular for the rural areas. The reasons for this are as follows: there are not enough students who come from rural areas, wages are relatively low, working and living conditions are poor, workloads are excessive, there are not enough possibilities for continuing education and professional development, there are currently shortages of health workers across the country, and these countries have a bigger percentage of their inhabitants residing in rural areas than other countries do. (Strasser, Kam and Regalado,2016).

In developing countries, people living in rural areas made up 68% of the total population in 2016, which was over 3.4 billion people. This percentage of the population is expected to continue rising until it reaches its highest point in the 2020s. On the other hand, in industrialised countries in 2016, people of rural areas made up only 19% of the entire population.37,39 Roughly 90% of the worldwide rural populace is concentrated in Asia and Africa; of these people, over half, or 45%, call India (857 million) and China (635 million), respectively, home. Nigeria, with a population of 95 million people, and Ethiopia, with 78 million, are the two countries in Africa that have the largest rural populations.

In India, the population density of urban areas had a doctor density of 1.71 per 1000 people, while the population density of rural areas had a doctor density of 0.45 per 1000 people. This difference is due to the fact that urban areas have a higher population density than rural areas do. In China, the urban population had a density of 3.00 doctors per 1000 people, while the rural population had a density of 1.33 doctors per 1000 people (Zhou et al., 2015). The circumstance in Africa is the direst of them. In Ethiopia, the urban density of doctors was 0.07 per 1000 people, while the rural density was 0.02 per 1000 people. These figures compare to the urban and rural doctor densities in Nigeria, which were 0.14 and 0.01 per 1000 people, respectively (The World Bank, 2018).

The chosen research is necessary to examine the role of the application of medical artificial technology for dealing with such kind of scenario of health inequality in the rural areas of developing countries.

Research Problem

Due to the poor working environment, it is difficult to recruit and retain high-quality medical professionals in rural areas. This makes it difficult to provide quality healthcare.. This makes it tough to deliver quality healthcare. In order to make up for the shortage of physicians, many developing countries have begun to implement shortened training programmes for those who want to become doctors, or they have given nurses permission to take on certain medical responsibilities.

For instance, in China there are a large number of institutions offer three years of medical education to students who have graduated from middle school or high school and are working towards a career as a physician. In China in 2014, there were around 2.9 million physicians who lacked at least a bachelor’s degree, and the majority of them were employed in rural areas of the country. However, despite the fact that this can sufficiently address the pressing demand for health workers in rural areas, the doctors and other medical staff are not efficient and expert enough to provide required level of care (Zhu, Li and Chen,2016).

Even if the physicians who operate in remote locations have adequate knowledge and abilities, they are unable to receive support from other types of medical professionals (such as specialists, chemists, and laboratory technicians). In circumstances like this, they are typically required to offer a more comprehensive selection of services. The quality of medical services will suffer as a result of the separation of professionals and the various scopes of their practises (Strasser, Kam and Regalado,2016). The field of medicine is undergoing significant change at the present time. As a result of the obstacles that prevent them from taking part in continuing education and professional development, rural physicians are unable to maintain and advance their level of knowledge (Wilson et al., 2009).

Objectives

• To examine the core issues of health inequity that are faced by the population in the rural areas of developing countries
• To examine the need for implication of new technology applications for dealing with the issue of health inequity in the rural areas of developing countries
• To find out the core benefits of application of Medical Artificial Intelligence Technology in rural areas of developing nations to promote health equality

Research Questions

RQ1: What are the core issues of health inequity that are faced by the population in the rural areas of developing countries?

RQ2: What is the need for implication of new technology applications for dealing with the issue of health inequity in the rural areas of developing countries?

RQ3: What are the core benefits of application of Medical Artificial Intelligence Technology in rural areas of developing nations to promote health equality?

Hypothesis

Whether the application of the Medical Artificial Intelligence Technology will prove a significant and supportive measure for rural areas of developing countries or not?

Significance of the Study

This research study will have a greater significance in the medical field for the health care institutions and healthcare department to improvise the level of health service accessibility and provision of equitable health services to rural population equally to the urban population through increasing the degree of awareness about the health inequity issues that are faced by rural population. This research will prove to have a valuable contribution in the medical field and in the academic field.

In the medical field, the research study will provide a great support to make them aware with the increasing benefits of application of the Medical Artificial Intelligence Technology. In the academic field, the research study will have greater significancein terms of finding new knowledge on the subject of the health inequity and Medical Artificial Intelligence Technology. Other than this, it will render the future researcher’s knowledge about the newer topics and subject matters for conducting the detailed and new research works in the same field.

The research study will fill the gap in the existing body of knowledge in the research field because in relation to the selected research context of health inequity in the rural areas of developing countries. The topic understanding will also be advanced with the help of getting insight into this research study.

Literature Review

Issues of Health Equity faced in Rural Areas in Developing Countries

            As perZiller and Milkowski (2020) health equity is defined as the availability of health care products among various groups of the country’s population. High effect of health equity is seen in rural areas. Some of the major issues of heath equity faced in rural areas in developing countries are having very little access to healthcare facilities, low transportation availability, not having proper health education, shortage of healthcare workforce.

            According to Weiss et al. (2020) rural areas have limited access to healthcare facilities because these services like hospitals, clinics, healthcare centres are situated  far away from the area which make it difficult for the people to reach there on time in case of an emergency. If the facilities are available in rural areas then limited resources are available there and also there is no availability of well-trained doctors or staff that can make the use of resources efficiently. Due to limited supply of electricity many equipment’s don’t operate well during surgeries or treatment.

            In the viewpoint of Varela et al. (2019) transportation is one of the major issue in heath equity faced in rural areas of developing country. Due to unavailability of adequate transportation facilities people of rural areas are unable to get proper treatment. Poor conditions of road lead to accidents or damage of the vehicles which leads to road blockage making ambulance or patient carrying vehicles unable to reach hospital on time. Unavailability of transportation can also lead to improper supply of medications and other healthcare resources as well.

            Torres et al. (2019) stated in their study that proper health education plays a vital role in the healthcare facilities in rural areas, but due to unavailability of qualified educators or institutions people of rural areas are unable to get proper health education. Improper education of people also leadsto inadequate use of healthcare facilities and resources. Basic health awareness is required among all the people in rural areas but due to illiteracy it is very difficult to provide written materials for their guidance.

            According to Russell et al. (2021) for proper healthcare treatment well trained workforce is needed which is not available in the rural areas because of illiteracy or if some people have knowledge about medical they are not fully trained and cannot make the proper use of all the health care facilities. A well trained doctor and nursing staff is required to provide a good treatment to the people but due to lack of amenities staff do not want to move in rural areas and it will cause issues in providing treatment to people in rural areas of developing countries.

Role of Medical Artificial Intelligence Technology in Rural Areas of Developing countries to solve the issue of health equity

            As per the Alami et al. (2020) Artificial intelligence is one of the most developing technologies of computer which is used in various medical fields to improvise the level of proficiency and clinical work efficiency and also to minimize the medical errors. Developing country faces a serious problem of the inequality of health services among urban and rural areas. Low quality healthcare is caused due to unavailability or shortage of qualified healthcare providers in rural areas. Artificial intelligence is also involved in providing healthcare in rural areas.

            The main mission of a developing country should be achieving heath equity and improving healthcare services in rural areas. According to Magrabi et al. (2019) rural areas of developing countries have large number of patients and a small number of trained physicians and healthcare staff.  Various problems are usually repetitive, simple, and easily treatable with few essential drugs. For critical diseases early detection and prevention system was developed which is a computer assisted diagnostic system. This system is used to provide guidance and also gives recommendations for doctors and medical staff. This study says that according to various surveys conducted it is concluded that the accuracy of a computer study is way better than health personnel and also the village nurses gets intrigued by new technology and takes interest in practicing on the system.

            Reddy et al. (2019) mentioned in their study that electronic devices like mobile phones, watches and laptops also proves useful for healthcare workers to improve their medical practise and advice.  Also these devices can be used in remote consultation. AI powered techniques is used to connect the rural living peoples to highly trained medical personnel from urban areas. Through this rural people can save their money and time of travelling long and can easily get the required treatment at the hospital in their area. This can help to reduce the number of casualties in rural areas of a developing country.

             In the viewpoint of Peters et al. (2018) artificial intelligence is also used in assisting disease and conditions by analysing medical images. Some of the algorithms of artificial intelligence is used to analyse medical images such as CT scans, X-Rays, MRIand ultrasounds, this can be used in the rural areas where there is a shortage of qualified staff. Recently a new portable healthcare device is introduced which is all in one diagnostic station which is used to run more than 6 tests in a device, including blood sugar, blood pressure, CBC and routine urine, it also can upload analysis and previous data online and can generate a diagnosis file for the reference . This can be proven very much useful in rural areas healthcare program.

            As per Schwalbe and Wahl (2020) artificial intelligence can contribute effectively in data analysis and surveillance. Algorithms of artificial intelligence are used to analyse the person’s past health data and can compare it with present and will detect the disease. AI can also provide the medications and prevention measures for the particular detected disease. Various AI driven system for special disease is being developed for rural areas such as swallowable endoscopic which is of low cost and have AI analysis technology which detects upper gastrointestinal cancer. Traditional method to cure this disease is quite expensive however this replaces the old method and is a perfect fit for rural areas of a developing country which is highly prone to gastric cancer.

             According to Ngwa, Olver and Schmeler (2020) artificial intelligence plays a vital role in providing support to clinical decision and treatments. From various surveys its concluded thatby comparing opinions of experts and decisions of AI, AI decisions proved to be very much accurate. This system is used to provide solution of various harmful diseases for rural people in absence of specialist.  AI technologies are widely used to improve the healthcare services, medical personnel’s efficiency and can also reduce the cost of medical service. For rural areas nursing staff and healthcare service providers can be trained for these tools so they can be used when there is low availability of staff.

Summary and Gap

Overall, based on the above discussion it is concluded that rural areas do not have very adequate healthcare services and medical staff and also discussed that artificial intelligence is proven to be a very useful tool to provide healthcare facilities in rural area and can also be used to provide appropriate medication to the people by analysing past and present health data. The gap is that  not much studies is present in context of this study.  

Research Methodology

This research study will take help of the qualitative research methodology because qualitative research study facilitates the more crucial and detailed data and information for the purpose of exploration of the selected research problem taken under investigation (Silvermanand Patterson, 2021). The use of the qualitative method will prove supportive to collect the most significant useful and accurate data and information about the research context. The research study with the help of this method will enable to reach the desired outcomes of the data.

Data Collection Method

In the light of the qualitative research methodology, the research study will take help of the interview method of data collection. The interview method of data collection will facilitate to have collection of the empirical data based on the real experiences of the individuals. In the same line it has been examined that with the use of the interview method in this research study there will be availed several benefits (Taylor, Bogdanand DeVault, 2015).

Firstly, interview method will facilitate to have a direct interaction with the respondents and henceforth it will enable to have effective communication with the participants without any hurdle in the communication process. Furthermore, in this research study, with the use of interview method extensive and useful data in detailed manner (Rutbergand Bouikidis, 2018). The execution of the interview method will be done in this research study through conducting the interview in telephonic manner. Each interview will take the time of around 25-30 minutes. This interview data will be collected in the form of interview transcripts and these will be recorded in the form of written transcripts.

Sampling

In any research study, for the purpose of the collection of the primary data in the empirical form it will be vital to have collection of the useful and experience-based data and hence selection of an appropriate sample population will be required in the research study (Bell, Bryman and Harley, 2022). For the purpose of sampling, in this research study, there will be required to have target of the suitable sample. For the same purpose in this research study, the health practitioners who are working in South Africa will be targeted in order to examine their viewpoints about the health inequality issues faced in the rural areas.

The selection of the suitable sample from this target population will be done with the help of the purposive sampling technique. The purposive sampling will prove helpful for selection of the sample with the consideration of the core characteristics of the participants such as their time availability, knowledge base, experience and willingness to take part in the data collection process.

Data Analysis

The data that will be collected in this research study will be analysed in qualitative manner because the interview method provides only qualitative data and with the use of the qualitative analysis proper analysis of the data will be done. The analysis of the data collected in this research study will be analysed using thematic analysis method. There are multiple reasons behind using the thematic analysis method (Braun and Clarke, 2021). Firstly, it has been determined that thematic analysis method is widely applied for analysing the qualitative data collected in any research in the form of a fundamental method. Secondly, thematic analysis method provides a systematic pattern to analyse the data in a very sequential and organised manner.

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Ethical Consideration

In this research study, for the purpose of getting the ethical approval on the research by the research committee, it will be ensured that all the ethical considerations are taken into account properly. For the same purpose, it will be ensured in this research study that all the risk factor are dealt in proper manner. The first potential risk that might be faced in the research study is that the data collection can be accessed unauthorisedly by any illegal party and hence to deal with this issue, in this research study, it will be ensured that the data will be protected in the proper password protected manner in one drive. With such initiation none will be able to access the data. Furthermore, in this research study, it will also be ensured that privacy and confidentiality of the participants will be maintained properly.

For the same purpose, the personal identity of the respondents will be anonymised (BERA, 2018). It will also be ensured in the research study that the data that will be provided by them is not disclosed to any other party. In this research study the potential risk of plagiarism will also be avoided through ensuring that all the data will be presented in the original form so that the issue of violation of the copyright act is also avoided in a crucial manner. The research will also avoid the risk of not including any member of the vulnerable group in this research study such that it can come into the risk of not collecting the data from a valid and reliable sample. The participants will also not be from minor group under 18 years.